Antipsychotic prescribing in people with intellectual disabilities: a clinical audit

Abstract

Purpose

Great controversy surrounds the prescribing of antipsychotics for people with an intellectual disability. This stems from a lack of research to support their use in this specific population together with their “off label” use to treat behaviour problems. This paper aims to review prescribing practice of antipsychotics by the Salford Intellectual Disability Psychiatry Department in accordance with standards adapted from nationally recognised guidelines.

Design/methodology/approach

Data was collected from all 178 patients under this department including patient demographics, severity of intellectual disability, co‐morbid diagnoses and details of any antipsychotic drug use. Main standards of prescribing measured: indication of antipsychotic prescribing; documented review of medications; documentation of side effects; documentation of physical health parameters including weight, blood pressure, blood glucose, lipids.

Findings

In total, 126 (72 per cent) were prescribed antipsychotics. 42 (33 per cent of these were for challenging behaviour. 91 (72 per cent) had indication documented. 123 (98 per cent) of prescriptions had been reviewed. There was not very regular documentation of side effects and physical parameters for monitoring metabolic syndrome.

Practical implications

Data was taken from all patients under the care of Salford Intellectual Disability Psychiatric team therefore eliminating sampling bias. The audit findings will be of value to other UK urban psychiatry departments as they should be highly representative of a wider population of patients. The authors are already aware of lack of evidence in use of antipsychotic medication for treating challenging behaviours in patients with learning disability.

Originality/value

This study confirms the use of antipsychotics in management of challenging behaviours in this population as a third of the sample population was being treated with antipsychotics for behaviour problems. The study also shows that there was lack of documentation of physical health and side effect monitoring. It highlights that there should be regular monitoring of physical and side effects with careful documentation.

Citation

Griffiths, H., Halder, N. and Chaudhry, N. (2012), "Antipsychotic prescribing in people with intellectual disabilities: a clinical audit", Advances in Mental Health and Intellectual Disabilities, Vol. 6 No. 4, pp. 215-222. https://doi.org/10.1108/20441281211236661