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The paper provides a Canadian perspective on the use of psychotropic medication in the management of problem behaviours in adults with intellectual disabilities in Canada. Psychotropic medication and intellectual disabilities were explored in the context of Canadian health and social services, clinical practices, medical training and factors that have shaped these over the past few decades. Informal physician intellectual disabilities networks and the newly formed Canadian Network of the National Coalition on Dual Diagnosis provided the opportunity to survey the use of psychotropic medication for problem behaviours across the country. Geographic, political, cultural and other influences on the development of health and social services are described, as well as training requirements for physicians. Survey responses were received from all provinces and represented clinicians in mental health multidisciplinary teams, health and social services ministry representatives, agency staff (up to executive director level) and family members of individuals with intellectual disabilities. Psychiatry and family medicine perspectives of the authors from working in Canada and the UK with people with intellectual disabilities presenting with problem behaviours are described. In Canada there are no national, provincial or territorial policies or guidelines on use of psychotropic medication for the management of such behaviours. There are no requirements for physicians prescribing these medications to have training in the care of people with intellectual disabilities. Services for people with intellectual disabilities and behaviour problems in Canada appear to be more crisis‐reactive than those in the UK.

The purpose of this paper is to examine the prescribed psychotropic medications taken by newly referred people with a range of substance use disorders (SUD) who attend a specialist community addiction service.

Anonymised data on newly referred people (n=1,537) with SUD attending a specialist community addiction service for their first episode of treatment between August 2007 and July 2010 were obtained from the database of the service. Data were cleaned and the percentage of people taking prescribed psychotropic medications at their first episode of treatment was calculated.

More than half (56.1 percent) of people attending the service were taking prescribed antidepressants and anxiolytics at their first episode of treatment whilst 15.2 percent of people were taking prescribed antipsychotics. Alcohol and opioids were the primary referral substances for 77.4 percent and 15.2 percent of people respectively. People referred for “other” substances (cannabis, stimulants, sedatives, hallucinogens, solvents and polydrug use) made up the remaining 7.5 percent and had the highest percentage of prescribed psychotropics (antipsychotics=47 percent, antidepressants and anxiolytics=64.3 percent) compared to those referred for alcohol and opioids (p<0.0005).

To the best of the authors’ knowledge, this is the first study of psychotropic prescribing among people with a range of SUD in the UK. The high prevalence of psychotropic prescribing raises questions about the appropriateness of these prescriptions and calls for scrutiny of prescribing practice in this group of people.

The programme – Stopping the over-medication of people with an intellectual disability, Autism or Both (STOMP) is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants and multiple psychotropic drug use. The purpose of this paper is twofold: Part 1 is to present the history and background to the use of psychotropic drugs in intellectual disabilities, autism or both; and Part 2 presents the progress with the STOMP programme.

The review tracks the various concerns, guidelines and attempts to tackle the issue of over medication of people with intellectual disability autism or both.

The review identifies that despite the many studies and guidelines associated with the prescribing of psychotropic drugs for people with an intellectual disability, autism or both the practice is common. Programmes that minimise the use of psychotropic drugs involve a full use of the multidisciplinary team and an availability of alternative methods of managing challenging behaviours.

STOMP is part of an English national agenda – Transforming care. The English Government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities, autism or both who have a mental illness or whose behaviour challenges services. This review identifies many studies, programmes and guidelines associated with psychotropic drug use for people with an intellectual disability, autism or both.

There is over‐use of psychotropic medication with people with intellectual disabilities. Many of these individuals do not have the capacity to understand and retain the relevant information about the use and effectiveness of medication. Professionals and health care practitioners need to be fully aware of the ethical and legal issues in the use and administration of psychotropic medication.

The majority of adults with intellectual disabilities (ID) are prescribed at least one, if not multiple medications, with psychotropic medications being the most commonly prescribed. Direct care staff play an important role in psychotropic medication administration and monitoring, yet little is known about their knowledge and comfort with medication. The paper aims to discuss this issue.

A 15-item survey, focusing on self-reported knowledge and comfort with psychotropic medication, was completed by 152 direct care staff employed at three agencies providing residential services for individuals with ID across Ontario.

In total, 62 per cent of staff respondents reported that psychotropic medications were among the top medications regularly taken by the individuals they support, with behaviour listed as the most commonly reported reason for taking this medication. The majority of staff reported monitoring medication, however, the frequency of monitoring varied considerably. Generally, staff reported feeling comfortable and knowledgeable about medication use, but, most reported a desire for additional medication training.

