Intended for healthcare professionals


Psychotropic prescribing in people with intellectual disability and challenging behaviour

BMJ 2017; 358 doi: (Published 18 August 2017) Cite this as: BMJ 2017;358:j3896
  1. Rory Sheehan, NIHR doctoral research fellow in psychiatry of intellectual disability1,
  2. André Strydom, reader in psychiatry of intellectual disability1,
  3. Nicola Morant, lecturer1,
  4. Elisavet Pappa, graduate student1,
  5. Angela Hassiotis, professor of psychiatry of intellectual disability1
  1. 1Division of Psychiatry, University College London, London UK
  1. Correspondence to: R Sheehan r.sheehan{at}

Aligning evidence, practice, and policy

Intellectual disability affects about 1 million people in England. People with intellectual disability are more likely to develop a mental disorder and often have multimorbity.1 Appropriate drug treatment of mental illness is important, but recent evidence confirms an over-reliance on psychotropic drugs, particularly antipsychotics, for challenging behaviour when no mental illness has been recorded. Such use is off-licence and unsupported by empirical evidence.2 Overuse of medication is concerning as people with intellectual disability are more sensitive to unwanted side effects3 and often lack capacity to consent to treatment.

Safe and appropriate use of psychotropic drugs has become a priority for people with intellectual disability, their care givers, and services after revelations of shocking abuse of patient trust and safety, prompting the UK government to review care for this group of patients with complex needs.4 The serious and systemic failings identified by the review galvanised clinicians across primary and secondary care, and an NHS policy drive, “Stopping over-medication of people with learning disabilities” (STOMP), now entering …

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