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Reducing antipsychotic medication in ID using QI methodology

Rebecca Rose Conway (Mental Health Services, North London, UK)
Bhathika Perera (Mental Health Services, North London, UK)
Ken Courtenay (Mental Health Services, North London, UK)
Spyros Tsolakidis (Mental Health Services, North London, UK)
Sheetal Gopal (Mental Health Services, North London, UK)

Advances in Mental Health and Intellectual Disabilities

ISSN: 2044-1282

Article publication date: 28 June 2019

Issue publication date: 22 July 2019




Research highlights that antipsychotic medications are prescribed more in people with Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological interventions recommended as alternatives, their application can be challenging due to heterogeneity of the patient group. The purpose of this paper is to discuss application of quality improvement (QI) methodology in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of antipsychotic medication.


Two interventions were introduced as “tests of change”; an “Attention-Deficit Hyperactivity Disorder (ADHD) clinic” and “Positive Behaviour Support (PBS) clinic”. Process (Clinical Global Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total antipsychotic use) were used to assess the interventions, with each being reviewed as per QI methodology guidelines.


There was an improvement in CGI scores for both interventions. MOAS scores reduced for those attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce for the PBS clinic, so there was no reduction in medication for this group.


Based on the introduction of pilot clinics, this paper provides a commentary on how QI interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations, emphasising scope for future research and service evaluation.



Conway, R.R., Perera, B., Courtenay, K., Tsolakidis, S. and Gopal, S. (2019), "Reducing antipsychotic medication in ID using QI methodology", Advances in Mental Health and Intellectual Disabilities, Vol. 13 No. 3/4, pp. 113-122.



Emerald Publishing Limited

Copyright © 2019, Emerald Publishing Limited

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