A review of antipsychotic drugs prescribed for people with learning disabilities who live in Leicestershire.
About forty percent of adults with learning disabilities can stay on lower doses or no antipsychotic after a careful year-long taper, so systematic reduction is possible but needs close watch.
01Research in Context
What this study did
Doctors in Leicestershire, England looked at 123 adults with learning disabilities who were taking antipsychotic drugs. The team tried to lower or stop the drugs for each person and watched what happened for one year.
This was a case series, not a true experiment. Each person got an individual taper plan and regular check-ups.
What they found
After twelve months, 31 people stayed completely drug-free. Forty others stayed on smaller doses than before. Fifty-two people had to go back to at least part of the original dose.
In plain numbers, about four in ten kept a lower dose or none at all, while six in ten needed some of the drug again.
How this fits with other research
Walley et al. (2005) also tracked adults with learning disabilities, but they added the seizure drug topiramate instead of taking anything away. Both studies show that careful, slow medication changes can be done safely in this group.
Robinson et al. (1981) and Wallace et al. (2010) tried low-cost behavior tricks—teacher wait-time and simple card labels—to cut problem behavior or boost thinking. Their good results line up with Branford (1996): you can often replace or reduce drugs if you watch closely and give other support.
No direct clash exists here, but the newer behavior papers hint that adding teaching tools first might let even more people taper drugs later.
Why it matters
If you serve adults with ID who take antipsychotics, this paper says a planned reduction is worth trying—but only with tight monitoring. Build a team: doctor, nurse, BCBA, and direct support staff. Track target behaviors weekly. Have a quick back-up plan if behaviors spike. Pair the taper with proven behavior or skill-building programs so the person gains something while the drug goes down.
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02At a glance
03Original abstract
Antipsychotic drugs are widely prescribed for people with learning disabilities to control challenging behaviour. Concern has been expressed that such prescribing is excessive, inappropriate and potentially harmful. A review of 198 patients with learning disabilities resulted in agreement to reduce or withdraw antipsychotic drug therapy in 123 cases. The antipsychotic drug therapy was totally withdrawn in 43 cases and the dose reduced for the remaining 80. Out of the 43 patients who underwent total drug withdrawal, 31 remained off such therapy and 12 required represcribing within a 12-month period. Out of the remaining 80 who underwent dose reduction, 40 suffered a deterioration in behaviour which resulted in some degree of dose increase, and 40, although maintained on a lower dose, neither achieved total withdrawal nor deteriorated to an extent that a dose increase was required.
Journal of intellectual disability research : JIDR, 1996 · doi:10.1046/j.1365-2788.1996.778778.x