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Leicestershire Centre for Integrated Living

Systematic over-medication blights learning disability care

Date: 16/7/2015
Summary: GPs are massively over-medicating people with learning disabilities, often prescribing antipsychotics that are entirely inappropriate for the individual according to a new health study.

Public Health England's research follows revelations from the government report on private hospital Winterbourne View, where people with learning disables were shown to have been abused. That report concluded there were "deep concerns" about over-prescribing antipsychotic and antidepressant medicines for patients with learning disabilities and autism.

The new report, using information from the Clinical Practice Research Datalink, revealed that 17 percent of adults with a learning disability were being prescribed an anti-psychotic by their GP, but more than half of those people did not have any kind of diagnosis that could possibly be construed as needing an antipsychotic -- disorders such as psychosis, bipolar disorder and depression.

Public Health England estimates that between 30,000 to 35,000 people with learning disabilities are inappropriately prescribed an antipsychotic, an antidepressant or both by their GP -- that's one in every six people with a learning disability, known to the health services.

 

"Psychiatric drugs are often given to people with learning disabilities to try and manage challenging behaviour," said co-director of the learning disabilities team at Public Health England, Gyles Glover, in a government post. "These drugs have important side effects, but the evidence that they are effective is limited. Services are overstretched and care is demanding, so we understand how the use of these drugs can be considered normal or necessary. However, the report, which is the first of its kind, suggests that psychiatric drugs are used more widely than is appropriate and this comes with risk."

Glover went on to urge for more evidence of how and when these drugs are being prescribed, so that a wider change in public health practice can be administered. 

The study looked at anonymised data of clinical records dating from April 2009 until March 2012, of those diagnosed as having a learning disability (17,887) or autism (11,136). All drugs prescribed to those people were recorded. When the study authors looked at instances of hypnotics, anxiolytics, antipsychotic drugs, antidepressants and antiepileptics being prescribed, they found adult patients were "exposed" to one or more of these on 41.3 percent of "person days", when the patient met with a doctor. Those aged over 65 were found to be prescribed antipsychotics 3.3 times more than those aged 18-24. In 90 percent of cases, the prescription was not short term -- patients returned, and were given a repeat prescription.

When the team behind the paper extrapolated the data to get countrywide estimates, it concluded that 13 percent of adults in England with learning disabilities (23,800 people) are being prescribed antipsychotics needlessly, and 10 percent (19,500 people) have been receiving antidepressants needlessly.

"Allowing for overlap, which is common, we estimate that between 30,000 and 35,000 adults with a learning disability in England are taking one or both of these types of drug in the absence of the conditions for which they are indicated," says the report. There is a chance these numbers could rise further, considering the report did not take into account drugs prescribed by secondary care staff or in inpatient settings, since this is not data that could be followed up on.

Though accepting the limitations of the analysis, the authors said that with "reasonably straightforward enhancements" the system developed could be used to track and monitor changes over time.

Source Wired


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