By Eric Emerson
By Stewart L. Einfeld
Publisher: Cambridge University Press
Print Publication Year: 2011
Online Publication Date:May 2011
Chapter DOI: http://dx.doi.org/10.1017/CBO9780511861178.010
Subjects: Psychiatry and Clinical Psychology
There have been a number of surveys assessing the extent of prescription of psychotropic medication to people with intellectual disability, and whether it has been in keeping with good clinical practice. These surveys have frequently documented high levels of medication use and poor prescribing practice (Matson and Neal, 2009; Rinck, 1998; Spreat et al., 2004). For example, Holden and Gitelson found that 37% of people with intellectual disabilities in one Norwegian county were using psychotropics, that prescriptions frequently violated current guidelines, especially when provided by general practitioners (Holden and Gitlesen, 2004). For example, many prescriptions had not been indicated by a diagnosis, alternatives to medications had rarely been explored and evaluation of effects and side effects were exceptions.
Doctors are often subject to considerable pressure to prescribe medication to diminish or contain challenging behaviours. This is not surprising since psychotropic medications are available that are potent in producing tranquilization, fast-acting, require little expertise on the part of untrained carers, and may be relatively inexpensive compared with behavioural analysis and intervention. Unfortunately, however, psychotropic medications are nearly always associated with unwanted effects, at least in some individuals. These can vary from minor nuisance to life-threatening. The presence of unwanted effects has sometimes led to inappropriately restrictive attitudes towards medication use. In some locales, authorities have been set up to authorize or monitor prescribing of medications, especially psychotropic drugs, to persons with intellectual disabilities. These authorities have varied in their sophistication, understanding and co-operation with or hostility towards, medical practitioners.
Reference Type: reference-list