Psychotropic medicines in people with learning disabilities – an updated summary of important learning

Summary

In my tweets and posts I have suggested that patients themselves need to take more responsibility for the medicines they are prescribed. But what about vulnerable groups who may depend on decisions being made for them, and in their best interests?

Whilst there are circumstances where antipsychotic (psychotropic) medicines are an appropriate option for people with autism and learning disabilities, these occasions are limited. In all cases the patient matters most, and any decision to prescribe must be part of a team based, patient-led decision, which is regularly reviewed.

Content

A recent blog I wrote (see link below) brings together key information for clinicians, and especially for prescribers, from a variety of sources, including patients, relatives and carers. The aim is to help to prevent patients with autism and learning disabilities being harmed by inappropriate medicines.

I began this in 2018 following the death of Oliver McGowan, which I cover in teaching for (non-medical) prescribing students and in my clinical education work. It links to the NHS Learning Disability Mortality (LeDeR) Review Programme.

Key points:

• Most of the prescribing in this area is ‘off label’ (#jargonbuster – that’s medicines prescribed for something that isn’t listed as an ‘indication’ for that medicine ).
• This prescribing can include multiple anti-psychotic medicines, often medicines in the same class. There is a limited evidence base for this type of prescribing.
• Psychotropic medicines in people with learning disabilities who show symptoms of distress are not always prescribed by a specialist in this area.
• Diagnostic overshadowing may lead to inappropriate prescribing. This is the attribution of a person’s symptoms to their mental condition, when such symptoms actually suggest a comorbid condition.

Further resources:

• The Oliver McGowan Mandatory Training in Learning Disability and Autism – “Oliver’s Story”
• Presentation: Stopping over-medication in people with learning disabilities – 'Reasonable adjustment'
• Learning Disabilities Mortality Review annual reports
• University of Bristol: Learning Disabilities Mortality Review

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