'As required' neuroleptics: have these drugs a place in the management of challenging behaviour in intellectual disability?
PRN neuroleptics are still handed out most to women and behavioral-unit residents, and more staff does not reduce the rate.
01Research in Context
What this study did
Suresh (1998) counted how often staff gave 'as-needed' neuroleptic shots or pills in one UK hospital for people with intellectual disability. The team looked at drug sheets, noted patient sex, ward type, and staffing levels, but ran no treatment test.
What they found
PRN neuroleptics were written most often for women and for people on the behavioral unit. Surprisingly, wards with more staff gave the drugs just as often as short-staffed wards.
How this fits with other research
Boswell et al. (2023) now dwarf this picture. Their Finnish register of 6,500 adults shows antipsychotic use is twelve times higher in ID services than in the general public. The new numbers replace the old single-hospital tally.
Jonker et al. (2024) widen the lens. They found that homes which rely on both PRN drugs and physical restraints still house the most severe behavior, so adding staff or cushions does not automatically cut drug need.
de Kuijper et al. (2010) echo the 1998 ward signal: one in three Dutch residents with ID also gets antipsychotics, and behavior—not psychosis—drives the script. The pattern holds across countries and settings.
Why it matters
If you work with adults who have ID and aggression, know that PRN neuroleptics remain common even when ratios look good. Do not assume extra hands will erase the order. Instead, track each PRN episode, ask whether a behavioral plan could replace the pill, and bring the data to the prescribing meeting.
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02At a glance
03Original abstract
The present study examined the prescription pattern and usage of 'as required' neuroleptics (PRNs) in the management of challenging behaviours in people with intellectual disability in a hospital setting. The prescription cards and drug administration records of residents were scrutinized to see how many of them were prescribed PRNs and how many had actually received these drugs during the previous 3 months. The results were compared in the following groups: (1) males and females; (2) the behavioural and nonbehavioural sectors; (3) intensive treatment wards (ITWs) for severe challenging behaviour which had a better staff:resident ratio than the rest of the behavioural wards; and (4) those prescribed PRNs together with the daily administration of neuroleptics and those without. It was found that more females used PRNs and that the prescription rate was higher in the behavioural sector. A better staff:resident ratio did not bring about any reduction in the usage of PRNs. The use of these drugs was not influenced by whether PRNs were prescribed along with regular neuroleptics or not. Further research is required to delineate the precise role of PRNs for challenging behaviours in this population, and to determine if PRNs can be used along with other modes of therapeutic interventions, instead of administering neuroleptics on a regular basis for this indication.
Journal of intellectual disability research : JIDR, 1998 · doi:10.1046/j.1365-2788.1998.4260500.x