The role of medication in the management of behaviour problems in people with learning disabilities

A high proportion of people with learning disabilities receive psychotropic medications such as antipsychotics, antidepressants, antianxiety drugs including benzodiazepines, buspirone and beta blockers, mood stabilisers such as lithium and some antiepileptic medications, psychostimulants, opioid antagonists and also vitamins and diets. Many receive these for behaviour problems for which these medications have not been indicated. Apart from a few exceptions of recent good quality randomised controlled trials (RCTs) of risperidone on the management of behaviour problems among children and adults with learning disabilities with and without autism, most of the evidence for the effectiveness of medication for the management of behaviour problems comes from non‐controlled or non‐randomised observational studies. The lack of evidence does not automatically mean that there is evidence that these medications are not effective. Current guidelines suggest that a thorough assessment of the cause and effect of the behaviour problems should be carried out before prescribing medications. A formulation should document the assessment and rationale for use of medications. Non‐medication based interventions should always be considered along with medication and where appropriate behavioural and psychological interventions should be employed either instead of or along with the medication. People with learning disabilities and their carers should be involved in the decision‐making process all along. Where necessary other relevant professionals should also be involved. At the outset the time, method and people involved with the follow‐up assessment should be determined. Follow up should involve an objective assessment of target behaviours but, more importantly, an assessment of the quality of life of the person and their carers. At each follow up a reformulation should be carried out along with consideration of non‐medication based management and the possibility of withdrawing medication. Important issues such as capacity, consent and legal issues should always be borne in mind. Medications should be used with some caution because of their adverse effects.