Pharmacy, Oxleas NHS Trust, Dartford, UK.
J Intellect Disabil Res. 2011 Jul;55(7):665-74. doi: 10.1111/j.1365-2788.2011.01421.x. Epub 2011 Apr 21.
Antipsychotics are perceived to be over-used in the management of behavioural problems in people with an intellectual disability (ID). Published guidelines have set good practice standards for the use of these drugs for behavioural indications. We sought to identify the range of indications for which antipsychotic drugs are prescribed in people with ID and to audit clinical practice against the standards.
Data were collected from the clinical records of individuals with ID who were under the care of mental health services in the UK, and prescribed an antipsychotic drug.
The sample comprised 2319 patients from 39 clinical services. Twenty-seven per cent of the patients had a diagnosis of a psychotic illness (ICD-10 F20-29) and 27% an affective illness (ICD-10 F30-39). The proportion who did not have a psychiatric diagnosis ranged from 6% of those with borderline/mild ID to 21% of those with severe/profound ID. Overall, the most common indications for prescribing an antipsychotic drug were comorbid psychotic illness, anxiety and agitation, and a range of behavioural disturbances. The prevalence of use of antipsychotic drugs to manage challenging behaviour in the absence of concomitant mental illness increased with the severity of ID and accounted for almost half of prescriptions in those with severe/profound ID. Adherence to the audit standards related to documentation of clinical indications and review of efficacy was high. Side effect monitoring was less assiduous.
In clinical practice, most prescriptions for antipsychotic drugs in people with ID are consistent with the evidence base and the overall quality of prescribing practice, as measured against recognised standards, is good, although in some patients potentially remedial side effects may not be detected and treated.
抗精神病药物在智障人士（ID）行为问题的管理中被认为过度使用。已发布的指南为这些药物用于行为指征制定了良好的实践标准。我们试图确定 ID 人群中抗精神病药物的各种指征，并根据这些标准对临床实践进行审核。
从英国精神卫生服务机构照护的 ID 个体的临床记录中收集数据，并为其开处了抗精神病药物。
样本包括来自 39 个临床服务机构的 2319 名患者。27%的患者被诊断为精神疾病（ICD-10 F20-29），27%的患者患有情感障碍（ICD-10 F30-39）。没有精神科诊断的患者比例从边缘/轻度 ID 的 6%到严重/重度 ID 的 21%不等。总体而言，开具抗精神病药物的最常见指征是合并精神病、焦虑和激越以及一系列行为障碍。在没有伴随精神疾病的情况下，使用抗精神病药物来管理挑战性行为的情况越来越多，在严重/重度 ID 患者中占处方的近一半。遵守与临床指征记录和疗效评估相关的审核标准的情况很高。副作用监测则不那么勤勉。
在临床实践中，大多数 ID 人群开具抗精神病药物的情况与证据基础一致，且整体开具处方的实践质量良好，按照公认的标准衡量，尽管在某些患者中，潜在的补救副作用可能未被发现和治疗。
