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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)
Medication matters: final report
- Author:
- NORAH FRY RESEARCH CENTRE. Medication Matters Team
- Publisher:
- Norah Fry Research Centre
- Publication year:
- 2007
- Pagination:
- 31p.
- Place of publication:
- Bristol
The aim of this project was to find out what people with learning difficulties, their carers and the prescribers of their medication understand about why psychotropic medication has been prescribed and what the implications of taking it are. Interviews were held with 21 people with learning difficulties living in four different regions of England. They were contacted via voluntary and statutory sector organisations providing support for people with learning difficulties living in those areas. People were selected on the basis that they had learning difficulties and had been prescribed psychotropic medication. The majority of people interviewed thought that people with learning difficulties should be given the same information about their medication as anyone else, in an easy to understand format. As a result of the research findings, the research team have been working on a number of resources to help people with learning difficulties, their carers and prescribers. These are: a booklet for people with learning difficulties, their families or carers where information about a medication can be recorded; a decision-making tool for people with learning difficulties to help them make informed choices about medications they are prescribed; and information about where to find out more about medications.
Your guide to taking medicine for behaviour problems: easy read
- Authors:
- UNWIN Gemma, DEB Shoumitro
- Publisher:
- University of Birmingham
- Publication year:
- 2006
- Pagination:
- 15p.
- Place of publication:
- Birmingham
This guidance provides advice for patients who are receiving medication to manage behaviour problems with a learning disability. It aims to facilitate the care process and to improve the way that behaviour problems are managed, thus leading to a better quality of life for people with a learning disability.
The use of medication to manage behaviour problems in adults with an intellectual disability: a national guideline
- Authors:
- UNWIN Gemma L., DEB Shoumitro
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 4(3), September 2010, pp.4-11.
- Publisher:
- Emerald
This article provides an overview of the development and contents of a national guideline for the use of medication in the management of problem behaviours in adults with an intellectual disability. MENCAP commissioned the University of Birmingham Neuropsychiatry and Intellectual Disabilities Research Group to develop the guideline and it was produced in association with the Royal College of Psychiatrists’ Learning Disability Faculty and the College Research and Training Unit. The guideline was produced following the methods used by the National Institute for Health and Clinical Excellence, and included a systematic literature review. This guide neither recommends nor rejects the use of psychotropic medications for the management of problem behaviours in adults with learning disabilities, but concentrates on good practice such as employing clear rationales following thorough assessments of individual patients and careful monitoring and recording of use and withdrawal. Twenty-five main recommendations for practice which are provided in the ‘Quick Reference Guide’ are listed in the article. The importance of access to ‘easy-read medication information leaflets’ for people with learning disabilities to be able to make choices is also highlighted.
Stopping over-medication of people with intellectual disability, Autism or both (STOMP) in England part 1 – history and background of STOMP
- Authors:
- BRANFORD David, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 13(1), 2019, pp.31-40.
- Publisher:
- Emerald
Purpose: The programme – Stopping the over-medication of people with an intellectual disability, Autism or Both (STOMP) is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants and multiple psychotropic drug use. The purpose of this paper is twofold: Part 1 is to present the history and background to the use of psychotropic drugs in intellectual disabilities, autism or both; and Part 2 presents the progress with the STOMP programme. Design/methodology/approach: The review tracks the various concerns, guidelines and attempts to tackle the issue of over medication of people with intellectual disability autism or both. Findings: The review identifies that despite the many studies and guidelines associated with the prescribing of psychotropic drugs for people with an intellectual disability, autism or both the practice is common. Programmes that minimise the use of psychotropic drugs involve a full use of the multidisciplinary team and an availability of alternative methods of managing challenging behaviours. Originality/value: STOMP is part of an English national agenda – Transforming care. The English Government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities, autism or both who have a mental illness or whose behaviour challenges services. This review identifies many studies, programmes and guidelines associated with psychotropic drug use for people with an intellectual disability, autism or both. (Publisher abstract)
Stopping over-medication of people with an intellectual disability, autism or both (STOMP) in England part 2 – the story so far
- Authors:
- BRANFORD David, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 13(1), 2019, pp.41-51.
- Publisher:
- Emerald
Purpose: The STOMP programme – stopping the over-medication of people with an intellectual disability, autism or both is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants. Part 1 presented the historical background to the use of psychotropic drugs for people with an intellectual disability, autism or both. The purpose of this paper (Part 2) is to present the approach adopted to reduce over-medication (the “Call to Action”) and the progress so far at the half way stage. Design/methodology/approach: The “Call to Action” methodology is described in a Manchester University report – mobilising and organising for large-scale change in healthcare “The Right Prescription: A Call to Action on the use of antipsychotic drugs for people with dementia”. Their research suggested that a social mobilising and organising approach to change operates could provide a mechanism for bringing about change where other approaches had failed. Findings: The adoption of the “Call to Action” methodology has resulted in widespread acknowledgement across intellectual disability practice that overuse of psychotropic medication and poor review was resulting in over-medication. Many individual local programmes are underway (some are described in this paper) however to what extent the overall use of psychotropic drugs has changed is yet to be evaluated. Originality/value: STOMP is part of an English national agenda – transforming care. The government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities autism or both who have a mental illness or whose behaviour challenges services. This paper describes a new approach to stopping the over-medication of people with an intellectual disability, autism or both. (Publisher abstract)
Adult ADHD outcome audit based on NICE guidelines
- Author:
- EDWIN Moshieve Febin
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(5), 2014, pp.331-337.
