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Stopping, rationalising or optimising antipsychotic drug treatment in people with intellectual disability and/or autism
  1. Rohit Shankar12,
  2. Mike Wilcock3,
  3. Katy Oak3,
  4. Paula McGowan4,
  5. Rory Sheehan5
  1. 1Cornwall Partnership NHS Foundation Trust, Truro, UK
  2. 2University of Exeter Medical School, Exeter, UK
  3. 3Royal Cornwall Hospitals Trust, Truro, UK
  4. 4Expert by Experience
  5. 5University College London, London, UK
  1. Correspondence to Rohit Shankar, Chygovenck Three milestone Industrial Estate, Truro, Cornwall, UK TR4 9LD; Rohit.shankar{at}nhs.net

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Key learning points

  • Antipsychotic medication is often prescribed to adults with intellectual disability (ID) and/or autism to manage behaviour that challenges despite little research evidence that antipsychotics are effective.

  • The STOMP (Stopping Overuse of Medication in People with Learning Disabilities and/or autism) campaign is aimed at reducing inappropriate prescribing of antipsychotic medication for people with ID and/or autism.

  • There is an absence of robust evidence on the most effective way to reduce or stop antipsychotic medication.

  • Withdrawing medication requires a multidisciplinary approach, consideration of comorbidity and the involvement of patients and their carers.

Introduction

Intellectual disability (ID; also known as learning disability) is characterised by significant impairment of both cognitive functioning and adaptive behaviours, and an onset in early childhood. People with ID experience a different pattern of morbidity to the general population and die considerably younger than their counterparts without ID.1 Autism is a neurodevelopmental disorder characterised by troubles with social interaction and communication, and by restricted and repetitive behaviour. In both conditions, complex mental and physical health problems, as well as social issues, are common and are associated with communication difficulties that can result in maladaptive behavioural patterns (often referred to as ‘behaviour that challenges’). Ideally, all people presenting with behaviour that challenges should be assessed by a specialist multidisciplinary team (comprising psychiatrists, psychologists, speech and language therapists, occupational therapists) to develop an understanding of the behaviour and an appropriate support plan with tailored treatment strategies and specialist follow-up.2 Non-pharmacological interventions for challenging behaviour, such as positive behavioural support or cognitive–behavioural therapy and manipulation of environmental triggers, are preferred to psychotropic medication. However, antipsychotic medication is often prescribed to adults with ID and/or autism to manage behaviour that challenges in the absence of severe mental illness, despite there being little research evidence that antipsychotics are effective in this context.3

Problems with antipsychotics

There …

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