scholarly journals Audit of the use of psychotropic medication for challenging behaviour in a community learning disability service

2004 ◽  
Vol 28 (12) ◽  
pp. 447-450 ◽  
Author(s):  
Tom Marshall
Keyword(s):  
Side Effects ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Evidence Base ◽  
Challenging Behaviour ◽  
Duration Of Treatment ◽  
Community Learning ◽  
Disability Service ◽  
People With Dementia ◽  
Multiple Drugs

Aims and MethodThe aims of the study were to identify patients in a community learning disability service receiving psychotropic medication for challenging behaviour, to examine prescribing practice and to compare this against local consensus standards. Local consensus standards were agreed by the consultants and the notes were reviewed by the author.ResultsA total of 102 patients were identified as receiving psychotropic medication for challenging behaviour (26.7% of notes examined). The most common additional diagnoses were autism (29%) and epilepsy (28%). The average duration of treatment was 5.3 years, and multiple drugs were used in 34% of these patients. Antipsychotics were the most commonly used drugs (96% of patients). There was rarely a detailed description of the challenging behaviour. There was little regular monitoring of side-effects or warning about potential side-effects when the medication was started.Clinical ImplicationsChallenging behaviour is a common cause of multiple prescribing in learning disability patients, and is often long-term in the absence of a strong evidence base. Other specialties use medication to control disturbed behaviour, particularly in people with dementia or personality disorder, so this audit may also be of interest to old age, adult and forensic psychiatrists.

scholarly journals Transfer and transition referrals of patients with intellectual disability from children's services to adult community learning disability teams

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S103-S103
Author(s):  
Jalil-Ahmad Sharif
Keyword(s):  
Intellectual Disability ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Limited Information ◽  
Children's Services ◽  
Term Care ◽  
Community Learning ◽  
Children’S Services ◽  
Support Plan ◽  
Transition Support

AimsThe audit aimed to assess if patients under the care of children's services in Wessex were transferred at the appropriate age and whether transition referrals to Community Learning Disability teams (CTLD) occurred timely. It also aimed to look at how many patients underwent transitions in a three month period, and if their transition support plan (TSP) was completed. A transition support plan should include chronological information on psychopharmacology, psychotherapy, and social support measures. Patients should be referred between the ages of 17–19 but require a justification after 18 years of age.MethodThe BI team was contacted to provide all IDs for patients referred within a three month period between the ages of 17–19. The BI team provided 42 patients with their ID. Patients discharged from services within a short time span were excluded for the following reason: inappropriate referral (9pts), discharged after 1st assessment (6pts), internal discussion (6pts), only referred to Autism team (4pts), moved out of area (1pts). From the initial 42 patients, 16 patients were analysed using the collection tool.Result4/16 had a TSP, and only two had a complete TSP and transitioned in another trust and were inter-team referrals.CAMHS services referred 1/16 patients.Psychotropic medication was prescribed to 12/16 prior to or on time of referral, but only two patients had a complete psychotropic medication history.8/16 patients' referral was commenced prior to their 18th birthday, and no information was provided for delay in transfer.Health records did mention psychotherapy, but apart from 2/16 TSP records, no additional information was available on the modality.ConclusionPatients with Intellectual Disability face challenges when transferring from children to adult services. Insufficient referral information may have a detrimental impact on patients wellbeing and long-term care.Access to a patient's chronological journey through the different children's services allows Adult CTLD health professionals to provide effective care. Historical psycho-social and pharmacological interventions provide a reference point for future interventions.Concerns included: limited information on most TSP regarding psycho-social and psychotropic treatments, lack of access to CAMHS/CHYPS paperwork and ineffective inter-trust communication for transition patients.This project highlighted the average number of transition cases in 3 months. It led to changes to the transition pathway, as awareness was raised in trust and CCG meetings to improve patient outcome. CTLD created the new role of transition facilitators to support children's services. They sit in meetings before patients transition referrals.

scholarly journals Abstract : stomp in HPFT

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S220-S220
Author(s):  
Anu Sharma ◽  
Kamalika Mukherji ◽  
Chetan Shah
Keyword(s):  
Data Collection ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Clinical Sample ◽  
Challenging Behaviour ◽  
Psychological Therapies ◽  
Nice Guidance ◽  
The Individual ◽  
Community Team ◽  
The Impact

