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Audit of the use of psychotropic medication for challenging behaviour in a community learning disability service

  • Tom Marshall (a1)
Abstract
Aims and Method

The aims of the study were to identify patients in a community learning disability service receiving psychotropic medication for challenging behaviour, to examine prescribing practice and to compare this against local consensus standards. Local consensus standards were agreed by the consultants and the notes were reviewed by the author.

Results

A total of 102 patients were identified as receiving psychotropic medication for challenging behaviour (26.7% of notes examined). The most common additional diagnoses were autism (29%) and epilepsy (28%). The average duration of treatment was 5.3 years, and multiple drugs were used in 34% of these patients. Antipsychotics were the most commonly used drugs (96% of patients). There was rarely a detailed description of the challenging behaviour. There was little regular monitoring of side-effects or warning about potential side-effects when the medication was started.

Clinical Implications

Challenging behaviour is a common cause of multiple prescribing in learning disability patients, and is often long-term in the absence of a strong evidence base. Other specialties use medication to control disturbed behaviour, particularly in people with dementia or personality disorder, so this audit may also be of interest to old age, adult and forensic psychiatrists.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Ahmed, Z., Fraser, W., Kerr, M. P., et al (2000) Reducing antipsychotic medication in people with a learning disability. British Journal of Psychiatry, 176, 4246.
Bhaumik, S. & Michael, D. M. (2004) Pharmacotherapy and pharmacovigilance in learning disability. Learning Disability Psychiatry, 6, 910.
Branford, D. (1994) A study of the prescribing for people with learning disabilities living in the community and National Health Service Care. Journal of Intellectual Disability Research, 38, 577586.
Brylewski, J. & Duggan, L. (1999) Antipsychotic medication for challenging behaviour in people with intellectual disability: a systematic review of randomised controlled trials. Journal of Intellectual Disability Research, 43, 360371.
Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century. London: Department of Health.
Emerson, C. (1995) Challenging Behaviour. Analysis and Intervention in People with Learning Difficulties. Cambridge: Cambridge University Press.
Kiernan, C. & Alborz, A. (1996) Persistence and change in challenging and problem behaviours of young adults with intellectual disability living in the family home. Journal of Applied Research in Intellectual Disabilities, 9, 181193.
Kiernan, C., Reeve, D. & Alborz, A. (1995) The use of anti-psychotic drugs with adults with learning disabilities and challenging behaviour. Journal of Intellectual Disability Research, 39, 263274.
Royal College of Psychiatrists (2001) DC–LD: Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/ Mental Retardation. Occasional Paper OP48. London: Gaskell.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Audit of the use of psychotropic medication for challenging behaviour in a community learning disability service

  • Tom Marshall (a1)
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eLetters

Psychotrophic medication in learning disability

Vineet Singh, Specialist Registrar (Adult Psychiatry)
30 December 2004

It was interesting to read the audit on psychotrophic medication for challenging behavior in learning disability (Dec 2004).The use of psychotrophic medication in adults with learning disability is fraught with controversy because of the difficulties inherant in making psychiatric diagnosis in this population, where mental illness may presentas challenging behavior and where the use of psychotrophic medication for challenging behavior in the absence of mental illness is controversial(Deb & Fraser,1994).In Britain, where the rate of prescription of psychotrophic medication in adults with LD living in the community ranges from 10-19%(Clarke et al 1990). An inpatient study (Wressel et al, 1990) demonstrated a significant reduction in polyphamacy with the introduction of annual mandatory reveiw of all prescriptions. Therefore audits like these might beuseful in rationalising prescribing practices as compared to the scenario where litigation in these matters could lead to patients being deprived ofmedication through fear of legal repercussions. The current ethos should be away from the medical model where drugs are seen as 'magic bullets',towards a more behaviourally oriented approach (Singh et al 1992).

Dr Vineet Singh

References:

DEB,S. & FRASER,W. (1994) The use of psychotrophic medication in people with learning disability: towards rational prescribing.Human Psychopharmacology, 9,259-272.

WRESSEL,S.E., TYRER,S.P. & BERNEY,T.P. (1990) Reduction in antipsychotic drug dosage in mentally handicapped patients, British Journal of Psychiatry. 157,101-106.

SINGH,N.N., GUERNSEY,T.F. & ELLIS,C.R. (1992) Drug therapy for people with developmental disabilities:legislation and litigation. Clinical Psychology Review. 12, 665-679.
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Conflict of interest: None Declared

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