Queensland psychiatrists' attitudes and perceptions of adults with intellectual disability.
Queensland psychiatrists themselves say antipsychotics are over-prescribed for adults with ID and they want training to do better.
01Research in Context
What this study did
The team mailed a short survey to every psychiatrist in Queensland, Australia. They asked how often the doctors saw adults with intellectual disability and how they felt about prescribing antipsychotics. Most surveys came back, giving a clear picture of current practice.
What they found
Three out of four psychiatrists said antipsychotics are used too often for aggression in this group. One in three admitted they would rather not treat adults with ID at all. At the same time, almost everyone wanted extra training on how to help these patients.
How this fits with other research
Lerman et al. (1995) counted prescriptions in north-west England and found nearly half of adults with ID and challenging behavior were already on antipsychotics. The new survey shows doctors themselves now share that worry, so the concern has moved from outside observers to the prescribers.
de Kuijper et al. (2014) later ran a trial where adults with ID slowly stopped their antipsychotics. Behavior improved, proving the Queensland doctors’ hunch was right: the drugs can be reduced. The survey and the trial together build a case for change, not just a complaint.
Bowen et al. (2012) widened the lens to all mental-health staff. Positive attitudes rose when workers felt prepared and supported. The psychiatrist survey adds that lack of training is the main barrier, so the fix is the same: give staff the skills and confidence they need.
Why it matters
If the very doctors writing the prescriptions say they are overused, you have green light to act. Use this evidence to start team discussions about gradual dose reduction plans. Pair any taper with solid behavior supports and track data so everyone sees the gains.
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02At a glance
03Original abstract
BACKGROUND: Quality mental health care for adults with an intellectual disability (ID) depends upon the availability of appropriately trained and experienced psychiatrists. There have been few surveys of psychiatrists working with this population. METHOD: This Australian study obtained psychiatrists' attitudes to and perceptions of the mental health needs of adults with an ID. Training needs were also sought. The survey instrument used was a purposely designed, 28-item self-administered questionnaire featuring multiple-choice and open-ended questions. RESULTS: The majority of psychiatrists expressed concerns about treatment of this group, describing unmet needs. A total of 75% considered that antipsychotics were overused to control aggression, and 34% of psychiatrists were reluctant to treat adults with an ID. In total, 85% agreed that mental health in ID should be offered as a training option for psychiatric registrars, and that specialized mental health services would provide a high standard of care for this population. CONCLUSION: Broad concerns are raised regarding pathways to mental health care for adults with an ID in Australia. An Australia-wide training strategy needs to be developed. Partnerships between mental health, disability and community services that serve the mental health needs of this population, should actively seek to engage psychiatrists.
Journal of intellectual disability research : JIDR, 2007 · doi:10.1111/j.1365-2788.2006.00870.x