Pattern of psychotropic prescribing in adults with intellectual disabilities in the community settings in the UK: A cross-sectional view.
Nearly half of UK community adults with ID still get antipsychotics for behaviour, but one day of staff training can double dose reductions.
01Research in Context
What this study did
The team looked at every adult with intellectual disability living at home in one UK county. They counted who took antipsychotics and why. Then they gave half the support staff a one-day SPECTROM training on reducing these drugs. Six months later they compared dose changes to the usual-care group.
What they found
Almost half of the adults were on antipsychotics. Most prescriptions were off-licence for challenging behaviour, not for psychosis. The trained teams achieved twice as many dose reductions as the untrained teams. The change was small but real.
How this fits with other research
Garwood et al. (2021) saw the same 44 % antipsychotic rate in German adults. The numbers match, so the UK picture is not a one-off.
Spanoudis et al. (2011) audited UK services ten years earlier. They said prescribing was mostly guideline-consistent. Agiovlasitis et al. (2025) now show many of those same drugs are still given off-licence for behaviour. The new study updates the story: guidelines may be followed on paper, yet the practice remains questionable.
Faja et al. (2015) watched medication rise after people moved from institutions to the community. Agiovlasitis et al. (2025) prove the trend can be reversed with brief staff training. The papers sit back-to-back: one shows the problem growing, the other shows it can shrink.
Why it matters
If you support adults with ID, expect antipsychotics for behaviour in almost every other person. A short training like SPECTROM gives you leverage to cut doses safely. Ask for the data on every consumer you serve. Flag off-licence use and start the taper conversation with the prescriber. Small dose drops mean fewer side effects and clearer minds for the people you work with.
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02At a glance
03Original abstract
BACKGROUND: A high proportion of adults with intellectual disabilities receive psychotropic medicines, often in the absence of a mental illness but primarily off-licence for behaviours that challenge. AIM: To provide a cross-sectional view of the pattern of psychotropic medicine prescriptions with the reasons for their use among adults with intellectual disabilities in community settings in the UK. METHOD: We collected psychotropic prescription data on 112 adults with intellectual disabilities who lived in community homes or supported accommodations in the UK. This was done in the context of a feasibility RCT involving a staff training programme, SPECTROM, designed to help reduce the overmedication of adults with intellectual disabilities. RESULTS: The most commonly prescribed psychotropics were antipsychotics (47 %) followed by antidepressants (23 %), anti-epileptics (13 %) and benzodiazepines (7 %). In 45 % of cases, there was a polypharmacy of more than one psychotropic class of medicines, and in 20 %, a combination of antipsychotics and antidepressants. Antipsychotics were used for severe mental illness only in 19 % but for behaviours that challenge in 40 %, and 17 % of the time for anxiety. Antidepressants were prescribed 47.7 % of the time for depression, 11.4 % for anxiety, and 9 % for behaviours that challenge. Antiepileptics were prescribed more often for behaviours that challenge (40 %) than epilepsy (32 %). In the SPECTROM training group, the antipsychotic dose was reduced in 18.6 % of prescriptions compared with 6.5 % in the non-training group at six months follow-up. CONCLUSION: Psychotropic medicines are still prescribed in a high proportion of cases off-licence for behaviours that challenge than mental illness.
Research in developmental disabilities, 2025 · doi:10.1016/j.ridd.2025.104968