Doctors May Be Inappropriately Prescribing Antipsychotics

A doctor writes a prescription for medicationDoctors routinely prescribe antipsychotic drugs to people with intellectual disabilities, even without a record of severe mental health conditions, according to a new study published in The BMJ.

Intellectual disabilities, which affect about 1% of the population, are characterized by difficulty with at least one major life skill, intellectual functioning limitations, and an IQ below 70. A variety of issues—including brain injuries and genetic factors—can cause intellectual disabilities.

Antipsychotics for Intellectual Disabilities

To explore how doctors manage intellectual disabilities, researchers pulled data contributed by 571 general practitioner clinics to The Health Improvement Network clinical database between 1999 and 2013. This provided them with information on 33,016 UK adults with intellectual disabilities. Fifty-eight percent of participants were male. A quarter of participants had been prescribed antipsychotic drugs, but 71% of that quarter had no history of mental health issues—such as schizophrenia—for which antipsychotics are appropriate.

Researchers found that doctors were more likely to prescribe antipsychotic drugs when their patients exhibited behavior outside social norms—such as aggression, self-injury, and destruction of property—rather than relying on these drugs solely to treat symptoms of severe mental health issues. Little evidence exists to support the theory that antipsychotic drugs may help address behavioral problems not associated with mental illness.

Side Effects of Antipsychotic Drug Use

Antipsychotic drugs carry a risk of severe side effects. These side effects can be difficult to tolerate, and as a result, people experiencing psychotic conditions may choose not to take their medication. Common side effects include changes in mood or personality, a blunted affect, changes in libido or sexual behavior, weight gain, muscle spasms, excessive sedation, drowsiness, and blurred vision.

These side effects may be especially challenging for people with intellectual disabilities to manage. The study’s authors note that people with intellectual disabilities may experience communication difficulties that interfere with their ability to communicate their symptoms. Additionally, other mental health issues, such as depression and anxiety, may manifest differently in people with intellectual disabilities, making it difficult for doctors to diagnose or properly treat these issues.

References:

  1. Antipsychotic drugs. (n.d.). Retrieved from http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=548
  2. Sheehan, R., Hassiotis, A., Walters, K., Osborn, D., Strydom, A., and Horsfall, L. (2015). Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ. doi:10.1136/bmj.h4326
  3. University College London. (2015, September 1). Antipsychotics inappropriately prescribed to people with intellectual disabilities. Retrieved from http://www.sciencedaily.com/releases/2015/09/150901204816.htm

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  • Sloan

    Sloan

    September 8th, 2015 at 10:37 AM

    Surely this has to be providers who are just grasping at straws, trying anything that they can to make behavior more tolerable? Someone who was truly trained in this field wouldn’t do this would they? I hope?

  • jamie p

    jamie p

    May 4th, 2018 at 12:15 PM

    Having a teen with autism and extreme aggression this may be our only choice….

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