The Overuse of Psychotropic Medication in People with Intellectual Disabilities: A Global Issue

Herman Wouters is a remedial educationalist and former member of the Board of the EAMHID (European Association for Mental Health in Intellectual Disability).

Herman Wouters1 December 2023, 12:13

Mom Odette recently sent a photo of her daughter Odette from Rwanda: “Elle n’a plus de morale.” I got to know them through the missions as a volunteer with Doctors without Vacation in Burundi. Odette has a mild intellectual disability and attended school in Bujumbura. During the riots they fled to Rwanda. They are now trying to survive there.

In the photo Odette looks dejected. Last year they started prescribing psychotropic drugs on the assumption that she had depression. It was later discovered that she had diabetes. I call the mother to find out what the problems are now. It’s about headaches. Mom Odette tells me that her daughter is on medication for diabetes and also takes Risperdal and Haldol every day. Possibly also for diabetes, she thought. Inquiries revealed that she had started taking the Risperdal several months earlier, because Odette regularly became angry. Haldol was added later. Haldol and Risperdal are antipsychotics, medications prescribed for people who have delusions, obsessive thoughts or tics, not because they regularly get angry.

Offlabel use

Many people with an intellectual disability are administered these types of psychotropic drugs because of all kinds of disruptive behavior, without a real psychiatric diagnosis being made for them. For example, a large group of people take antipsychotic medication without having delusions or obsessive thoughts. This has now become a worldwide phenomenon. This is called off-label use: prescribing medication that is not registered as a medicine for the complaint in question.

Research in various countries shows that there is an excessive and inappropriate use of psychotropic drugs, especially among people with a more severe intellectual disability and among people who cannot communicate very well. This problem is not sufficiently recognized. Studies show that adolescents and adults with intellectual disabilities use 30 to 80 percent more psychotropic drugs compared to the general population. This is only partly due to the fact that they have more mental problems. In various countries – including Flanders – guidelines have been drawn up to restrict this excessive use, but the effects are limited.

Psychiatric consultation

It is not that easy to gain insight into the mental problems of a person with an intellectual disability, especially if the person in question cannot communicate about what is going on inside him or her. As a psychiatrist or doctor you must be very well trained to be able to distinguish between behavior that is the result of the intellectual disability and possibly normal physical health problems or behavior that may indicate mental problems or a psychiatric disorder.

Problem behavior that cannot be handled by the environment is usually the reason for a psychiatric consultation. The psychiatrist then has the time ‘provided for in the consultation’ to form an impression. People who come for a consultation often demand that something be done immediately and prescribing a psychotropic drug is the simplest option. However, there is little evidence that this medication will indeed be effective.

Supervisors in the disability sector do not talk about ‘psychopharmaceuticals’ (medication that affects the psyche), but about ‘behavioral medicine’. It is the behavior with which one has difficulties: aggression, self-injurious behavior, excessive attention seeking, constant resistance, inappropriate sexual behavior… It is believed that there is medication to improve this behavior: a pill to reduce aggression. to stop, to reduce resistance, and so on. I once heard a female psychiatrist say at a conference that her husband could stop any behavior – he was an anesthetist.

The package leaflet for the psychotropic drug Risperdal states that pharmacological treatment should form an integral part of a more comprehensive treatment program, including psychosocial and educational intervention. For many people, these other treatment methods are much more effective than medication. The sector still has to learn to ‘believe’ in this. Focusing on this will reduce the use of psychotropic drugs. They will only be deployed when they can really make a contribution.

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2023-12-01 11:13:33
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