UK psychiatrists’ experience of withdrawal of antipsychotics prescribed for challenging behaviours in adults with intellectual disabilities and/or autism

Abstract

Background A high proportion of adults with intellectual disabilities are prescribed off-licence antipsychotics in the absence of a psychiatric illness. The National Health Service in England launched an initiative in 2016, ‘Stopping over-medication of people with a learning disability [intellectual disability], autism or both’ (STOMP), to address this major public health concern. Aims To gain understanding from UK psychiatrists working with adults with intellectual disabilities on the successes and challenges of withdrawing antipsychotics for challenging behaviours. Method An online questionnaire was sent to all UK psychiatrists working in the field of intellectual disability (estimated 225). Results Half of the 88 respondents stated that they started withdrawing antipsychotics over 5 years ago and 52.3% stated that they are less likely to initiate an antipsychotic since the launch of STOMP. However, since then, 46.6% are prescribing other classes of psychotropic medication instead of antipsychotics for challenging behaviours, most frequently the antidepressants. Complete antipsychotic discontinuation in over 50% of patients treated with antipsychotics was achieved by only 4.5% of respondents (n = 4); 11.4% reported deterioration in challenging behaviours in over 50% of patients on withdrawal and the same proportion (11.4%) reported no deterioration. Only 32% of respondents made the diagnosis of psychiatric illness in all their patients themselves. Family and paid carers’ concern, lack of multi-agency and multidisciplinary input and unavailability of non-medical psychosocial intervention are key reported factors hampering the withdrawal attempt. Conclusions There is an urgent need to develop national guidelines to provide a framework for systematic psychotropic drug reviews and withdrawal where possible.

COVID-19 pandemic impact on psychotropic prescribing for adults with intellectual disability: an observational study in English specialist community services

“…A multitude of factors influence prescribing of psychotropic medications, which are not easy to unpick at the best of times. Recent studies 24 , 26 and the recent Royal College of Psychiatrists report 27 highlight the complexity of the problem of high usage of psychotropic prescribing in PwID. However, these have not taken into consideration the added impact of the pandemic.…”

Antipsychotic prescribing for patients with intellectual disabilities and challenging behaviours

“…Antipsychotics are frequently prescribed to patients with intellectual disabilities and challenging behaviours. However, this practice has raised concerns because of the potential side effects of antipsychotics and because of the lack of concrete evidence on the efficacy of antipsychotics in this population (Branford, 1996; Chapman et al , 2006; Clarke, 1997; Deb et al , 2020). This audit examined the antipsychotic prescribing patterns for people with intellectual disabilities and challenging behaviours in the MHS in Qatar.…”

“…There have been growing concerns about the use of antipsychotics in patients with intellectual disabilities (Clarke, 1997; Deb et al , 2020). At present, for adults, there is no trial-based evidence on the effectiveness of antipsychotics on challenging behaviour (Bowring et al , 2017).…”

Process evaluation in intellectual disability research: A case study and the need for adaptation of frameworks

“…In ANDREA‐LD, it was apparent that much of the concern from clinicians around the intervention did not relate to the practicalities of clinical management (participants could safely progress through to full withdrawal) but rather to wider care team co‐operation (as also reported by Deb et al, 2020) and some elements of research procedure—specifically consent. Clinicians and carers would have been familiar with the Mental Capacity Act (Shickle, 2006) which makes provisions relating to the care, treatment and decisions made on behalf of people who lack capacity.…”