Drug treatments in people with intellectual disability and challenging behaviour

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4323 (Published 04 July 2014) Cite this as: BMJ 2014;349:g4323
  1. Peter Tyrer, professor of community psychiatry1,
  2. Sally-Ann Cooper, professor of learning disabilities2,
  3. Angela Hassiotis, professor of psychiatry of learning (intellectual) disabilities3
  1. 1Centre for Mental Health, Imperial College, London W6 8RP, UK
  2. 2Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  3. 3University College, London, UK
  1. Correspondence to: P Tyrer p.tyrer{at}imperial.ac.uk

Time to rethink?

Do we still need to be reminded that the drug treatment of people with intellectual disability is often prolonged and not without dangers? We probably do. Drug treatment has been a mainstay for managing a common syndrome subsumed under the label “aggressive challenging behaviour” since chlorpromazine was first introduced for its treatment over 40 years ago.

We have no fundamental criticism of the transfer of a successful treatment for one disorder in general psychiatry to the same disorder in people who are intellectually disabled. However, challenging behaviour has no equivalent in general psychiatry, so there is no treatment to transfer. Challenging behaviour is the most common disturbance requiring intervention in intellectual disability services, but it does not have proper diagnostic status in standard psychiatric classifications.

Yet this does not inhibit the wholesale import of adult psychopharmacology into its management. Psychotropic medication in its many formsmainly antipsychotics, sedatives and tranquillisers, antidepressants, and mood stabilisers—has seen extensive off-label prescribing for the past 50 years. Thus, a recent population based cohort study of 1023 adults with intellectual …

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