Antipsychotics Prescribed Off-Label for Challenging Behaviors

Justin Karter
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Antipsychotics are being prescribed to people who may have challenging behaviors but no mental disorder, according to new research published in this month’s issue of BMJ.  In people without intellectual disability, approximately 50% of prescriptions for antipsychotics are given in the absence of a diagnosis of severe mental illness.   According to the new analysis, an even higher proportion (71%) of those with intellectual disabilities receive antipsychotics without such a diagnosis.

The new study, led by Rory Sheehan, set out to investigate whether antipsychotics are being prescribed, against clinical guidelines, to help manage challenging behaviors in those with learning disabilities.

“Excessive use of psychotropic drugs has individual and systemic implications,” the researchers write. “Antipsychotics, in particular, are associated with several adverse side effects that can impair quality of life and lead to deleterious health outcomes.”

In recent years, there has been an increased concern that antipsychotics may be overprescribed to people with intellectual disabilities but obtaining accurate and adequate data on these practices has proven difficult and no comprehensive analysis had yet been carried out.  Sheehan and his fellow researchers were able to make use of the UK electronic primary healthcare records to examine the files of 33,016 patients with intellectual disabilities.

After analyzing the records, the researchers concluded that “adults with intellectual disability are treated with psychotropic drugs at a rate far exceeding that of recorded mental illness and that certain subgroups (such as those with challenging behaviour) are significantly more likely to receive antipsychotic drugs.”

The researchers note that the general practitioners in the UK have been incentivized to record all known intellectual disabilities and mental disorders through the health care system.  Despite this incentive to mark such diagnoses, most antipsychotics were prescribed to people without documented mental disorders.

The likelihood of an antipsychotic prescription for those with a learning disability was independently associated with the existence of challenging behaviors.  Thirty-six percent of those studied had a history of challenging behavior, and almost half of those had been prescribed antipsychotic drugs. “Autism, dementia, and older age were also independently associated with antipsychotic use in people with intellectual disability,” according to the study.

In an Op-Ed about the study for City A.M. in London, Sheehan adds the additional concern that the inappropriate prescribing of antipsychotics may also be a drain on the healthcare system.  He writes:

Medication is expensive, and while the exact cost of this concerning practice is difficult to estimate, doctors must be aware of the long-term risks, both in purely economic terms and on the health and wellbeing of the patients who are inappropriately treated. To deny the complexity of factors that contributes to the development and persistence of challenging behaviour by reactively reaching for the prescription pad does them a disservice.

Read Sheehan’s full Op-Ed here →

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Sheehan, R., Hassiotis, A., Walters, K., Osborn, D., Strydom, A., & Horsfall, L. (2015). Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. (Full Text)

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Justin Karter
MIA-UMB News Editor: Justin Karter is a writer, researcher and community organizer with graduate degrees in both journalism and community psychology. He is a doctoral candidate in Counseling Psychology at UMass Boston, an active member of the Society for Humanistic Psychology, and is currently working on several scholarly projects at the intersection of psychology, social theory, and political philosophy.

3 COMMENTS

  1. We told you so…
    I’m not sure if there is any legitimate use of these drugs for anyone. Maybe some people voluntarily take them to blunt their psychosis but then they shouldn’t take them for long time periods anyway and if it’s about short-term, one time use for “calming down” benzos or other sedatives would do the trick for most people (not that these are much better but there’s hardly anything worse than an “anti-psychotic”).

  2. Btw, given the absurdity of the “all have disorder” DSM – how is it possible that people who prescribe these drugs didn’t even bother to find some label? It’s not that hard – pass me the book and I can slap one over anyone’s forehead. I guess it just goes to show how little people care when prescribing drugs. I remember when me and my friend were watching Dr House with a mix of amusement and terror as he was using “diagnosis by prescription” (if a drug against A it doesn’t kill you and helps – it means the patient has A). Turns out a lot of “doctors” watch this series not as dumb amusement but as “how to” manual. Scary…

    • So-called “developmentally disabled”/”retarded” folks are given anti-psychotics / major tranquilizers, as a form of behavior control, and to drive profit$…. There’s no “mental illness” “diagnosis” involved, because the system doesn’t require there to be. As far back as the 1950’s, with Thorazine, it was called “chemical restraints”, “chemical straitjacket”, “chemical lobotomy”, etc., BY THE STAFF!….