1. 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 Clinical guidelines recommend that antipsychotics are reduced or withdrawn in people who do not have psychosis.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 % year on year increases
Concerted action is needed to reduce antipsychotic prescribing in line with good practice recommendations.