A report published by the British Medical Journal has found that thousands of people with learning difficulties in the UK are being over-prescribed antipsychotics with no clinical justification.
The study, which has been led by University College London, analysed data from 33,016 adults with an intellectual disability over a period of 14 years. The study covered patients with conditions such as autism, epilepsy and Down’s syndrome as well as people with severe mental illnesses such as depression and anxiety. Many in the study have difficulties with communication, daily living skills, information processing and social skills.
Although such medication is an important element in the management of specific psychiatric conditions, the study reveals that many adults with intellectual disabilities are treated with antipsychotic drugs, even if they do not have a severe mental illness. For example, the report found that, of 9,135 people treated with antipsychotic drugs, 71% did not have a record of severe mental illness.
Further, certain sub groups such as patients who presented with challenging behaviour are significantly more likely to receive antipsychotic drugs. Of the 11,915 people with a record of challenging behaviour, 47% had received antipsychotic drugs, whereas only 13% had a record of severe mental illness.
The findings also evidenced that the rate of new antipsychotic prescribing was significantly more common in older people and for those with autism and dementia.
Roy Sheehan, of UCL’s department of psychiatry and a contributor to the study, commented that the research “does not support using anti-psychotics to manage behaviour problems in people with intellectual disabilities.” He further noted that: "Many people with intellectual disability and behaviour disturbance have complex needs and other interventions, such as looking at the support people receive and their communication needs, should be prioritised.”
Such findings will, understandably, raise concerns for the families of people with intellectual difficulties whose loved ones are clearly vulnerable and at risk of being prescribed drugs they do not need.
NHS England has advised that, if patients or their families are worried, they should speak to the person responsible for prescribing the medication.
At Penningtons Manches, many of our clients have intellectual difficulties which are often caused by or associated with brain and head injuries sustained at birth or by a catastrophic event. These findings suggest that changes need to be made to the way antipsychotic drugs are used when treating patients with intellectual difficulties. Clearly, inappropriate prescription of antipsychotic drugs in patients with intellectual difficulties results in unnecessary severe side effects. In addition, there is a risk that an underlying condition may go untreated.