Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 17;6(5):e112.
doi: 10.1192/bjo.2020.97.

UK psychiatrists' experience of withdrawal of antipsychotics prescribed for challenging behaviours in adults with intellectual disabilities and/or autism

Shoumitro Deb  1 , Tom Nancarrow  2 , Bharati Limbu  1 , Rory Sheehan  3 , Mike Wilcock  4 , David Branford  5 , Ken Courtenay  6 , Bhathika Perera  7 , Rohit Shankar  2
Affiliations

UK psychiatrists' experience of withdrawal of antipsychotics prescribed for challenging behaviours in adults with intellectual disabilities and/or autism

Shoumitro Deb et al. BJPsych Open. .

Abstract

Background: A high proportion of adults with intellectual disabilities are prescribed off-licence antipsychotics in the absence of a psychiatric illness. The National Health Service in England launched an initiative in 2016, 'Stopping over-medication of people with a learning disability [intellectual disability], autism or both' (STOMP), to address this major public health concern.

Aims: To gain understanding from UK psychiatrists working with adults with intellectual disabilities on the successes and challenges of withdrawing antipsychotics for challenging behaviours.

Method: An online questionnaire was sent to all UK psychiatrists working in the field of intellectual disability (estimated 225).

Results: Half of the 88 respondents stated that they started withdrawing antipsychotics over 5 years ago and 52.3% stated that they are less likely to initiate an antipsychotic since the launch of STOMP. However, since then, 46.6% are prescribing other classes of psychotropic medication instead of antipsychotics for challenging behaviours, most frequently the antidepressants. Complete antipsychotic discontinuation in over 50% of patients treated with antipsychotics was achieved by only 4.5% of respondents (n = 4); 11.4% reported deterioration in challenging behaviours in over 50% of patients on withdrawal and the same proportion (11.4%) reported no deterioration. Only 32% of respondents made the diagnosis of psychiatric illness in all their patients themselves. Family and paid carers' concern, lack of multi-agency and multidisciplinary input and unavailability of non-medical psychosocial intervention are key reported factors hampering the withdrawal attempt.

Conclusions: There is an urgent need to develop national guidelines to provide a framework for systematic psychotropic drug reviews and withdrawal where possible.

Keywords: Intellectual disabilities; STOMP; adults; antipsychotics; withdrawal.

PubMed Disclaimer

Conflict of interest statement

Supplementary material

References

    1. Smith S, Branford D, Collacott RA, Cooper SA, McGrother C. Prevalence and cluster typology of maladaptive behaviours in a geographically defined population of adults with learning disabilities. Br J Psychiatry 1996; 169: 219–27. - PubMed
    1. Deb S, Thomas M, Bright C. Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community-based population aged between 16-64 years. J Intellect Disabil Res 2001; 45: 506–14. - PubMed
    1. Hemmings C, Deb S, Chaplin E, Hardy S, Mukherjee R. Research for people with intellectual disabilities and mental health problems: a view from the UK. J Ment Health Res Intellect Disabil 2013; 6: 127–58.
    1. Deb S, Bethea T, Havercamp S, Rifkin A, Underwood L. Disruptive, impulse-control, and conduct disorders In Diagnostic Manual – Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability (2nd edn) (eds Fletcher R, Barnhill J, Cooper S-A): 521–60. NADD Press, 2016.
    1. Lundqvist LO. Prevalence and risk markers of behavior problems among adults with intellectual disabilities: a total population study in Örebro County, Sweden. Res Dev Disabil 2013; 34: 1346–56. - PubMed