THE USE OF PSYCHOTROPIC MEDICATION IN PEOPLE WITH LEARNING-DISABILITY - TOWARDS RATIONAL PRESCRIBING

Between 20 per cent to 50 per cent of institutionalized people with a learning disability receive psychotropic medication. A similar or a slightly lower proportion of those who live in the community also receive these drugs. There is a decreasing rate of use of these drugs with the increasing age. The rate of psychotropic drug use seems to have declined in the last decade among the community-based population. The two main reasons for the use of these drugs are psychiatric illness and behaviour disorder. These drugs cause unacceptable side-effects in a proportion of patients. Recent double-blind studies lend some support to the efficacy of zuclopenthixol in the treatment of behaviour disorder. Some drugs have been used on an experimental basis to treat behavioural problems with equivocal results. These include lithium carbonate, carbamazepine, sodium valproate, fluoxetine, buspirone, naloxone, naltrexone, dextroamphetamine, methylphenidate, fenfluramine, propranolol, nadolol, amantadine and midazolam. Non-drug dietary regimes, such as folic acid, vitamin B6, magnesium, and specific amino-acid rich diets have also been applied in the treatment of behavioural problems. Guidelines have been proposed for a common-sense rational approach to the use of psychotropic drugs in people with a learning disability.