Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services
Version of Record online: 21 APR 2011
© 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd
Journal of Intellectual Disability Research
Mental Health and Intellectual Disability: XXVIII (Edited by S.-A. Cooper)
Volume 55, Issue 7, pages 665–674, July 2011
How to Cite
Paton, C., Flynn, A., Shingleton-Smith, A., McIntyre, S., Bhaumik, S., Rasmussen, J., Hardy, S. and Barnes, T. (2011), Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. Journal of Intellectual Disability Research, 55: 665–674. doi: 10.1111/j.1365-2788.2011.01421.x
- Issue online: 13 JUN 2011
- Version of Record online: 21 APR 2011
- Accepted 1 March 2011
- challenging behaviour;
- intellectual disability;
Background Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed in people with ID and to audit clinical practice against the standards.
Method Data were collected from the clinical records of individuals with ID who were under the care of mental health services in the UK, and prescribed an antipsychotic drug.
Results The sample comprised 2319 patients from 39 clinical services. Twenty-seven per cent of the patients had a diagnosis of a psychotic illness (ICD-10 F20–29) and 27% an affective illness (ICD-10 F30–39). The proportion who did not have a psychiatric diagnosis ranged from 6% of those with borderline/mild ID to 21% of those with severe/profound ID. Overall, the most common indications for prescribing an antipsychotic drug were comorbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances. The prevalence of use of antipsychotic drugs to manage challenging behaviour in the absence of concomitant mental illness increased with the severity of ID and accounted for almost half of prescriptions in those with severe/profound ID. Adherence to the audit standards related to documentation of clinical indications and review of efficacy was high. Side effect monitoring was less assiduous.
Conclusions In clinical practice, most prescriptions for antipsychotic drugs in people with ID are consistent with the evidence base and the overall quality of prescribing practice, as measured against recognised standards, is good, although in some patients potentially remedial side effects may not be detected and treated.