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Quality of prescribing of antipsychotic medication for people with intellectual disability under the care of UK mental health services: a cross-sectional audit of clinical practice
  1. Carol Paton1,
  2. Sumera Bhatti2,
  3. Kiran Purandare3,
  4. Ashok Roy4,
  5. TRE Barnes5
  1. 1Oxleas NHS Foundation Trust, Dartford, UK
  2. 2Royal College of Psychiatrists Centre for Quality Improvement, London, UK
  3. 3Central and North East London Foundation Trust, London, UK
  4. 4Coventry and Warwickshire Partnership Trust, Coventry, UK
  5. 5Imperial College, London, UK
  1. Correspondence to Carol Paton; carol.paton{at}


Objectives To determine the prevalence and quality of antipsychotic prescribing for people with intellectual disability (ID).

Design A clinical audit of prescribing practice in the context of a quality improvement programme. Practice standards for audit were derived from relevant, evidence-based guidelines, including NICE. Data were mainly collected from the clinical records, but to determine the clinical rationale for using antipsychotic medication in individual cases, prescribers could also be directly questioned.

Settings 54 mental health services in the UK, which were predominantly NHS Trusts.

Participants Information on prescribing was collected for 5654 people with ID.

Results Almost two-thirds (64%) of the total sample was prescribed antipsychotic medication, of whom almost half (49%) had a schizophrenia spectrum or affective disorder diagnosis, while a further third (36%) exhibited behaviours recognised by NICE as potentially legitimate targets for such treatment such as violence, aggression or self-injury. With respect to screening for potential side effects within the past year, 41% had a documented measure of body weight (range across participating services 18–100%), 32% blood pressure (0–100%) and 37% blood glucose and blood lipids (0–100%).

Conclusions These data from mental health services across the UK suggest that antipsychotic medications are not widely used outside of licensed and/or evidence-based indications in people with ID. However, screening for side effects in those patients on continuing antipsychotic medication was inconsistent across the participating services and the possibility that a small number of these services failed to meet basic standards of care cannot be excluded.

  • intellectual disability
  • learning disability
  • antipsychotic
  • prescribing practice
  • quality

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  • Contributors CP, SB and TREB contributed to the conception and design of the data collection form and the acquisition and analysis of data. All five authors contributed to the drafting of the manuscript and critically revising it for important academic content. All five authors approved the final version submitted for publication and agreed to be accountable for the accuracy and/or integrity of the work.

  • Funding The work of the Prescribing Observatory for Mental Health (POMH-UK) is funded solely by subscriptions from participating healthcare organisations, the vast majority of which are NHS Trusts.

  • Competing interests CP has participated in a neurosciences advisory board in relation to neurodegenerative diseases for Eli Lilly. TREB has acted as a member of scientific advisory boards for Sunovion and Otsuka/Lundbeck in relation to antipsychotic medication.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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