A case series on the use of risperidone for the management of aggression in adults with intellectual disabilities
| Pages | 39-44 |
| Published date | 27 September 2010 |
| DOI | https://doi.org/10.5042/amhid.2010.0542 |
| Date | 27 September 2010 |
| Author | Shoumitro Deb,Ajit Gomez |
| Subject Matter | Education,Health & social care |
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Advances in Mental Health and Intellectual Disabilities Volume 4 Issue 3 September 2010 © Pier Professional Ltd
10.5042/amhid.2010.0542
RESEARCH
Introduction
The use of psychotropic drugs in the management of
challenging (problem) behaviours including aggression in
adults with intellectual disability remains controversial (Aman
et al, 2000; Deb & Weston, 2000). In the past, not all
studies have firmly established the efficacy of psychotropic
medication in managing aggression (Brylewski & Duggan,
1999), although some studies have shown the effectiveness of
psychotropics in the treatment of problem behaviours (Deb,
2007). The psychological, social and biological factors that
come into play are often quite varied, and require a broad
and holistic assessment of individual cases before deciding on
treatment. Recently national and international guides have
been developed for assessment and management of problem
behaviours (Deb et al, 2006, 2009; Banks et al, 2007) that
have led to the development of care pathways in streamlining
care for a condition of complex aetiology.
A large proportion of people with intellectual disability
receive psychotropic drugs, and in doses higher than
recommended by the British National Formulary (Deb &
Fraser, 1994). Clarke and colleagues (1990) showed that 36%
of adults with intellectual disability who did not have a diagnosis
of psychiatric disorders received psychotropic medication.
The aim of this study was to assess the outcome of use of
risperidone in a consecutive sample of adults with intellectual
disability who were referred to the Learning Disability Psychiatric
Team primarily for management of aggressive behaviour. The
study was used as a pilot before a more definitive randomised
controlled trial (RCT) could be set up. One aim of the
case series was to assess the usefulness of certain outcome
measures, both for research (RCT) and for day-to-day use by
clinicians. The aim was to use standardised outcome measures
for frequency and severity of target behaviours and, more
important, complement them with measures of patients’
quality of life, carer burden, side-effect profile, etc. We also
used the Mini Psychiatric Assessment Schedule for Adults with
Developmental Disability (Mini PAS-ADD) (Prosser et al, 1998)
to identify any underlying psychiatric disorder contributing to
aggression. We have also provided some clinical explanations of
the outcome of each case.
Methods
We carried out a prospective longitudinal observation
study. The research project was launched after obtaining
appropriate ethical approval and assent from carers for those
lacking capacity to consent. Carer consent was obtained in all
Shoumitro Deb
Consultant Psychiatrist and Clinical Professor, University of Birmingham, UK
Ajit Gomez
Consultant Psychiatrist in Learning Disability, UK
Abstract
Antipsychotic drugs are often used outside their licensed indication to manage aggression in adults with intellectual disabilities in the absence
of a diagnosed psychiatric disorder. The current case series shows that antipsychotics could be effective, but they are often used with non-
drug measures and sometimes cause side-effects. Clinicians did not always carry out a thorough assessment followed by a formulation before
prescribing medications, as recommended in the national and international guides (Deb et al, 2009; Unwin & Deb, 2010). It is also apparent
that clinicians did not carry out tests to detect side-effects of risperidone such as metabolic syndrome. Clinicians should use psychotropic
medication for a minimum period of time and at the lowest possible dose, and should consider non-drug management of aggression at the
outset and at a regular interval.
Key words
adults; intellectual disability; learning disabilities; management; aggression; risperidone; case series
A case series on the use of risperidone for
the management of aggression in adults
with intellectual disabilities
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