Study highlights inappropriate prescribing in patients with learning disabilities

One in six adults with learning disabilities is being prescribed antipsychotics, despite over half lacking a relevant diagnosis, a study by Public Health England has found.

It is critical that GPs and specialists work together to monitor patients with learning disabilities taking psychotropic medicines. | iStock
It is critical that GPs and specialists work together to monitor patients with learning disabilities taking psychotropic medicines. | iStock

The report, Prescribing of psychotropic drugs to people with learning disabilities and/or autism by general practitioners in England, was produced in collaboration with researchers at the Clinical Practice Research Datalink. 

Key findings include: 

  • 17% of adults with a learning disability known to their GP were being prescribed antipsychotics (furthermore, 14% were receiving antidepressants, 21% anticonvulsants, 3% hypnotics and 4% anxiolytics)   
  • 58% of patients prescribed antipsychotics and 32% of those prescribed antidepressants did not have a diagnosis in their GP record of an illness that would justify such treatment.

Based on these data, an estimated 30,000–35,000 patients with learning disabilities are being prescribed an antidepressant, antipsychotic (or both) by their GP without having a recorded diagnosis of a condition the drugs are intended to treat.

Patients with learning disabilities are more likely than the general population to have psychiatric illnesses. However, antipsychotic drugs are also used in patients with learning difficulties who do not have these conditions, and in young people with autism, in an attempt to manage difficult behaviours.

This usage is generally unlicensed and in most cases, there is a lack of substantial evidence of efficacy. In addition, antipsychotic drugs have well-known side-effects including movement disorders, anticholinergic effects, sedation and weight gain.

The study showed that over 90% of the prescribing of psychotropic drugs was not short term, that is, was followed by at least one repeat prescription.

The authors noted that the load of medication given to adults with learning disabilities appears to accumulate through their adult life, with the rate of antipsychotic prescribing 2.9 times higher in people aged 65 and over than in those aged 18 to 24. New drugs are added to address newly emerging problems, but drugs rarely removed when the problem changes or the likely efficacy of the drug wanes. 

NHS England has urged GPs and specialists to work together, through shared care arrangements, to monitor and regularly review patients taking psychotropic medications. Patients of all ages with learning disabilities should only be prescribed medication when there is a clear clinical diagnosis.

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