Medication for behaviour problems associated with learning disabilities

Abstract

Many adults with learning disabilities show behaviour problems. It is imperative to find out the cause for and the consequences of the behaviour problems before deciding on an appropriate mode of management. Consider a non-medication management approach first. Sometimes it is necessary to use medication simultaneously with non-medication-based managements. Many medications, including antipsychotics, antidepressants, mood stabilizers such as lithium and some antiepileptic medications, opioid antagonists such as naltrexone and naloxene, benzodiazepines and buspirone, β-blockers, psychostimulants, and diet and vitamins, although not licensed for this use, have been shown to be effective in managing behaviour problems. However, the overall quality of evidence supporting their effectiveness is poor. Newer antipsychotics such as risperidone, olanzapine, amisulpiride, quetiapine and aripiprazole are preferred over the older generation of antipsychotics, although one has to be watchful about certain adverse effects such as weight gain, somnolence, cardiac abnormalities and metabolic effects such as glucose intolerance, hyperlipaedimia and hyperprolactaenimia. Overall, a lower dose of antipsychotics than is recommended in the British National Formulary for antipsychotic use is sufficient for the management of behaviour problems. Like antipsychotics, the newer generation of antidepressants such as SSRIs and SNRIs are preferred over the older generation of antidepressants. Once medication is prescribed, arrangements should be in place to monitor objectively the effectiveness and adverse effects. Medication treatment should be included within an overall person-centred planning or health action plan or care programme approach. As far as possible, the patients and the carers, and other relevant professionals, should be involved in the decision of prescribing medication.