Integration of a psychiatric service in a long-term charitable facility for people with intellectual disabilities: a 5-year medication survey.
On-site psychiatry can cut antipsychotics in group homes, but only steady team review stops other drugs from creeping back in.
01Research in Context
What this study did
Ciro and colleagues watched medicine charts for five years. The site was a large UK home for adults with intellectual disability.
A new psychiatrist joined the team at the start. Staff compared every drug given in 1989 with drugs given in 2004.
What they found
Calming pills and antipsychotic shots went down. Drugs for seizures went up.
Overall, people were not taking fewer total drugs. The drop in some pills was matched by new prescriptions elsewhere.
How this fits with other research
Nøttestad et al. (2003) also counted pills before and after a big move. They saw no change when residents left large institutions. Ciro’s later data show a drop only after on-site psychiatry arrived, hinting that place matters more than timing.
Faja et al. (2015) looked at people who just moved to the community. Medicine use rose sharply. Ciro’s stable home, by contrast, lowered some drugs, suggesting staying put plus expert review beats relocation alone.
Agiovlasitis et al. (2025) trained UK community staff to check doses. Their small dose cuts echo Ciro’s drop, but happened faster with brief teaching, showing staff skill is still the missing piece.
Why it matters
You cannot fix over-medication by moving people or adding one doctor. You need a team that keeps watching. Ask for quarterly drug reviews, track side effects, and pair each pill change with a behavior plan. Push for the same team to stay involved so gains do not fade.
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02At a glance
03Original abstract
Since the implementation of a psychiatric service in a long-term facility for people with intellectual disability, the usage of psychotropic and anti-convulsant drugs has been surveyed over the 5-year period 1994-1999. At that time, although the overall prevalence rate of residents on medication was not declining significantly, a decrease in number, dosage and polypharmacy of those receiving neuroleptic drugs occurred than 1994. A reduction also resulted among the in-patients prescribed anxiolytic preparations, despite a relative increase in their mean daily intake. Anti-convulsant drugs climbed slightly during the same interval with a parallel increase in the mean daily dosage. A retrospective comparison of current findings to prevalence, dosage and type of psychoactive medications dispensed 10 years previously in 1989 revealed no trend towards drug rationalisation. Until interdisciplinary training programmes as well as effective community services combining disability and mental health needs are forthcoming, a therapeutic approach involving early psychiatric inputs may contribute to ensure a more rational prescribing practice for long-stay adults with intellectual disability who are referred for neuro-psychiatric consultation.
Research in developmental disabilities, 2004 · doi:10.1016/j.ridd.2003.09.004