Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: a randomised controlled trial (NACHBID)

Abstract

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A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities

“…87 Median MOAS scores were a little lower than those recorded in a trial of neuroleptic drug treatment for aggressive behaviour in people with intellectual disabilities, which reported a median [interquartile range (IQR)] MOAS score of 12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) at baseline in the placebo-treated group, and a dramatic fall (to a median score of ~3: considerably lower than the present participants) during subsequent weekly assessments under placebo treatment. 115 There is a limit to the extent of challenging behaviour that could in principle be observed in this study because most of the services from which participants were recruited would often exclude individuals who are overtly challenging. Nevertheless, the 26% of participants who met the criterion for severe challenging behaviour is higher than the proportion among the general population supported by the participating services.…”

Managing with Learning Disability and Diabetes: OK-Diabetes – a case-finding study and feasibility randomised controlled trial

“…[162][163][164][165]168,169 The intensity of reminders and GP visits to assist completion in case finding was not replicated in the feasibility RCT and, in fact, the return rate increased in the second phase of the study. It is not possible to say whether this was because the surgeries became more adept at completion over time or whether it was because the questionnaires were asking about a shorter time span in the RCT.…”

“…Six studies [164][165][166][167][168][169] that detailed costs or costs and outcomes of interventions for people with learning disabilities met the inclusion criteria. Resource-use data were collected in all studies: four of these 164,165,168,169 used the Client Service Repository Inventory (CSRI), which is a research instrument that provides retrospective information on service use, and three studies 165,168,169 used a proxy informant who was familiar with the person with a learning disability.…”

“…Resource-use data were collected in all studies: four of these 164,165,168,169 used the Client Service Repository Inventory (CSRI), which is a research instrument that provides retrospective information on service use, and three studies 165,168,169 used a proxy informant who was familiar with the person with a learning disability. Resource use (for which GP visits, nurse visits, hospital inpatient and outpatient visits were the most frequently utilised, with chiropodist, psychiatrist and dentist also having high utilisation rates), staff (salaries and training) and accommodation were the main drivers of cost in relation to the cost-of-illness studies; 165,167 medications, transportation and carer time were also included.…”

“…Health outcomes were measured in four of the studies using different methods: QALYs derived from EQ-5D, 164 social interaction activity patterns 166,168 and an aggression scale plus a Quality Of Life Questionnaire. 169 Overall, the diabetes studies showed a variety of data collection methods, with staff time for intervention delivery as the greatest driver of costs. In the studies including people with learning disabilities, hospital-based care, GP, nurse care and accommodation were the main drivers of costs.…”