News Release

Antipsychotic drugs should not be used routinely to treat aggression

Should not be used with people with intellectual disability

Peer-Reviewed Publication

The Lancet_DELETED

Antipsychotic drugs do not reduce aggression in people with intellectual disability, and their prescribing in routine practice should be reviewed and alternatives examined, according to an Article in this week’s issue of The Lancet.

Aggressive challenging behaviour is frequently reported in adults with intellectual disability, and it is commonly treated with antipsychotic drugs. Around 200 000 people with intellectual disability in the UK, who show challenging aggressive behaviour, are given antipsychotic drugs. Despite the widespread use of these drugs evidence of their efficacy for treating challenging behaviour is scarce and there is potential for long-term side-effects with both typical and atypical antipsychotics*. Previous studies have reported no evidence of whether antipsychotic medication helps or harms adults with intellectual disability and challenging behaviour.

Professor Peter Tyrer (Imperial College, London, UK) and colleagues measured the effects of antipsychotic drugs and placebo on the aggressive behaviour of 86 non-psychotic patients from ten inpatient and community settings in England and Wales and Australia. The patients, most with moderate or severe intellectual disability, were randomly assigned to receive haloperidol (a typical, first-generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), or placebo. Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects, and carer uplift (positive feelings about the disabled person) and burden, were recorded at 4, 12, and 26 weeks.

The researchers found that aggression had decreased substantially with all three treatments by 4 weeks, but patients receiving placebo had the greatest change. The authors noted no important differences between the treatments in terms of adverse side-effects, aberrant behaviour, quality of life, and effects on carers. Importantly, in subsequent weeks, patients given placebo showed no evidence of worse response than did patients assigned to either haloperidol or risperidone.

The authors conclude: “Our trial shows that aggressive challenging behaviour in people with intellectual disability decreases whether or not active medication is given…The routine prescription of antipsychotic drugs early in the management of aggressive challenging behaviour, even in low doses, should no longer be regarded as a satisfactory form of care.”

In an accompanying Comment, Dr Johnny Matson and Mr Jonathan Wilkins (Louisiana State University, Louisiana, USA) question whether the measures used to assess aggression were sufficiently sensitive to detect treatment effects. But say: “Their data add substantially to the international debate on treatment of aggression in intellectually disabled people…The interface of assessment and treatment with behavioural and drug interventions nonetheless requires further study.”

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Professor Peter Tyrer, Imperial College, London, UK. T) +44 (0)7976208253 and +44 (0)7714765885 p.tyrer@imperial.ac.uk

Comment: Dr Johnny Matson Louisiana State University, Louisiana, USA. T) +1 225 752 5924 johnmatson@aol.com

Notes to Editors

*Antipsychotics are associated with a range of side-effects including dystonias, akathisia, parkinsonism (rigidity and tremor), tardive dyskinesia, tachycardia, hypotension, impotence, lethargy, seizures, hyperprolactinaemia, and dysphoria.

View the PDF associated with this press release at http://multimedia.thelancet.com/pdf/press/Intellectual disability p57-63 Jan 5.pdf.


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