Audit of antipsychotic prescribing shows good efficacy reviewing but poor monitoring of side effects

medicine in blisterpack

Antipsychotics are widely used for the management of behavioural problems in people with learning disability, despite concerns about the lack of a good evidence base for this practice (see Cochrane review)

The researchers in this study set out to audit clinical practice of prescribing anti-psychotics against standards of good practice.

The authors collected data from clinical records of individuals with learning disabilities in the care of mental health services in the UK who were prescribed an antipsychotic drug. The sample comprised 2319 patients from 39 clinical services.

The audit found 27% had a diagnosis of a psychotic illness  with a further 27%  an affective illness.

Those without a psychiatric diagnosis ranged from 6% (borderline/mild LD) to 21% ( severe/profound LD.)

The most common indications for prescribing an antipsychotic drug were co-morbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances.

The authors found that the use of antipsychotic drugs to manage challenging behaviour in the absence of mental illness increased with severity of the learning disability. Working to audit standards on documentation of clinical indications and the review of efficacy was high although monitoring for side effects was found to be less well done.

The authors conclude that most prescriptions for antipsychotic drugs in people with learning disabilities were consistent with the evidence base and that the overall quality of prescribing practice was good. However they sound a note of caution about the need to improve the monitoring and appropriate treatment of side effects.

Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services, Paton, C et al., in Journal of Intellectual Disability Research, 55: 665–674.

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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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