Use of medication for challenging behaviour in people with intellectual disability

Glover, Gyles; Bernard, Sarah; Branford, David; Holland, Anthony; Strydom, André

doi:10.1192/bjp.bp.113.141267

Cited by 31 publications

(24 citation statements)

References 7 publications

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“…Especially prescriptions that are not supported by scientific evidence, for example, the use of antipsychotic drugs for challenging behaviours, should according to guidelines be limited to a short period (Deb, Kwok, Bertelli, Salvador‐Carulla, Bradley, Torr et al ). Despite these recommendations and the growing awareness of clinicians that antipsychotics should not be prescribed long‐term on an off‐label base, this still frequently is the case in people with ID (Sheehan et al , Matson, Neal , Scheifes et al , Glover et al ).…”

Section: Introductionmentioning

confidence: 99%

Physicians' reasons not to discontinue long‐term used off‐label antipsychotic drugs in people with intellectual disability

Kuijper

Hoekstra

2017

J intellect Disabil Res

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The prevalence of antipsychotic drug use for off-label indications in people with ID remains high. The results of this study indicate that there is a large variation in clinical practice of physicians regarding discontinuation of long-term antipsychotic drug prescriptions, which may be partially related to environmental factors as setting culture and attitudes of staff towards off-label antipsychotic drug use in persons with ID.

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Section: Introductionmentioning

confidence: 99%

Physicians' reasons not to discontinue long‐term used off‐label antipsychotic drugs in people with intellectual disability

Kuijper

Hoekstra

2017

J intellect Disabil Res

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“…Where behaviour is framed as problematic or challenging, an individual may be viewed only as a perpetrator rather than having been a victim in the past, and so, management may be more punitive than therapeutic for example with seclusion, restraints [38,39], being moved to out of area placements [37] and medication. Anti-psychotics are used extensively with people with intellectual disabilities [40], often controversially to manage behaviour where no underlying diagnosis such as PTSD has been identified and with limited evidence base for their clinical or cost-effectiveness [41,42]. Medication also has side effects [43], and its use may mean that potentially effective treatment is delayed [44•].…”

Section: Trauma and Challenging Behaviourmentioning

confidence: 99%

Trauma and Life Events in Adults with Intellectual Disability

Wigham

Emerson

2015

Curr Dev Disord Rep

102

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Exposure to adverse life events and environmental stressors (e.g. violence, poverty, sexual abuse) has been found to be high in intellectual disability populations. Notwithstanding resilience, for some people with intellectual disability, adverse life events and environmental stressors may lead to PTSD and may affect well-being in more diffuse but potentially still clinically impactful ways (e.g. challenging behaviour, obesity, substance misuse). Advances have occurred in the field of trauma in intellectual disability. More specifically, a small number of assessment measures have been developed for PTSD and a small number of studies evaluated treatment interventions such as cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR). Awareness has also increased regarding the potential life course effects on mental health of exposure to environmental stressors. While these developments are promising, the field warrants more research and development. This paper considers recent developments in knowledge on the psychological effects of exposure to adverse life events and environmental stressors in adults with intellectual disabilities.

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“…In the aftermath of the Winterbourne View Scandal in the United Kingdom, Glover et al (2014) have emphasised the need for a national audit of antipsychotic prescriptions including data on specific neurological abnormalities and evidence (if any) of mental illness. The issue of psychotropic medication use for PWDID in the absence of a diagnosed mental illness is extremely pertinent to the need for a classificatory system which has clinical utility in the more severe degrees of intellectual impairment.…”

Section: The Icd and Disorders Of Intellectual Development (Did)mentioning

confidence: 99%

Intellectual disability and the ICD-11: towards clinical utility?

Cooray

Bhaumik

Roy

et al. 2015

Advances in Mental Health and Intellectual Disabilities

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Purpose -The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The International Classification of Diseases (ICD) underpinning principle of clinical utility is currently poor for persons with Disorders of Intellectual Development (DID) and mental disorders. This impedes access to healthcare resources; services and social inclusion thereby further aggravating their vulnerability. The purpose of this paper is to present a critical overview and evidence informed recommendations within the context of an international collaborative programme, undertaken by the Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists, UK with support from the World Health Organisation (WHO). Design/methodology/approach -The authors carried out: first, a systematic review (SR) of literature, using PRISMA guidelines regarding the reliability, validity and utility of the ICD-10/Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria in people with DID (PWDID); second, a national and international consultation exercise with partners, stakeholders and experts; third, a multicentric survey of problem behaviours in PWDID; and finally, information dissemination/dialogues including presentations and workshops at key scientific events, consultation networking, data gathering and consensus building. Findings -The SR revealed a dearth of robust studies -most consisting of weak research methodologies. Significant difficulties were highlighted regarding the application of diagnostic criteria in the current classificatory systems -particularly in people with severe/moderate DID. Recommendations supported the introduction WHERE APPROPRIATE of modifications based on observed phenomena (signs) in PWDID in lieu of reported symptoms to facilitate DIAGNOSIS AND better access to healthcare and the community. Heterogeneity precluded quantitative pooling and meta-analysis. The consensus building exercise globally revealed that problem behaviours were the commonest reasons for referral to healthcare services with significant numbers without a diagnosed mental disorder being prescribed psychoactive medication.Research limitations/implications -The consensus gathering exercise WAS SELECTIVE AND did not cover all of the 194 member states of WHO due to resource and time constraints and this constitutes the main limitation of our study. Based on the SR and expert consensus, the authors submitted evidence informed pragmatic proposals to the WHO aimed at addressing the shortcomings of the ICD-10. The key recommendations focused on improving clinical utility within the context of epistemic iteration which would consolidate and strengthen the future evidence base. It was also recommended that self-injurious behaviour should form a standalone sub category in view of its relevance for healthcare services and resources which underpin clinical utility. Practical implications -The ICD-11 is a global, multidisciplinary a...

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Use of medication for challenging behaviour in people with intellectual disability

Cited by 31 publications

References 7 publications

Physicians' reasons not to discontinue long‐term used off‐label antipsychotic drugs in people with intellectual disability

Physicians' reasons not to discontinue long‐term used off‐label antipsychotic drugs in people with intellectual disability

Trauma and Life Events in Adults with Intellectual Disability

Intellectual disability and the ICD-11: towards clinical utility?

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