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Rate of psychotropic drug prescription far exceeds rate of mental illness in the UK

In the UK, individuals with intellectual disabilities and a history of challenging behavior are often prescribed psychotropic drugs, despite not having any record of severe mental illness, according to recently published data in the BMJ.

“Our findings confirm a high rate of prescription of psychotropic drugs to people with intellectual disability in UK primary care and show independent associations of prescribing antipsychotics with challenging behaviors, autism, dementia and advancing age,” Rory Sheehan, academic clinical fellow, division of psychiatry at University College London, and colleagues wrote.

To assess the correlation between mental illness, challenging behavior and psychotropic medication prescriptions in intellectually disabled patients, researchers evaluated data from the Health Improvement Network clinical database on 33,016 adult patients with intellectual disabilities across 571 general care practices in the UK.

According to the study, challenging behavior was defined as a behavior with “an intensity, frequency or duration that threatens the physical safety of the person or others or restricts access to community facilities,” including, aggression, self-injury, stereotypic behavior, agitation, disruptive or destructive acts, withdrawn behavior, arson and sexual misconduct. 

Results demonstrated that at baseline, 21% of participants had a history of mental illness, 25% had a history of challenging behavior and 49% had a history of psychotropic drug prescriptions.

At the conclusion of the study, 34% of participants had a record of mental illness, 36% had a record of challenging behavior and 63% had a record of prescriptions for psychotropic drugs.

After adjusting for sociodemographic factors and comorbidity, participants with a history of challenging behavior (P < .001), autism (P < .001), dementia (P < .003), and who were older in age were significantly more likely to be newly prescribed antipsychotics.

Overall, between 1999 and 2013, rates of new severe mental illness declined by 5% per year (P < .001) and rates of new antipsychotic prescriptions declined by 4% per year (P < .001).

The researchers noted the importance of identifying health care providers’ reasoning for prescribing antipsychotics in patients without severe mental illness and why it is so often prescribed to patients with a history of challenging behavior.

“The results suggest that these conditions are managed, in some instances, with antipsychotic drugs, which will often reflect a departure from evidence based clinical guidelines,” Sheehan and colleagues wrote. – by Casey Hower

Disclosures: Sheehan reports receiving financial support from the Bailey Thomas Charitable Fund and the UK National Institute for Health Research. Please see the full study for a list of all other author’s relevant financial disclosures.