A high proportion of adults with learning disabilities living in community homes and supported living accommodations in the UK are still receiving psychotropic medicines, often off-licence, for behaviours that challenge in the absence of a severe mental illness.
The study, published in Research in Development Disabilities, found that the most commonly prescribed psychotropics among adults with learning disabilities were antipsychotics (47 %), followed by antidepressants (23 %), anti-epileptics (13 %) and benzodiazepines (7 %).
Despite the widespread condemnation of and lack of evidence for the use of polypharmacy of antipsychotic medications, the study found that in 45 % of cases, there was a polypharmacy of more than one psychotropic class of medicines, and in 20%, a combination of antipsychotics and antidepressants.
Psychotropic prescription data were collected on 112 adults with learning disabilities who lived in community homes or supported accommodations in the UK. This was done in the context of a feasibility RCT involving a staff training programme, SPECTROM.
The primary aim of developing SPECTROM was to help implement the NHS England STOMP (Stopping Over-Medication of People with Learning Disabilities, Autism, or Both) initiative.
The study also found that there was a higher proportion of antipsychotic and antidepressant dose reduction at six-month follow-ups among adults with learning disabilities whose support staff received the SPECTROM training than those whose support staff did not receive the training.
NICE guidance on psychotropic medicines states that people with a learning disability and behaviour that challenges should only receive antipsychotic medication as part of treatment that includes psychosocial interventions.
Psychosocial interventions include a broad range of therapeutic approaches designed to support the person. They are generally non‑pharmacological and aim to identify underlying factors for behaviour, reduce the person’s distress and increase their skills. Approaches include communication interventions, applied behaviour analysis, positive behaviour support and cognitive behavioural therapy.
The study found that antipsychotics were used 19 % of the time for severe mental illnesses and 40% of the time for behaviours that challenge. Antiepileptics were used more often for behaviours that challenge (40 %) than epilepsy (32 %).
