Psychoactive drug use in an institution for intellectually handicapped persons (for editorial comment, see page 68)

Abstract

Objective: To study the use of psychoactive drugs for the treatment of long‐stay develop‐mentally disabled individuals in an institution in New South Wales. Setting: Three wards dedicated to the long‐term care of developmentally disabled individuals situated on the premises of a large psychiatric hospital. Subjects: All residents (n = 53) of these wards in August 1989. Method: All subjects were examined by the author. Charts and medication records were extensively reviewed. Mental retardation was classified by DSM‐III‐R criteria. Categorisation of problem behaviour was done with the assistance of nurses, who also supplied information on behavioural problems and functional level and completed checklists of self‐injurious and stereotypic behaviour. A standardised neurological examination was performed and scales for abnormal involuntary movements completed. Results: The most commonly used drugs were the neuroleptics, with 60.4% of subjects currently receiving one or more neuroleptic drug at relatively large doses. The use of these drugs was not associated with current or past psychiatric illness, but was more closely related with the severity of problem behaviour. Thirty‐four per cent of the subjects receiving neuroleptics had dyskinetic movements suggestive of tardive dyskinesia, and 30% had mild tremor. Antidepressant, anxiolytic and sedative drugs were used less commonly. The management of epilepsy was considered to be suboptimal. Conclusion: Even though studies over the last two decades have consistently highlighted the problem of overmedication of intellectually handicapped individuals in institutions, the problem does not seem to have been redressed in at least some institutions.