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Using medication to manage behaviour problems among adults with a learning disability: quick reference guide
- Authors:
- DEB Shoumitro, CLARKE David, UNWIN Gemma
- Publisher:
- University of Birmingham
- Publication year:
- 2006
- Pagination:
- 43p.
- Place of publication:
- Birmingham
This quick reference guide has been produced to provide advice to people who are considering prescribing medication to manage behaviour problems among adults (aged 18 years and over) with a learning disability. It does not consider in any detail the indications for choosing specific medication to manage behaviour problems among adults with a learning disability. Rather, it provides recommendations for clinical practice surrounding the use of medication to manage behaviour problems among adults with a learning disability. All relevant medication and related issues are considered. The guide is divided into the following sections: initiation of treatment (assessment, formulation, and treatment plan); monitoring of treatment; discontinuation of treatment; high-dose medication; poly-prescribing; intramuscular (IM) medication; rapid tranquilisation; as required (PRN) prescribing; communication and information sharing; interdisciplinary working; consent and capacity; and the referral pathway.
Apathy and depression in Alzheimer's disease are associated with functional deficit and psychotropic prescription
- Authors:
- BENOIT M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(4), April 2008, pp.409-414.
- Publisher:
- Wiley
Apathy and depression are the most common neuropsychiatric features in Alzheimer's disease (AD). The clinical and functional specific correlates of these syndromes are not well known independently from cognitive deficits and other behavioural disturbances. Six hundred and eighty-six patients diagnosed with possible or probable AD were included in a prospective multicenter study (REAL-FR). They had an assessment of their cognitive and functional status. Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory (NPI) and caregiver's burden was measured with Zarit's Burden Scale. A majority of patients at any stage of the disease presented with one or several behavioural and psychological disturbances. Apathy concerned 43% of patients and, with or without depression, was associated with more pronounced deficits in global cognition, everyday life and instrumental abilities, nutritional status and with a higher burden level. A high level of psychotropic prescription, especially with antidepressant, was observed in patients with apathy. In a multivariate analysis taking into account the cognitive and functional variables of AD, apathy and depression were the only significant predictors of psychotropic prescription. Some negative neuropsychiatric symptoms such as apathy and depression have a specific relation with functional and therapeutic outcomes of AD, independently from cognitive status. Further studies are needed to establish if apathy represents a particularly severe phenotype of AD.
Challenging behaviours: views and preferences of people with intellectual disabilities
- Authors:
- WOLKORTE Ria, HOUWELINGEN Ingrid van, KROEZEN Marieke
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 32(6), 2019, pp.1421-1427.
- Publisher:
- Wiley
Background: Challenging behaviour is a common problem among people with ID and in services for people with ID. This paper aims to provide an overview of the views and preferences of people with ID on challenging behaviour. Method: Semi‐structured interviews were conducted with thirteen adults with mild to moderate ID and seven proxies (family or close associates of adults with ID who were unable to communicate and/or with severe or profound ID) in the Netherlands. The interviews were audio‐recorded, transcribed and analysed thematically. Results: People with ID and (a history of) challenging behaviour have clear views and preferences on factors related to challenging behaviour, assessments, non‐pharmacological and pharmacological interventions and health professionals’ approach. Conclusions: The identified views and preferences of people with ID are not always in accordance with current procedures and treatments for challenging behaviour and should be included in future care processes and research. (Publisher abstract)
A structured programme to withdraw antipsychotics among adults with intellectual disabilities: the Cornwall experience
- Authors:
- SHANKAR Rohit, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 32(6), 2019, pp.1389-1400.
- Publisher:
- Wiley
Background: Antipsychotic medications are used among 19%–58% of adults with intellectual disabilities to manage challenging behaviour against the NICE guideline recommendations. Studies show that it is possible to completely withdraw antipsychotics in about one third of adults with intellectual disabilities and a dose reduction of 50% or more in another third. Method: In Cornwall, over three years the present authors developed a structured pathway to withdraw antipsychotics among adults with intellectual disabilities which involved people with intellectual disabilities and their carers, GPs, community learning disability team members and pharmacists. Results: The present authors managed to withdraw antipsychotics totally among 46.5% (33/71) and reduced over 50% of dosage in another 11.3% (8/71) of adults with intellectual disabilities. At three months follow‐up no one required hospital admission or change in placement. Conclusion: It is possible to withdraw/reduce antipsychotics in a high proportion of adults with intellectual disabilities if a concerted effort is made involving all stakeholders from the outset. (Publisher abstract)
Caregiver and care recipient characteristics as predictors of psychotropic medication use in community-dwelling dementia patients
- Authors:
- GRACE Elsie L., et al
- Journal article citation:
- Aging and Mental Health, 20(12), 2016, pp.1297-1304.