- Publisher:
- Emerald
Purpose: Adult ADHD is a neuro-developmental disorder. The current prevalence of ADHD in adults is around 1.9-4 per cent. The service for adults with ADHD based on NICE guideline recommendation. Hence, the author decides to audit the Adult ADHD case loads against the gold standard set by the NICE. The paper aims to discuss these issues. Design/methodology/approach: The study was based on a retrospective analysis and collection of data from electronic patient records for a duration of five months between October 2011 and February 2012. The data findings were matched against the NICE standards. There were 15 standards identified. Six service outcome questions were also used to improve the Quality of the service provided. Findings: As the service outcomes were set for 100 per cent, the performance fell short in few areas. The service managed to achieve roughly 80-95 per cent in areas such as medication monitoring, transition service and care plan with shared care guidelines for prescription in primary care. The service under performed in areas on non-pharmacological interventions such as cognitive-behavioural therapy (CBT). The service continues to provide a exceptional service for adults with intellectual disability and ADHD. Research limitations/implications: The research was limited by information and recall bias due to the retrospective nature of data analysis. There was also over representation of the numbers in co-morbid cases due to more than two diagnosis. Practical implications: The paper outlines the regional outcome of the audit. However the findings have wider implications. For example the prevalence rate is more common in males than females. CBT is an important resource in the management of ADHD in adults. Priority and importance need to be given for providing a service for CBT in adults with ADHD. Social implications: The cost of sickness and non-employment due to ADHD is significantly high. Treating this complex group with medications and CBT improves the outcome and get them back in employment and reduce recidivism rates in offenders. Originality/value: The author feels the adult ADHD service audit has huge service implications. Currently it is a controversial diagnosis significantly under-resourced. The outcome survey had highlighted the areas of need as a neurodevelopmental disorder. (Edited publisher abstract)
A multi-level ecological model of psychotropic prescribing to adults with intellectual disability
- Authors:
- EDWARDS Niki, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(1), 2014, pp.24-31.
- Publisher:
- Emerald
Purpose: Simple linear accounts of prescribing do not adequately address reasons “why” doctors prescribe psychotropic medication to people with intellectual disability (ID). Greater understanding of the complex array of factors that influence decisions to prescribe is needed. Design/methodology/approach: After consideration of a number of conceptual frameworks that have potential to better understand prescribing of psychotropic medication to adults with ID, an ecological model of prescribing was developed. A case study is used to outline how the model can provide greater understanding of prescribing processes. Findings: The model presented aims to consider the complexity and multi-dimensional nature of community-based psychotropic prescribing to adults with ID. The utility of the model is illustrated through a consideration of the case study. Research limitations/implications:The model presented is conceptual and is as yet untested. Practical implications: The model presented aims to capture the complexity and multi-dimensional nature of community-based psychotropic prescribing to adults with ID. The model may provide utility for clinicians and researchers as they seek clarification of prescribing decisions. Originality/value: The paper adds valuable insight into factors influencing psychotropic prescribing to adults with ID. The ecological model of prescribing extends traditional analysis that focuses on patient characteristics and introduces multi-level perspectives that may provide utility for clinicians and researchers. (Publisher abstract)
A multi-centre audit of the use of medication for the management of behavioural problems in adults with intellectual disabilities
- Authors:
- UNWIN Gemma L., DEB Shoumitro
- Journal article citation:
- British Journal of Learning Disabilities, 36(2), June 2008, pp.140-143.
- Publisher:
- Wiley
The aim was to investigate prescribing practices surrounding the use of medication for the management of behavioural problems in adults with intellectual disabilities with reference to a national guideline development project. A case note review methodology was employed to explore adherence to the audit criteria that were derived from the recommendations made in the guideline. A total of 154 cases were identified as meeting the inclusion criteria. There was some variation in adherence to the examined audit criteria with some areas achieving high compliance whereas others were deemed as lacking. Such areas achieving high compliance included assessment of the behaviour, assessment of surrounding behavioural, medical, psychological/psychiatric and social issues and communication of the treatment plan to other relevant professionals. However, the assessment of capacity issues and acquisition of consent or assent were rarely documented. The results highlighted certain areas of clinical practice that may need to be formally documented in patient case notes in order to provide evidence of the quality of healthcare an individual has received.
Learning disability: behaviour that challenges: (QS101)
- Author:
- NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
- Publisher:
- National Institute for Health and Care Excellence
- Publication year:
- 2019
- Pagination:
- 57
- Place of publication:
- London
Quality standard covering care and support and services for children, young people and adults with a learning disability (or a learning disability and autism) and behaviour that challenges, and their families and carers. The standard includes 12 quality statements which describe what high quality care should look like. They include quality statements on: a lead commissioner to oversee strategic commissioning of services for all people with a learning disability; provision of annual health checks; initial assessment of behaviour that challenges; the provision of a named lead practitioner; involving families and carers; parent-training programmes; personalised daily activities; services in the community; housing; review of restrictive intervention; and use and review of medication. The standard is expected to contribute to improvements in the following outcomes: promotion of independence, choice and control over daily life; experience of using social care and healthcare services; use of restrictive practices; and quality of life for people with a learning disability and behaviour that challenges, and their carers. Originally published in 2015, this quality standard was updated in July 2019 to add four new statements, update one statement and amend one statement. (Edited publisher abstract)