Learning disabilities: part five

Withdrawing and/or optimising the use of antipsychotics and other psychotropic medicines is a complex task that may require input from a multidisciplinary team. Few studies exist to guide this process but success has been shown to depend on many factors, including social and environmental issues, as well as the training and attitude of care staff. There is therefore a need for a multidisciplinary team of healthcare professionals to be involved in planning the withdrawal of these medicines and modifying plans if initial withdrawal is unsuccessful.

The success of withdrawing psychotropic medicines is dependent on several pharmacological and non-pharmacological factors. There needs to be an emphasis on family and carers to be able to manage the process and the potential issues related to medicines withdrawal. In many cases, family and carers are fearful of what may happen if the medicine is removed. This is where pharmacy professionals have a role in providing relevant information to allow people to make an informed choice. Many secondary care community teams are working with carers groups and social service providers to train staff to better understand positive behavioural support that underpins the non-pharmacological approaches to managing behaviour that challenges.

Pharmacy professionals in mainstream settings have a role in ensuring the correct adherence to the principles laid out in NICE guideline NG11, Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges, as follows:

• Clearly defined target behaviours and outcomes
• Review the effectiveness and side effects of these medicines after between three and four weeks of treatment
• Exit strategy if the medicines have failed to achieve the desired impact on behaviour
• You should check that the appropriate monitoring of antipsychotics is in place
• You should check that the prescribing of antipsychotics is included within the annual health check
• An ongoing review process should occur three months after initiation of the medicine and then every six months.

Further information

• For more information and access to all the learning disabilities activities, visit: cppe.ac.uk/learningdisabilities.
• Access the CPPE learning disabilities e-challenge at: cppe.ac.uk/e-challenge.