bottle pillsLarge numbers of people with learning disabilities are being inappropriately prescribed antipsychotic drugs, according a new UCL study.

The study, published in The BMJ, looked at anonymised GP records of 33,016 UK adults with learning disabilities between 1999 and 2013. It found that more than a quarter had been prescribed antipsychotic drugs, of whom 71% had no record of severe mental illness.

Antipsychotic drugs are designed to treat severe mental illnesses such as schizophrenia. There is little evidence that they help to address behavioural problems not due to mental illness in people with learning disabilities. Despite this, the study found that antipsychotics were often prescribed to people with behaviour problems who had no history of severe mental illness. Behaviour problems that might be seen in people with learning disabilities include aggression, self-injury, destruction to property and other behaviours outside social norms. 

People with learning disabilities who also had autism or dementia were also more likely to receive an antipsychotic drug, as were older people.

“The number of people with intellectual disabilities who have been prescribed antipsychotics is greatly disproportionate to the number diagnosed with severe mental illness for which they are indicated.” said study author Dr Rory Sheehan from the psychiatry department of UCL. “People who show problem behaviours, along with older people with intellectual disability or those with co-existing autism or dementia, are significantly more likely to be given an antipsychotic drug, despite this being against clinical guidelines and risking possible harm.”

But the study also found that the rate of prescribing of antipsychotic drugs to people with learning disabilities had fallen gradually but consistently over the past 15 years, indicating that alternative therapies are being utilised and GPs are changing their practice.

Other classes of drugs used to treat mental illness were also prescribed to people with learning disabilities in large numbers. Drugs used to treat anxiety were the most frequently prescribed, followed by the antidepressants. Like the antipsychotic group, these types of drugs were given at substantially higher rates than those dispensed to people with mental disorders. This suggests these drugs might also be prescribed inappropriately in some cases.

The researchers paid particular attention to investigating the use of antipsychotics due to their risk of serious side-effects, which include sedation, weight gain, metabolic changes that can ultimately lead to diabetes, and movement problems such as restlessness, stiffness and shakiness.

“Side-effects can be managed, but the risks and benefits must be carefully considered before prescribing antipsychotics to people without severe mental illness,” added Dr Sheehan. “Research evidence does not support using antipsychotics to manage behaviour problems in people with intellectual disabilities. Many people with intellectual disability and behaviour disturbance have complex needs and other interventions, such as looking at the support people receive and their communication needs, should be prioritised. Antipsychotics, or indeed any medications, should not be prescribed lightly and are no substitute for comprehensive care.”

The author suggests that changes are needed in the prescribing of psychotropic drugs for people with learning disabilities. Sheehan also called for more evidence on the efficacy and safety of psychotropic drugs in this group, particularly when they are used for challenging behaviour.

Mounting evidence

This research adds to mounting evidence on the over-use of antipsychotic medication in people with learning disabilities. In June, a report by Public Health England estimated that up to 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant or both without appropriate clinical justification.

Meanwhile, the 2014 Learning Disability Census found that 73% of people with a learning disability in inpatient settings received antipsychotic medication.
NHS England has pledged to tackle this issue and held a summit in July with professional and patient groups to devise an action plan and establish a delivery board to drive the necessary changes.

Dan Scorer, head of policy at Mencap, said: “Sadly the report findings are not a surprise as they confirm what we have heard from families time and time again about their loved ones being given high levels of antipsychotic or antidepressant medication, often for years. In many cases families report serious side effects and no evidence that the medication is helping the individual.

“The research published today shows this is happening not just in inpatient units like Winterbourne View but in the community as well.”