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We describe the results of a qualitative study that explored the knowledge and views 20 adults with learning disabilities and their carers had of medication prescribed for behaviour problems. We found that the adults with mild and moderate learning disabilities can provide sensible, consistent and valuable information about their thoughts and experiences of medication prescribed when questions are asked in an open‐ended format. We also found that few people with learning disabilities were fully informed about their treatment. Nevertheless, the prescribing of such medication emerged as a positive experience, in keeping with the wishes of the majority of participants interviewed who expressed satisfaction with the medication based on perceived benefit. For the minority of participants who expressed dissatisfaction with medication, the reasons related mainly to their perceived lack of role in the treatment decision, their experience of adverse effects, a perceived lack of efficacy and a ‘desire to lead a normal life’. Alternatives to medication were discussed by both adults with learning disabilities and their carers, and the relevance of these findings to clinical practice is addressed in the paper.

The purpose of this paper is to produce the views of parents and siblings of adults with intellectual or developmental disability (ID/DD) around the use of psychotropic medication to manage challenging behaviour (CB) where there is no co-existing mental illness.

Seven family members of six adults with ID/DD were interviewed using semi-structured interviews, over the telephone or face-to-face. The interviews were transcribed, coded and thematically analysed.

This paper identified that if used appropriately, psychotropic medication to manage CB may be of benefit to some people with ID/DD; but there is a need to ensure the medication is prescribed for the benefits of people with ID/DD rather than those around them. Drawing on the knowledge of family may allow for the use of alternative strategies and the reduction of medication to manage CB. There is the need for improved communication with family members, inclusive decision making, and access to information regarding the philosophy and legislation regarding medication used to manage CB in adults with ID/DD.

This paper presents views of a small cohort of family members of people with ID/DD in Queensland, Australia. Findings can be used to improve approaches taken by service providers in their interactions with people with ID/DD prescribed psychotropic medication to manage CB, and their family members.

This study aims to assess the accessibility of women to health-care facilities in the rural areas with a view to unties possible recommendation of enhancing its service delivery. It provides an insight into the levels of satisfaction of the services provided by conventional health-care providers in the area where the majority in the developing countries concentrated. The study unravels the reasons for the low patronage of regular health-care facilities to boost unscientific ones by rural women.

The study relies on extensive field work conducted in the study area mainly rural nature. data was sourced by questionnaire, mainly administered on the women in the area and field observation. Data collected were analysed using descriptive statistics.

The paper provides information on the low socio-economic attributes of rural women. It is further showed that medical facilities and personnel were not relatively available and performed in health-care centres to the satisfaction of the users. Poor roads, poor human relation, low quality of services, inadequate medical personnel and drug shortage hindrance to women accessing appropriate health-care facilities in the rural areas. Rural women, therefore, opted for self-medication folk medicine, disguising and spiritual remedies. Health-care facilities suffered poor patronage as a result of these obstacles The study recommended proper overhauling of health-care facilities.

The paper builds a relationship on the reasons for health-care facilities neglect in the rural area in developing countries and revealed unscientific means by which health care needs are realised rural women.

This commentary aims to define STOMP and STAMP, describes its history and evolution and the authors’ thoughts about future directions given the lack of clear evidence base for prescribing and deprescribing psychotropic medication given for behaviour thought to be challenging.

This commentary defines the authors’ clinical experience and personal thoughts about STOMP achievements and challenges for the future delivery.

This commentary details STOMP development to date and highlights the potential areas for further study and research to grow understanding, professional confidence and delivery.

This commentary highlights much of the currently accepted research and areas that have poor quality evidence or are of interest for future study. STOMP definition, especially of inappropriate prescribing, is key to redefining the work.

This commentary highlights the potential impact of STOMP and STAMP on prescribing rates and the need for better definition, processes and education for workforce development. There is a major need to understand the benefit of behavioural intervention to support the optimisation of medication.

This commentary builds on personal experience and current understanding to postulate considerations to further the delivery of STOMP and STAMP.

The current literature on attention-deficit/hyperactivity disorder (ADHD) shows a tangled picture of its etiology and diagnosis. It directs at over-medicalization in ADHD cases due to the pharmaceutical-based models surrounding its treatment. Further, the authors observed the negligible reporting of India’s ADHD scenario in the reviewed literature. Thus, this study aims to explore the status of ADHD in India’s urban setting through a pilot study.

Social constructivist viewpoint guided this study. The authors conducted the pilot in two phases: face-to-face semi-structured qualitative interviews with 11 mental health professionals in the first phase, and, in the second phase, five mental health professionals responded to an online survey with same questions. After qualitative analysis, four major themes were identified: participants’ opinions on ADHD etiology, issues in diagnosis, social context of ADHD and alternatives to medication.

The findings highlight the need to re-visit the ADHD narrative in the Indian context. These findings also emphasize future investigation on the medicalization of ADHD in India.

A countrywide epidemiological survey is required to explore the distribution of the disorder to standardize diagnosis and treatment procedures pan-India. This paper is an attempt to iron out the ADHD-related information that needs further exploration and research.

