There are many studies of the prescribing of psychotropic medications for people with intellectual disability. This chapter provides data about that prescribing, the issues associated with the data and the trends in usage. Excessive or unnecessary prescribing of psychotropic medication that exposes individuals to unwanted side-effects and imposes unwarranted costs on services has been the focus of many medications review programmes. This section will review outcomes data from medication reduction programmes for individuals with intellectual disability and present practitioner guidelines. The NHS England programme STOMP (Stopping The Over-Medication of People with a learning disability and autistic people) and STAMP (Supporting Treatment and Appropriate Medication use in Paediatrics) has been the focus for many initiatives in England, resulting in the generation of many resources to assist both professions and non-professionals involved with intellectual disability.

Eating and drinking difficulties are highly prevalent in the intellectual disability population and include all aspects of the eating and drinking process. This can include stable positioning and pacing the meal all the way through to safe swallowing. Dysphagia is a subset of wider eating and drinking difficulties, often seen in the intellectual disability population. Dysphagia presents as a difficulty chewing and swallowing. It is often the underlying cause of malnutrition, dehydration, weight loss, choking, and aspiration pneumonia, with risks to mental health, social isolation, dignity, and enjoyment. A deterioration in eating and drinking skills is often a symptom of a broader physical and mental health diagnosis. People with eating and drinking difficulties can also experience a cyclical decline in health and an increased risk of malnutrition and dehydration. In addition to eating and drinking difficulties this chapter covers surgical intervention requiring insertion of a gastric tube, the impact of medication on feeding, and strategies to manage eating and drinking difficulties.

Depressive disorders are very common and are among the leading causes of disability worldwide. The worldwide prevalence of depression is estimated to be 4.4 per cent and prevalence in the UK is 4.5 per cent . The point prevalence of affective disorder in a large population study with intellectual disability (n=1023) was 6.6 per cent, based upon expert clinical assessment, compared with 5.7 per cent, 4.8 per cent, and 3.6 per cent for diagnoses made according to various standard criteria, respectively (Cooper et al. 2007). However, other authors have suggested higher rates of depression based on a broader criterion for a diagnosis. Depression is a common mental health problem but can be difficult to diagnose in people with intellectual disability. Antidepressants are in many areas the most widely prescribed mental health medication. The chapter presents an overview of the condition, the treatments with medication available, and their relevance.

Bipolar disorders are episodic mood disorders defined by the occurrence of manic, mixed, or hypomanic episodes or symptoms. Manic and hypomanic symptoms are characterised by a subjective experience of increased energy and activity, along with various other symptoms. These episodes typically alternate over the course of these disorders with depressive episodes or periods of depressive symptoms such as lowering of mood, decreased energy and activity (ICD-11, 2019; DSM-5, 2013). Both the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders DSM-5 and the International Classification of Diseases ICD-11 broadly subclassify the condition as follows: bipolar I disorder: one or more manic episodes or mixed episodes. Individuals often have one or more major depressive episodes; bipolar II disorder: one or more major depressive episodes accompanied by at least one hypomanic episode. Bipolar affective disorders present a major diagnostic and treatment challenge to services for people with intellectual disability. The chapter presents an overview of the condition, the treatments with medication available, and their relevance. The chapter includes the use of mood stabilisers such as sodium valproate.

People with intellectual disability have a higher rate of mortality and morbidity. Prescribing medication requires regular physical monitoring to ensure that the person with intellectual disability is not put at additional risk of health problems. The chapter provides details of necessary testing.