- Publisher:
- Taylor and Francis
Objectives: The current practice of prescribing psychotropic medication for the management of dementia-related behavioural disturbances is under substantial debate. Using Pearlin's stress process model as theoretical underpinning, the aim of this investigation is to identify caregiver and care recipient characteristics as predictors of anxiolytic, antipsychotic, and antidepressant use among community-dwelling dementia patients. The authors hypothesised that caregiving burden and patient characteristics, particularly behaviour disturbances and pain, would be positively associated with psychotropic medication use. Methods: Data for this exploratory, cross-sectional study were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Only participants with full baseline information were examined (N = 598). Caregiver characteristics, such as confidence managing problematic behaviours, and care recipient characteristics including pain, problem behaviours, cognitive impairment, and functional impairment, were examined in relation to care recipient psychotropic medication use. Results: Contrary to the hypothesis, behavioural disturbances and burden associated with these disturbances were not significantly associated with psychotropic use. Rather, caregiver characteristics such as race and overall vigilance, and care recipient characteristics such as cognitive status, functional status, and pain were significantly associated with the use of psychotropic medication. Findings differed by class of medication. Conclusion: These exploratory findings suggest the utility of a holistic approach to understanding the factors associated with pharmacotherapy among community-dwelling elders with dementia. Significant associations between caregiver characteristics and care recipient psychotropic medication use suggest that educating caregivers in non-pharmacologic strategies hold promise for a more balanced biopsychosocial approach to maintaining dementia patients in the community. (Edited publisher abstract)
The treatment of challenging behaviour in intellectual disabilities: cost-effectiveness analysis
- Authors:
- ROMEO R., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 53(7), July 2009, pp.633-643.
- Publisher:
- Wiley
Antipsychotic drugs are used in the routine treatment of adults with intellectual disabilities (ID) and challenging behaviour in the UK despite limited evidence of their effectiveness. There is no evidence on their cost-effectiveness. The relative cost-effectiveness of risperidone, haloperidol and placebo in treating individuals with an ID and challenging behaviour was compared from a societal perspective in a 26-week, double-blind, randomised controlled trial. Outcomes were changes in aggression and quality of life. Costs measured all service impacts and unpaid caregiver inputs. After 26 weeks, patients randomised to placebo had lower costs compared with those in the risperidone and haloperidol treatment groups. Aggression was highest for patients treated with risperidone and lowest for patients treated with haloperidol; however, quality of life was lowest for patients treated with haloperidol and highest for patients treated with risperidone. The authors conclude that the treatment of challenging behaviour in ID with antipsychotic drugs is not a cost-effective option.
Restraint procedures and challenging behaviours in intellectual disability: an analysis of causative factors
- Authors:
- MATSON Johnny L., BOISJOLI Jessica A.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.111-117.
- Publisher:
- Wiley
Persons with intellectual disability often evidence challenging behaviours. Physical/mechanical and chemical restraint and the factors that may result in the use and maintenance of restraint are reviewed. The type, rate and intensity of challenging behaviours, and the age of the affected individual and residential placement appear to be among the major factors that put these persons at risk for restraint. Restraint is still a commonly used intervention employed with people with challenging behaviours. Physical and chemical restraint should be used as a last resort, part of a planned programme, and implemented by trained people.
Prescribing patterns in a Hong Kong institution for adults with severe to profound learning disabilities
- Author:
- LIM Woon Chu Winston
- Journal article citation:
- Tizard Learning Disability Review, 10(4), October 2005, pp.3-9.
- Publisher:
- Emerald
There has been increasing concern about inappropriate or excessive medication of people with learning disabilities. This paper reports on a survey of prescribing patterns in an institution that cares for adults with severe to profound learning disabilities in Hong Kong. The survey found that 27% of the 294 hospital patients were receiving psychotropic drugs, but this rate was significantly higher (90%) in the ward for people with challenging behaviours. Most patients (67%) received a single psychotropic drug, 26% received two and 7%, three. Around half the patients (151) had epilepsy, of whom 90% received anticonvulsants. Of these, 52% received a single anticonvulsant, 37% received two and 11% received three or more. Dosages were generally within the recommended ranges. This survey revealed several good aspects of prescribing practice at Siu Lam Hospital, but also areas that need improvement. The latter include a drug-reduction programme for the people with challenging behaviours, trials of drug-free periods for seizure-free patients receiving anticonvulsants and replacement of phenytoin and phenobarbitone with safer alternatives.
Drugs may meet service needs - but they fail the clients
- Author:
- WALSH Paul
- Journal article citation:
- Community Living, 7(2), October 1993, pp.18-19.
- Publisher:
- Hexagon Publishing
Reports on SE Kent HA's approach to severe behaviour disorder, which has developed several drug-reduction programmes with emphasis on client needs and not service needs.
Minimising the use of restraint in care homes for older people: creative approaches
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2010
- Place of publication:
- London
Exploring the case of an unsettled new care home resident, this video shows how finding out more about a person’s life story provides clues to new approaches to care. There is an interview with the care home manager who describes what happened in this particular case and how, by providing relevant activities for the resident, it was possible to take him off antipsychotic drug treatment. The National Director of the National Association of Providers of Activities for Older People (NAPA) also encourages care home managers to support their staff in examining routine care practices. Staff can be empowered to look at what is going on and to make creative changes to the care they provide. Other interviews include the Director of Dementia Care for BUPA and the new Clinical Director for Older People.