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Off-label medicines

Report highlights extent of inappropriate prescribing in adults with learning disabilities

Over half of adults with learning disabilities prescribed antipsychotics do not have a recorded diagnosis of a condition that the drugs are designed to treat.

Adults with learning disabilities but no diagnosis of mental illness are being prescribed inappropriate antipsychotic drugs, according to a report published by Public Health England (PHE). In the image, a person with learning disability painting

Source: Adrian Buck / Alamy

It is common for many vulnerable adults to be prescribed a cocktail of inappropriate psychotropic drugs

One in six adults with learning disabilities but no diagnosis of mental illness is being prescribed antipsychotic drugs by a GP, according to a report[1] published by Public Health England (PHE) on 14 July 2015.

The report, commissioned by NHS England, found that over half of adults with learning disabilities prescribed antipsychotics do not have a recorded diagnosis of a condition that the drugs are designed to treat.

The report reveals that it is common for many vulnerable adults to be prescribed a cocktail of inappropriate psychotropic drugs.

“It wasn’t just antipsychotic drugs that people were being prescribed inappropriately,” says David Branford, former chairman of the England Pharmacy Board of the Royal Pharmaceutical Society (RPS), who was involved in the report. “We found that they are receiving a multitude of psychotropic drugs — people being prescribed more and more medicines.”

The PHE report says that 17% of adults with a learning disability known to their GP were being prescribed an antipsychotic. Antidepressants were prescribed in 16.9% of cases; drugs used for mania or hypomania in 7.1% of cases; anxiolytics in 4.2% of cases and hypnotics in 2.7% of cases.

Just under 30% of the adults were prescribed one or more of the drugs. And 58% who received antipsychotics and 32% who were treated with antidepressants did not have the appropriate diagnosis. Overall, 51% of these vulnerable adults did not have a mental illness that the prescribed drug was designed to treat.

The report’s authors examined data held by the Clinical Practice Research Datalink (CPRD) primary care database and based their analysis on GP prescriptions and diagnoses for patients with a learning disability between April 2009 and March 2012.

The findings form part of “robust evidence of the inappropriate use of powerful medicines in people with learning disabilities”, say chief pharmaceutical officer for England Keith Ridge and the national clinical director for learning disability Dominic Slowie in a letter to health professionals, published by NHS England to coincide with the report.

“This is not acceptable practice and must improve,” they write in the letter, endorsed by the RPS, the Royal College of Nursing and the Royal College of Psychiatrists.

One of the authors of the PHE report Gyles Glover, consultant in public health and co-director of the PHE learning disabilities team, says psychiatric drugs are often given to people with learning disabilities to deal with challenging behaviour. “These drugs have important side effects, but the evidence that they are effective is limited,” he says. “It is crucial that we build our evidence of what drugs are being used to manage behaviour and how often to support and guide a change in practice.”

Commenting on PHE’s findings, Maureen Baker, chair of the Royal College of General Practitioners, says: “While psychotropic drugs can have benefits for some patients with learning disabilities, it is important that every patient is taken on a case-by-case basis and not simply prescribed drugs as a matter of course.”

NHS England is hosting a meeting of patients, carers and health professionals on 17 July 2015 in London, where a national call to action will be officially launched to stamp out inappropriate prescribing of antipsychotic and other powerful psychiatric drugs to adults with learning disabilities.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20068986

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  • Adults with learning disabilities but no diagnosis of mental illness are being prescribed inappropriate antipsychotic drugs, according to a report published by Public Health England (PHE). In the image, a person with learning disability painting

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