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. 2004;2004(3):CD000377.
doi: 10.1002/14651858.CD000377.pub2.

Antipsychotic medication for challenging behaviour in people with learning disability

J Brylewski  1 , L Duggan
Affiliations

Antipsychotic medication for challenging behaviour in people with learning disability

J Brylewski et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: The term 'challenging behaviour', in the absence of psychiatric disorder, encompasses a wide range of behaviours that may be harmful to people or property, may be difficult to manage and may limit access to community facilities. Antipsychotic medications have been used to modify such behaviours in people with learning disability, but there is little evidence to suggest that the benefits outweigh the risks.

Objectives: To determine the effectiveness of antipsychotic medication for people with learning disability and challenging behaviour without additional mental illness.

Search strategy: Biological Abstracts, the Cochrane Library, EMBASE, MEDLINE, PsycINFO and BIOSIS were searched. Further references were sought from published trials and pharmaceutical companies. Trials were reliably identified and data extracted.

Selection criteria: All randomised controlled trials of antipsychotic medication versus placebo.

Data collection and analysis: Reviewers independently evaluated and analysed data on an intention to treat basis. Data were evaluated at 4, 8 and 12 weeks as longer follow-up data were not available. Reviewers assumed that those subjects lost to follow-up had a bad outcome.

Main results: Only nine randomised controlled trials could be included in the analyses. These provided no evidence of whether antipsychotic medication helps or harms adults with learning disability and challenging behaviour.

Reviewers' conclusions: There are limited data on this important issue and more research is urgently needed.

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Conflict of interest statement

Jane Brylewski ‐ has received an honorarium from Janssen for speaking at a conference.

Lorna Duggan ‐ has attended functions sponsored by Lundbeck, Janssen, Pfizer and Zeneca, has received honoraria from Janssen for speaking at conferences and has accepted sponsorship from Eli Lilly for internal flights in the United States.

Figures

1.1
1.1. Analysis
Comparison 1 ANY ANTIPSYCHOTIC DRUG vs PLACEBO, Outcome 1 Global effect. No important clinical response ‐ 12 weeks.
1.2
1.2. Analysis
Comparison 1 ANY ANTIPSYCHOTIC DRUG vs PLACEBO, Outcome 2 Behaviour ‐ not improved to an important extent.
1.3
1.3. Analysis
Comparison 1 ANY ANTIPSYCHOTIC DRUG vs PLACEBO, Outcome 3 Behaviour ‐ other less direct measuers.
1.4
1.4. Analysis
Comparison 1 ANY ANTIPSYCHOTIC DRUG vs PLACEBO, Outcome 4 Behaviour ‐ in autistic disorder (Ritvo‐Freeman Real‐life Rating Scale ‐ high score = poor).
1.7
1.7. Analysis
Comparison 1 ANY ANTIPSYCHOTIC DRUG vs PLACEBO, Outcome 7 Adverse effects ‐ various by 8 to 12 weeks.
1.8
1.8. Analysis
Comparison 1 ANY ANTIPSYCHOTIC DRUG vs PLACEBO, Outcome 8 Adverse effects ‐ any reported.
1.9
1.9. Analysis
Comparison 1 ANY ANTIPSYCHOTIC DRUG vs PLACEBO, Outcome 9 Leaving the study early.
See this image and copyright information in PMC

Update of

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