Are antipsychotics overused in treating people with learning disabilities with aggressive behaviours?

Medication

The prevalence of psychiatric disorders in people with learning disabilities is very difficult to ascertain with studies varying in their definitions and inclusion criteria. Estimates suggest that it may be as low as 3%, but despite this, antipsychotic medications comprise between 30–50% of all psychotropics prescribed for people with learning disabilities.

This literature review set out to look at the association of aggressive behaviours with psychiatric disorders and other contributing factors and to explore the past and current treatment options for such behaviours. The review also looked at what basic research exists on the brain receptors implicated in aggressive behaviours and on the anti-aggressive properties of antipsychotics.

The review found that aggressive behaviours serve different functions for people with learning disabilities and that many factors also contribute to their initiation, maintenance and exacerbations or attenuation. Amongst these factors, the authors cite psychiatric and personality disorders.

The review author argues for more appropriate and effective treatments than antipsychotics to be used for people with learning disabilities and aggressive behaviours. He argues that a focus on genetic disorders, early victimisation, non-enriched and restrictive environments were considered, the use of such antipsychotics could be significantly reduced.

He suggests that anti-aggressive properties of antipsychotics have not been supported by reviews of clinical studies and that much of the basic research is absent.

He concludes that most people with learning disabilities and aggressive behaviours have been found to not have a diagnosis of psychotic disorder. The current review has shown there is a lack of strong evidence supporting anti-aggressive properties of antipsychotics.

He suggests that overuse of antipsychotics may be explained by old ideas that such aggressive behaviours in people with learning disabilities is associated with psychotic disorders. He suggests this notion is discredited by the evidence and that the continued use of antipsychotics therefore may, in some cases, be considered mistreatment rather than proper treatment.

He recommends matching treatment with variables contributing to aggressive behaviours and looking for long-term solutions to behaviour difficulties to improve the quality of life for people with learning disabilities.

Pharmacotherapy for aggressive behaviours in persons with intellectual disabilities: treatment or mistreatment? Tsiouris, J, in Journal of Intellectual Disability Research, 54: 1–16.

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