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The purpose of this paper is to ascertain the training status of staff in care homes for people with intellectual disabilities managed by the non‐health sector in High Wycombe, with regard to administering emergency antiepileptic medication and to identify training needs.

Management of seizures in people with intellectual disabilities and epilepsy comes with its challenges. Although there are clear guidelines for the same, implementing them in the community, especially in the non‐health sector setting, raises the issue of training staff in the administration of emergency antiepileptic medication. A survey was undertaken in response to the varying staff training needs. A short semi‐structured questionnaire was designed and administered over the telephone to the managers of these care homes.

Less than half of the care homes had staff trained to administer emergency antiepileptic medication. The commonest reason cited was their policy of admitting only patients with well controlled seizures. This paper identified the need for staff training and raising awareness amongst relevant healthcare professionals.

The survey highlights the practical difficulties arising in the implementation of national and trust level healthcare policies in the community.

This paper is of value to clinicians working with people with intellectual disabilities and epilepsy, GPs, and staff and management in the care homes in the health and non‐health sectors. It raises questions around delineation of responsibility and communication between various professionals in various levels of care involved in managing people with intellectual disabilities and epilepsy to ensure provision of safe and effective care for this population.

The purpose of this paper is to discuss the challenges of assessment and management of psychotic symptoms in a background of intellectual disability (ID) and treatment-resistant epilepsy caused by a genetic syndrome.

Ring chromosome 20 [r(20)] syndrome is characterised by the triad of severe refractory epilepsy, mild to severe ID and behavioural problems. This paper describes the presentation of r(20) syndrome in a young woman with moderate ID and treatment-resistant epilepsy, who experiences psychotic symptoms at times of improved seizure control.

There are several diagnostic possibilities for such a presentation, including psychotic symptoms due to adverse effects of anti-epileptic medications and forced normalisation (alternating psychosis).

This paper advocates judicious use of antipsychotic medication to manage psychotic symptoms, as well as involvement of both patient and close family members throughout all stages of care. It is essential to strike a balance between control of epileptic seizures and psychiatric symptoms, providing an optimal benefit to the patients’ quality of life by meeting their complex needs through a multidisciplinary and multi-agency team input.

This article describes the changes in the population of people with learning disabilities in Sheffield and the associated demand for specialist learning disability services, primary and acute health services and the wider public realm. It comments particularly on people with the most complex needs. The study to produce this data was in two parts: an analysis of changes in the overall number of people with a learning disability which included a projection of how the number might change over the next ten years, and an analysis of the health and support needs of young people with profound and multiple learning disabilities (PMLD), and how these might change in the future. The findings are compelling. The overall number of people with a learning disability in Sheffield increased by 25% in the 10 years from 1998 to 2008, the number of children and young people with a learning disability increased by nearly 120% and young people with PMLD were found to have an unprecedented level of health and social care need, which will increase further as they enter adulthood. The implications of the findings are discussed and suggestions for further research are offered.

The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.

Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.

While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.

There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.

While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.

Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs.