Background
A high proportion of adults with intellectual disabilities receive psychotropic medicines, often in the absence of a mental illness but primarily off-licence for behaviours that challenge.
Aim
To provide a cross-sectional view of the pattern of psychotropic medicine prescriptions with the reasons for their use among adults with intellectual disabilities in community settings in the UK.
Method
We collected psychotropic prescription data on 112 adults with intellectual 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, designed to help reduce the overmedication of adults with intellectual disabilities.
Results
The most commonly prescribed psychotropics were antipsychotics (47 %) followed by antidepressants (23 %), anti-epileptics (13 %) and benzodiazepines (7 %). 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. Antipsychotics were used for severe mental illness only in 19 % but for behaviours that challenge in 40 %, and 17 % of the time for anxiety. Antidepressants were prescribed 47.7 % of the time for depression, 11.4 % for anxiety, and 9 % for behaviours that challenge. Antiepileptics were prescribed more often for behaviours that challenge (40 %) than epilepsy (32 %). In the SPECTROM training group, the antipsychotic dose was reduced in 18.6 % of prescriptions compared with 6.5 % in the non-training group at six months follow-up.
Conclusion
Psychotropic medicines are still prescribed in a high proportion of cases off-licence for behaviours that challenge than mental illness.