University of Glasgow, Institute of Health and Wellbeing Trends in antipsychotic drug prescribing in adults with learning disabilities, between 2004 and 2014 in Scotland Angela Henderson, Colin McCowan, Deborah Kinnear, Paula McSkimming, Kevin Ross, Jill Morrison, Linda Allan, Sally-Ann Cooper, University of Glasgow, Institute of Health and Wellbeing Introduction People with learning disabilities are prescribed psychotropic medications, particularly antipsychotics, at rates that do not correlate with reported rates of mental ill-health. These drugs are often used for indications that they are not licenced for, for example to manage problem behaviours. Clinical guidelines recommend that antipsychotics are reduced or withdrawn in people who do not have psychosis. Few studies analyse psychotropic prescribing over time. Project Aims To analyse trends in psychotropic prescribing over a decade in Scotland Methods Adults (aged 16 years and over) with learning disabilities living within the geographical area of Greater Glasgow and Clyde Health Board, Scotland, were identified and recruited: Large, population-based, cross-sectional samples Longitudinal cohort Psychotropic medications were analysed at 2004 (T1), 2006 (T2), and 2014 (T3) Logistic regressions with the longitudinal cohort, to determine whether there was an association between taking each type of medication and time (adjusting for T1 gender, age, level of learning disabilities, mental ill-health, and problem behaviours) Sample Table 1: Cross-sectional samples’ characteristics at T1, T2 and T3 Table 2: Longitudinal cohort characteristics at T1, T2 and T3 Characteristics 2004 T1 N=1201 2006 T2 N=648 2014 T3 N=4065 Gender Male Female 677 (56.4%) 524 (43.6%) 353 (54.5%) 295 (45.5%) 2358 (58.0%) 1707 (42.0%) Age Mean 44 years 46 years Level of learning disabilities Mild Moderate Severe Profound Not known 455 (37.9%) 321 (26.7%) 234 (19.5%) 191 (15.9%) 256 (39.5%) 188 (29.2%) 117 (18.1%) 86 (13.3%) 1057 (38.5%) 878 (32.0%) 618 (22.5%) 195 (7.1%) 1317 Characteristic 2004 T1 N=368 2006 T2 N=368 2014 T3 N=368 Gender Male Female 196 (53.3%) 172 (46.7%) Level of learning disabilities Mild Moderate Severe Profound 161 (43.8%) 103 (28.0%) 59 (16.0%) 45 (12.2%) Mean age 41 years 43 years 51 years Results Cross-sectional samples’ prescribing rates at T1, T2 and T3 Longitudinal cohort prescribing rates at T1, T2 and T3 People in the longitudinal cohort: Were 1.8 times more likely to take antidepressants over time (OR=1.78, 95% CI (1.43, 2.21)) Were 2.5 times more likely to take hypnotics/anxiolytics over time (OR=2.54, 95% CI (1.83, 3.52)) Were 1.2 times more likely to take antipsychotics over time (OR=1.19, 95% CI (0.98, 1.43)), however this was not statistically significant Conclusions There was no statistically significant increasing trend in antipsychotic prescribing, but no reduction either. Antipsychotic prescribing is much higher than the rate of psychosis Findings from the cohort study show that people are not being withdrawn from antipsychotic drugs, although the cross-sectional samples’ results suggest that fewer new prescriptions are being initiated than in the past There was a significant increasing trend in hypnotic/anxiolytic and antidepressant prescribing Increased antidepressant prescribing may mirror findings reported in general population studies which have reported 7.5-10% year on year increases Concerted action is needed to reduce antipsychotic prescribing in line with good practice recommendations.