This is the first Canadian study to examine staff knowledge and comfort regarding medication use, and the first study to assess PRN (“as needed”) as well as regularly administered medications.

The purpose of this paper is to explore the perceptions of staff towards psychotropic Pro Re Nata (PRN) medication in a residential care setting.

Three male and seven female participants were interviewed using a semi-structured interview. Transcripts were analysed using thematic analysis.

Four themes pertaining to PRN medication emerged from the data: behaviour change, calming effect, importance of timing and perceived uniqueness.

The participant group was not homogenous and findings may have been different in a more qualified cohort. This care setting may not be representative of other environments where PRN medication is administered. The findings do, however, highlight some of the challenges facing the administration of PRN medication in mental health and care settings.

The awareness of these themes is significant for improving staff knowledge, training practices and policies towards the use and administration of psychotropic PRN medication.

This is the first study to engage in a thematic analysis of staff views towards the administration of PRN medication.

Psychotropic medications are a treatment commonly used for people with learning disabilities. Legislation and guidance suggest that, for a person to give informed consent to treatment, they must have knowledge of the potential treatment. This study of 21 people with learning disabilities, and their carers and prescribers, living in four different regions of England, suggests that few of the people with learning disabilities were fully informed about their treatment. Many of their carers said that although they knew how to administer the medication, they knew little about why the person was taking it and what the implications might be. Despite this, people with learning disabilities made the general assumption that carers would, or should, know everything about their medication. The current provision of information to people with learning disabilities and carers was found to be poor. Four key strategies identified in supporting people with learning disabilities in obtaining information about medication were spending more time providing and reiterating key information, providing accurate, up‐to‐date, accessible information about medications, providing training for carers in wider aspects of medication usage, and tailoring information to each person's individual needs.

The world’s aging population has led to a greater use of prescription and non-prescription medication by the elderly. Besides, older drinkers consume alcohol often regardless of the medication they consume. The purpose of this paper is to examine the intake of medication and alcohol simultaneously in a group of elderly in the community of Madrid, and the possible differences in consumption between men and women.

An observational cross-sectional study of 342 elderly in Madrid, aged 65–96 years was conducted, including the collection of anthropometric data (weight, height, waist circumference, BMI), information about the quantity of daily alcohol intake and medication taken from each subject.

A high percentage of the sample used medication, especially women. A smaller percentage of the sample consumed alcohol, being more frequent among men and decreasing with age. In addition, almost half of the sample (46.4 percent) combined medication intake with alcohol, especially men. High alcohol consumption was observed simultaneously in those subjects taking medication; in addition to the non-perception of the real risk to health. Statistically significant sex differences were observed, since men drank more, including when taking medication; although women may be more vulnerable to harm derived from alcohol.

This study contributed to estimate the risk to the public health of old people, and the integrity of their health, by observing the consumption of both medication and alcohol, given that medication taken in conjunction with alcohol can cause adverse side effects.

This paper aims to disseminate the results of research aiming to identify the prevalence of dysphagia and related clinical factors in nursing home residents.

A cross-sectional descriptive study was developed, including 99 residents in five nursing homes. A sociodemographic questionnaire and the Gugging Swallowing Screen for dysphagia screening were used for data collection.

The prevalence of dysphagia was 59.59%. A significant correlation was found between dysphagia and worse scores for fall risk, pressure ulcer, level of independence for activities of daily living and cognitive functioning.

Results should be interpreted carefully due to sample size and specific country context. A larger sample must be achieved in further research.

Nurses must receive proper training to perform systematic dysphagia screening, and it should be considered, given the high prevalence, the inclusion of professionals specially trained for rehabilitating dysphagic residents in nursing home teams.

The social and economic burden of dysphagia, in addition to all the implications on the person’s quality of life, requires a differentiated focus on this issue by nursing home managers.

Nursing homes have nurses providing health care; however, trained professionals for dysphagia treatment commonly are not. These results highlight the importance of systematic screening for dysphagia in all residents, thus promoting timely intervention to prevent respiratory and nutritional complications.

The dementias are important disorders of ageing which result in cognitive and functional decline, behaviour change, increasing dependency and premature death. Alzheimer's disease and other dementias are at least as prevalent in older people with learning disabilities as in the general population. In addition, people with Down's syndrome have high rates of early onset Alzheimer's disease. Assessment of dementia in people with learning disabilities is confounded by pre‐existing cognitive and functional impairments and high rates of comorbid disorders. This paper discusses assessment of dementia in people with learning disabilities from a clinical perspective, with reference to the current evidence base.