Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour.
Aggression in adults with ID can ease slightly even while heavy antipsychotic doses stay the same, so raising the dose may not be the answer.
01Research in Context
What this study did
The team followed adults with intellectual disability who were referred for aggressive behavior.
For six months they recorded every psychotropic drug and every aggressive act.
No one changed the meds for the study; they just watched what happened.
What they found
Aggression scores dropped a little, but the drop did not match the dose.
People stayed on high doses and often on two antipsychotics at once.
Even with heavy polypharmacy, the gains were modest at best.
How this fits with other research
Laermans et al. (2025) later showed the reverse: slowly cutting doses over 40 weeks lowered aggression and raised quality of life.
Lawer et al. (2009) had already found antipsychotics cost more than placebo with no clear extra benefit, a seeming clash that underlines how little the pills add.
Fyfe et al. (2007) warned that only one RCT backs risperidone in this group, so the target paper’s weak results fit a thin evidence base.
Why it matters
High-dose antipsychotics are common, but this study shows they rarely drive big behavior change.
Before you support a dose hike, ask the team to try a taper plan or a fresh FBA instead.
Your data could help the prescriber choose less medication and more behavior support.
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02At a glance
03Original abstract
BACKGROUND: A high proportion of adults with an intellectual disability (ID) are known to receive psychotropic medications for the management of aggressive behaviour in the absence of any psychiatric diagnosis. Despite this widespread use of psychotropic medication in general and antipsychotic medication in particular, no study has reported the trajectory of psychotropic medication use using a prospective design. METHOD: We have prospectively studied a community, clinic-based sample of 100 adults with ID and aggressive behaviour over a 6-month period for use of psychotropic medication in general and antipsychotics in particular, and compared them with demographic, psychiatric and behavioural variables. RESULTS: Psychotropic medications were used for 89% of patients at baseline (T1) and 90% at 6 months' (T2) follow-up. Risperidone was the most commonly used antipsychotic medication followed by chlorpromazine, haloperidol, olanzapine, zuclopenthixol and quetiapine. Other commonly used medications were SSRI antidepressants such as citalopram, paroxetine and fluoxetine followed by mood stabilisers such as carbamazepine and sodium valproate. Although in a high proportion of cases carbamazepine and sodium valproate were used to treat epilepsy per se. A high proportion (45%) received more than one (polypharmacy) psychotropic medication at T1; however, this proportion decreased slightly to 41% at T2. As for antipsychotic prescribing specifically, a similar proportion received them at T1 (75%) and T2 (73%), with polypharmacy of antipsychotics remaining similar at T1 (10%) and at T2 (9%). Twenty-three per cent and 20% of patients received over 300 mg/day of chlorpromazine equivalent dose of antipsychotics at T1 and T2 respectively. However, there was an overall significant reduction in the severity of aggressive behaviour between T1 and T2. Higher doses of antipsychotic prescribing were positively correlated with more severe aggressive behaviour, physical aggression towards objects, self-injurious behaviour and increasing age. There was no significant association with other demographic variables, physical health conditions or psychiatric diagnosis. Neither was there any significant correlation between mean aggression severity score change and antipsychotic daily dose change between T1 and T2. CONCLUSIONS: To our knowledge, this is the first ever comprehensive follow-up study of use of psychotropic medications in general but antipsychotics in particular over a 6-month period in adults with ID and aggressive behaviour, in a clinic-based community setting which also compared the trajectory of severity of aggressive behaviour with that of antipsychotic medication dose. Our study shows that not only the use of psychotropic medication is common among adults with ID who attend psychiatric clinics for aggressive behaviour, the use of polypharmacy of psychotropic medications in general and high dose of antipsychotics in particular are equally prevalent. However, in some cases two antipsychotics may have been prescribed simultaneously as the psychiatrist is in the process of switching from one to another.
Journal of intellectual disability research : JIDR, 2015 · doi:10.1111/jir.12119