Time to Stomp out drugs that don’t help
‘Evidence for the efficacy of antipsychotics on those with learning disabilities is scant’
In general practice, you frequently come across a patient with learning disabilities (often associated with autism), who has a long-standing prescription for a drug from a group known as atypical antipsychotics, such as Risperidone or Aripiprazole. It is also not unusual in such a case to find, on exploration of the patient’s records, that there is no history of psychotic illness.
A report last year from the Royal College of Psychiatrists discovered “compelling evidence that a significant number of people with intellectual difficulties are prescribed a psychotropic drug that, at best, is not helping them”.
Now a coalition of professional and voluntary organisations has launched Stomp (vodg.org.uk/ campaigns/stompcampaign), a campaign aimed at stopping over-medication of people who have a learning disability, autism or both.
Atypical antipsychotics are so-called because they were developed as alternatives to the major tranquillisers long used in the treatment of schizophrenia.
Yet they have come to be widely used in people with learning disabilities to contain “challenging” behaviour, effectively as a chemical restraint. Matt Hoghton, a Clevedon GP and medical director of the Royal College of General Practitioners’ Clinical Innovation and Research Centre, points out that, though there is little evidence for the efficacy of antipsychotics in people with learning disabilities, there is considerable evidence of their risks. A long list includes weight gain, diabetes and heart disease; on average, says Dr Hoghton, these patients “lose 10 years of life”.
The Stomp campaign aims to encourage GPS and psychiatrists to consider alternative ways of managing challenging behaviour before starting medication. It also emphasises the importance of regularly reviewing prescriptions.
The campaign is working closely with the British Institute of Learning Disability (bild.org.uk/ capbs) to promote the “positive behaviour support” model as an alternative to medication. Over the summer, Bild is organising a series of workshops around the country to raise awareness among families and carers of the risks of antipsychotics, and to explain the principles of dose reduction and discontinuation of these medications.
Noting the success of the campaign to reduce the use of antipsychotics in the care of people with dementia, Dr Hoghton is optimistic that we can curtail inappropriate prescribing for people with learning disabilities, and improve both their quality of life and their life expectancy.
Towers of London
The Grenfell Tower fire disaster has provoked comparisons with the partial collapse of the Ronan Point tower block in Newham in 1968, when four people died following a gas explosion. Many years later, when I was a trainee GP in the area, I occasionally visited patients in adjacent – identical – tower blocks on the Freemasons estate (all were subsequently demolished).
Though the inquiry into the disaster revealed defects in design and construction, my recollection of the estate is of spacious flats with spectacular views across the now fashionable Docklands landscape.
I have similar memories of home visits to Ernő Goldfinger’s Balfron Tower in Limehouse, the twin of Trellick Tower, only a few hundred yards across the Westway from Ronan Point, where one of the towers lost an entire corner in 1968 Grenfell. I also recall that these flats were generally popular with residents. My conclusion was that, with proper management and maintenance, tower blocks can provide decent – and safe – housing. Sadly, it appears that these conditions were lacking at Grenfell Tower.
The end of Aids?
Recent reports have raised hopes of an end to the Aids epidemic. Public Health England reports a 17 per cent decline in new cases of HIV among gay men over the past year, rising to 32 per cent in five big clinics in London. The key to success appears to be a combination of frequent testing and rapid treatment of people at high risk.
This success also reflects a welcome shift in the public health strategy, away from the moralising and scaremongering of the notorious “Don’t Die of Ignorance” campaign of 30 years ago, to the discreet focus on groups at high risk of infection and the development of effective medications.