Antipsychotics continue to be used for challenging behaviour in learning disabilities with poor monitoring of side effects


People with learning disabilities are often prescribed anti-psychotic medication, whether or not there has been a diagnosis of psychiatric disorder. There continues to be some concern about the evidence base to support this. The most recent Cochrane review which looked at the issue in relation to people with learning disabilities and schizophrenia found that there is a limited evidence base for their continued use in dual diagnosis.

The researchers in this audit were very aware of this limited evidence base, and set out to look at the prescribing practice of anti-psychotics in a Psychiatry Department in the north west of England, to identify whether such practice was in accordance with nationally recognised guidelines.

They collected data from every patient under the care of the department, (178) covering demographic information, the severity of learning disability, diagnoses and anti-psychotic drug use.

They also looked at standards of prescribing by looking at the indication of antipsychotic prescribing; reviews of medication; side effects documented and a range of physical health parameters (weight, blood pressure, blood glucose, lipids).

They found that 72%, or 126 of the patients were prescribed anti-psychotics, with 33% of these (42) being prescribed for challenging behaviour 72% had indication documented and nearly all had been reviewed (98%)

They did not however, find regular documentation of side effects, or measurement of physical parameters for the monitoring of metabolic syndrome.

As the researchers looked at all patients under the care of the department, this audit eliminates any possibility of sampling error or bias and shows that a significant number of people are receiving anti-psychotics for challenging behaviour. They suggest that the findings should be representative of the wider population of patients.

They conclude that the study confirms

  • anti-psychotics in use to manage challenging behaviours
  • lack of documentation of physical health and side effect monitoring.

They recommend regular monitoring of physical and side effects with careful documentation.

Antipsychotic prescribing in people with intellectual disabilities: a clinical audit, Griffiths H et al, in Advances in Mental Health and Intellectual Disabilities, 6, 4, 215 – 222

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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