With in-depth interviews of mental health professionals, the study explores the state of ADHD in an urban setting in India. Future research must build on the current findings to establish the etiological and diagnostic framework of ADHD.

Research has long focused on the notion of access and the trajectory towards a healthcare encounter but has neglected what happens to patients after these initial encounters. This paper focuses attention on what happens after an initial healthcare encounter leading to a more nuanced understanding of how patients from a diverse range of backgrounds make sense of medical advice, how they mix this knowledge with other forms of information and how they make decisions about what to do next.

Drawing on 160 in-depth interviews across four European countries the paper problematizes the notion of access; expands the definition of “decision partners”; and reframes the medical encounter as a journey, where one encounter leads to and informs the next.

This approach reveals the significant unseen, unrecognised and unacknowledged work that patients undertake to solve their health concerns.

De-centring the professional from the healthcare encounter allows us to understand why patients take particular pathways to care and how resources might be more appropriately leveraged to support both patients and professionals along this journey.

This paper proposes a model for a dual diagnosis service within a male local prison. Dual diagnosis can be considered usual rather than exceptional within the establishment and indeed within the prison estate. For a variety of reasons, it is found that effective dual diagnosis service delivery represents core business for a range of stakeholders. The dual diagnosis definition preferred is ‘a mental disorder and substance misuse problem in the same person at the same time’. Analysis of the strengths of current service provision and the risks to the development of a new service model are explored through a strengths, weaknesses, opportunities and threats (SWOT) analysis. Current literature and policies inform the model, and it is concluded that a dual diagnosis service can be implemented mostly within existing resources. An implementation schedule highlights one such pathway. Stakeholders were consulted and generally found to be receptive.

The purpose of this paper is to provide a commentary on the article by Lee and colleagues, entitled “Positive Behavioural Support as an alternative to medication”, from the perspective of Dimensions, a national provider of social care support to people with learning disabilities and/or autism. As a supporter of the NHS England STOMP campaign, Dimensions recognises that people with learning disabilities and/or autism who have displayed “challenging behaviours” are at risk of being wrongly or over prescribed psychotropic medications intended to control that behaviour, and encourages the use of non-medical support strategies as an effective alternative to psychotropic medications.

Dimensions surveyed the approximately 1,400 people with learning disabilities and/or autism for whom they provide 24-h support. The survey was intended to assess the extent of use of psychotropic medications and the level of adherence to NICE “best practice” guidelines. The survey was the precursor to an awareness raising campaign and development of an operational toolkit intended to inform and empower people supported, families and colleagues to take a more proactive role in the prescription and review of psychotropic medications.

In total, 54 per cent of people surveyed were being prescribed psychotropic medication, of whom 97 per cent had been prescribed one or more medications for at least six months. Around 51 per cent were having six monthly multi-disciplinary reviews and around 31 per cent had not had a multi-disciplinary review within the preceding 12 months. Only 13 per cent of people taking psychotropic medication had a plan in place that was specifically aimed at reducing or stopping the medication.

Empowering people to participate in and challenge clinical decision making can have a transformative effect on the lives of a group of people who have experienced a significant negative impact from prolonged use of psychotropic medications.

The purpose of this paper is to investigate if positive behavioural support (PBS) can be an effective alternative to medication, and can aid medication reduction in people with a learning disability, autism or both who are prescribed psychotropic medication for behaviour thought to be challenging. STOMP is an initiative supported by NHS England which aims to reduce inappropriate prescribing of psychotropic medication, i.e. antipsychotics used for challenging behaviour in the absence of a documented mental health diagnosis. PBS has been described as the first line of intervention for behaviours which challenge, (NICE, 2015) and has been highlighted as a non-pharmacological alternative to, medication.

A two-group, experimental design was utilised. Both groups were considered for medication reduction. The experimental group of 25 people received input from a specialist PBS team, while the control group of 29 people underwent unsupported medication challenge.

There was a significantly higher success rate for medication reduction and discontinuation when PBS assessment and intervention was provided as an alternative to medication.

This study indicates that providing PBS is associated with decreased medication and if replicated should be become standard practice for specialist teams.

This is the first study to investigate the effect of PBS on medication reduction in patients prescribed psychotropic medication for behaviour thought to be challenging.

The purpose of this paper is to demonstrate how Positive Behavioural Support (PBS) can be used as an alternative to psychotropic medication to improve the quality of life of an individual with a learning disability and behaviour described as challenging.

A single case design was utilised. A unique PBS stopping over medication of people with a learning disability, autism or both (STOMP) clinic model was developed and PBS was used in line with National Institute for Health and Care Excellence (NICE) guidance. This included functional behavioural assessment, to support understanding of the reasons behind behaviour described as challenging, and a gradual medication reduction.

This case study found that antipsychotic medication used to manage behaviour that challenges could be safely reduced and individual quality of life increased when PBS was used as an alternative.

STOMP is a project supported by NHS England aimed at reducing the inappropriate prescribing of psychotropic medication to manage behaviour that challenges. NICE guidance recommends that behaviour should be more appropriately understood through PBS. More research is needed to demonstrate how the two work together for safe medication reduction and improved quality of life.