Psychotropic prescribing in adults with learning disabilities


Background

Psychotropic medications, such as antidepressants, antipsychotics and mood stabilisers are commonly prescribed to people with learning disabilities. However there is concern that these are being over-prescribed, often to manage problem behaviours, and in the absence of good quality evidence of their effectiveness in this context. Guidelines recommend that psychotropic medications and antipsychotics in particular, are withdrawn or reduced in the absence of severe mental ill health.

What we did

Health and medication data for 1,190 adults with learning disabilities who had agreed to be part of the study between 2002 and 2004 were compared with medication data for 3,906 adults with learning disabilities, living in the same health board area in 2014. A longitudinal cohort of 545 people, for whom data was available across the whole period, was also created to investigate changes in prescribing for the same group of people over a decade.

What we found

Analysis of the cross-sectional data in 2002/2004 showed that over 50% of adults with learning disabilities were prescribed at least one psychotropic medication. This reduced slightly to 48% in 2014. Almost a quarter of people with learning disabilities were prescribed antipsychotics in 2002/2004 and 16.7% in 2014. Antidepressants were prescribed to 11.2% of participants in 2002/2004 and to 19.1% in 2014. 30.0% of those prescribed antipsychotics in 2002/2004 had psychosis or bipolar disorder, 33.2% had no mental ill health or problem behaviours, and 20.6% had problem behaviours but no psychosis or bipolar disorder.

For the longitudinal cohort, with data at both time points, psychotropic increased from 47.0% (256/545) in 2002/2004 to 57.8% (315/545) in 2014 (p<0.001). Antipsychotic prescribing did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), but there was a significant increase in antidepressant (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytic (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptic (OR 1.40; 95% CI 1.06 to 1.84; p=0.017) prescribing. People who were identified as having mental health problems in 2002/2004 had increased levels of antipsychotic prescribing in 2014 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001). However for those identified with problem behaviours in 2002/2004 the increase in was even higher (OR 6.45; 95% CI 4.41 to 9.45; p<0.001).

What this means

Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by 2014 than in 2002/2004, people were not withdrawn from them had been prescribed. People with problem behaviours had increased levels of prescribing. There was also a striking increase in antidepressant prescriptions which requires further investigation. Adults with intellectual disabilities need frequent and careful medication reviews.

The original publication associated with this research - Henderson A, Mcskimming P, Kinnear D, et al Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study is available online via the 

For further information on this research, please contact Angela Henderson