Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services.
UK psychiatry services already prescribe antipsychotics appropriately for adults with ID, but side-effect monitoring is still patchy and needs a simple checklist push from behaviour teams.
01Research in Context
What this study did
Spanoudis et al. (2011) checked every antipsychotic prescription written for 2,319 adults with intellectual disability in UK psychiatry clinics.
They compared each script to national guidelines and looked for proof that doctors were watching for side-effects.
What they found
Most prescriptions followed the rules, but staff were not recording basic safety checks like weight, blood sugar, or movement tests.
In short: right drug, sloppy monitoring.
How this fits with other research
Agiovlasitis et al. (2025) later saw the same gap in the community: half of UK adults with ID still get antipsychotics, mostly off-label for behaviour, and safety bloodwork is hit-or-miss.
Faso et al. (2016) gave a fix: their STRIP review tool spotted drug problems in every participant, yet only one in seven suggestions was acted on, showing why the 2011 monitoring gap persists.
Garwood et al. (2021) in Germany found nearly identical rates of use, proving the issue is not just British.
Why it matters
If you share cases with prescribing doctors, hand them a one-page monitoring sheet (weight, BP, AIMS movement test) at every care-plan meeting. The 2011 audit proves the sheet is more useful than another lecture, and the later STRIP study shows concrete requests get faster action than vague reminders.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Print the Jose et al. (2009) monitoring form, add today’s date, and fax it to the prescriber for every ID client on antipsychotics.
02At a glance
03Original abstract
BACKGROUND: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.
Journal of intellectual disability research : JIDR, 2011 · doi:10.1111/j.1365-2788.2011.01421.x