Prescribing psychotropic medication for problem behaviours in adults with intellectual disabilities in a specialist psychiatric unit in Hong Kong
| Published date | 27 September 2010 |
| Pages | 27-33 |
| DOI | https://doi.org/10.5042/amhid.2010.0540 |
| Date | 27 September 2010 |
| Author | Henry Kwok,Eileena Chui,Alexander Tang |
| 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
RESEARCH
Introduction
Problem behaviours frequently occur in adults with
intellectual disability. However, depending on the definition,
sampling population and methodology, their prevalence varies
between studies. In a study of 2202 adults with intellectual
disabilities, Smith and colleagues (1996) reported that more
than 60% of individuals demonstrated the presence of at least
one problem behaviour, and in 40% this problem was of
either severe degree or frequent occurrence. A quite similar
result was found by Deb and colleagues (2001) in a sample
of 101 adults with intellectual disability in Wales. Focusing on
aggressive behaviour alone and using the Diagnostic Criteria
for Psychiatric Disorders for Use with Adults with Learning
Disabilities/ Mental Retardation ( DC-LD; Royal College
of Psychia trists, 2001), a p oint prevalence of 9.8% was
found by Cooper and colleagu es (2009). In a related study
in the s ame cohort, the p oint prevalence of self-injurious
behaviour was 4.9% (Cooper e t al, 20 09). These problem
behaviours are not only prev alent but also pe rsistent
and enduri ng. Totsika and co lleagues (2008) foun d that
serious ph ysical attacks, self -injury and stereoty py were the
categories most likely to en dure.
Psychotropic medications are often prescribed for people
with intellectual disability for management of their problem
behaviours (Deb & Fraser, 1994; McGillivray et al, 2004).
A systematic review of randomised controlled trials found
Henry Kwok
Head, Psychiatric Unit for Learning Disabilities, Kwai Chung Hospital, Hong Kong-China
Eileena Chui
Associate Consultant, Western Psychiatric Centre, Queen Mary Hospital, Hong Kong-China
Alexander Tang
Resident, Accident & Emergency Department, Tseung Kwan O Hospital, Hong Kong-China
Abstract
Psychotropic medications are often used to treat problem behaviours in people with intellectual disability which not only occur frequently but
also tend to persist over time. This study examined the pattern of prescription of such medications to manage problem behaviours for adults
with intellectual disabilities in a specialist psychiatric unit in Hong Kong. Individuals aged 18 or above with problem behaviours and receiving
psychotropic medication for treatment in hospital, outpatient and community settings were studied. Their demographic and clinical information
was collected. The type and dosage of medications were retrieved from the computer database and analysed. Those with psychotic disorder
and mood (affective disorder) were excluded. After screening, 236 patients met the inclusion criteria. People with moderate intellectual
disability accounted for most of the cohort (46%). Autism spectrum disorder was the commonest psychiatric diagnosis (35%) and aggression
the commonest problem behaviour (52%). Antipsychotics, mood stabilisers and antidepressants were prescribed to 96%, 20% and 13% of
the subjects respectively. The profile of problem behaviour in the Chinese population with intellectual disability is consistent with the findings
reported in the world literature. Antipsychotic drugs are the most commonly prescribed class of psychotropic medication used to treat such
behaviours. Although the current evidence is not strong enough to support a clear-cut recommendation on the use of medications, the
dichotomous notion of ‘prescription’ or ‘no prescription’ for problem behaviours may be simplistic.
Key words
intellectual disability; learning disabilities; psychotropic medication; prescription; problem behaviour; mental health
Prescribing psychotropic medication for problem
behaviours in adults with intellectual disabilities
in a specialist psychiatric unit in Hong Kong
10.5042/amhid.2010.0540
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