AimsAnalyse the pattern of psychotropic drug use and deprescribing (in the context of STOMP) in people with Intellectual disability and Challenging behaviour in Hertfordshire community team(s) during 2016-17. STOMP stands for Stopping Over Medication in People with Learning Disability, Autism or both.BackgroundPublic Health England in 2015 estimated that on an average day in England, between 30,000 and 35,000 adults with a learning disability, autism or both were taking prescribed psychotropics without appropriate clinical indications . HPFT signed up to the STOMP pledge in 2017 to actively review psychotropic prescribing in line with NICE guidance alongside patients, carers and professional partnerships. This audit provides the outcomes of applying the STOMP Pledge to clinical practice.MethodData collection for the current audit occurred over Q1-5 in 2016–2017. All patients with Intellectual Disabilities on psychotropic medication were reviewed in psychiatric clinics. Awareness was raised about STOMP in teams. A semi-structured tool was developed based on the Self assessment framework published by the ID faculty RCPsych and prospective data were collected after each outpatient visit.Result347 patients were prescribed psychotropic medication and reviewed quarterly between 2016-2017. 96 patients were prescribed antipsychotics for challenging behaviour. Other prescribed medications included mood stabilisers, anticonvulsants, anti-depressants and benzodiazepines. Common antipsychotics used: Risperidone (63), Aripiprazole (14), Quetiapine (9), Olanzapine (4); Chlorpromazine (2). Four patients were maintained on two antipsychotics in varying combinations. The data collection tool noted that alternatives to medication were tried in 32 cases. Deprescribing occurred in 41 casesConclusionThis study represents an attempt to capture the impact of the STOMP principles in a clinical sample. Various alternatives to medications were pursued in the sample such as positive behaviour support, sensory integration, psychological therapies, social support. Younger adults (under 30 years) represented the largest proportion of cases where medication was increased. Adults over 30 years represented the largest proportion of cases where a STOMP reduction occurred. This may reflect the individual factors at play. Younger people with ID and /or Autism are more likely to experience changes in support and structure at transition, whilst older adults may have more physical comorbidities that may influence this decision.zcvv

Community learning disability teams: the need for objective methods of prioritization and discharge planning

2002 ◽  
Vol 15 (4) ◽  
pp. 223-233 ◽  
Author(s):  
Anna Caffrey ◽  
Margaret Todd
Keyword(s):  
Mental Health ◽  
Learning Disability ◽  
Discharge Planning ◽  
Evidence Base ◽  
Planning System ◽  
Community Learning ◽  
Referral Criteria ◽  
Formal Mechanism ◽  
Health Domains ◽  
Do So

As part of caseload management for community learning disability teams (CLDTs), it would appear reasonable that services would have a mechanism for prioritizing referrals and discharge planning. However, any formal mechanism in relation to these two aspects apparently is lacking within the literature. This theoretical article attempts to illustrate this evidence-base need, and demonstrate how a prioritization and/or discharge planning system would aid CLDTs. In light of the scarcity of material for the learning disability sector, information has been examined from other health domains such as mental health. The paper also presents a discussion on whether rationing of services is best done via explicit or implicit means. Issues related to setting referral criteria and the allocation of referrals are also considered. Although suggestions have been made for CLDTs, it is difficult to do so whilst the evidence base for this sector is so lacking.

Commentary on “Causing trouble: the language of learning disability and challenging behaviour”

2016 ◽  
Vol 21 (3) ◽  
pp. 150-153
Author(s):  
Bob Marks
Keyword(s):  
Learning Disabilities ◽  
Learning Disability ◽  
Design Methodology ◽  
Social Constructionist ◽  
Challenging Behaviour ◽  
Community Learning ◽  
Content Type ◽  
Potential Benefits ◽  
Positive Behaviour Support ◽  
The Way

Purpose – The purpose of this paper is to consider the findings of the research studies on referral to a community learning disability team presented in “Causing trouble: the language of learning disability and challenging behaviour”. Design/methodology/approach – The commentary is based on a review of the article and associated literature. Findings – The studies were undertaken from a social constructionist perspective. It is argued that the use of language in referral texts and the way they represent people with learning disabilities and challenging behaviour is influenced by wider social and historical ideas of what is accepted knowledge. The analysis of these texts contributes to the understanding of how outmoded responses to challenging behaviour are maintained and has potential benefits when used in the context of positive behaviour support. Originality/value – The commentary considers the studies presented from a practitioner perspective.

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