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Antipsychotic drugs are often used outside their licensed indication to manage aggression in adults with intellectual disabilities in the absence of a diagnosed psychiatric disorder. The current case series shows that antipsychotics could be effective, but they are often used with non‐drug measures and sometimes cause side‐effects. Clinicians did not always carry out a thorough assessment followed by a formulation before prescribing medications, as recommended in the national and international guides (Deb et al, 2009; Unwin & Deb, 2010). It is also apparent that clinicians did not carry out tests to detect side‐effects of risperidone such as metabolic syndrome. Clinicians should use psychotropic medication for a minimum period of time and at the lowest possible dose, and should consider non‐drug management of aggression at the outset and at a regular interval.

The purpose of this study was to evaluate the increase in sensitivity of a single risperidone administration in relation to energy intake of Wistar rats treated with cafeteria diet from birth to adulthood (119 days).

During the lactation period, six litters of Wistar rats (dam + 8 pups each litter) were fed one of the following two diets: Control (n = 3) or Cafeteria (n = 3) diets and water ad libitum. After weaning, the males were placed in individual cages, receiving the same diet offered to their respective dams (Control = 18; or Cafeteria = 18) until adulthood (119 postnatal days). The following parameters were evaluated: food and energy intake; macronutrient intake; weight gain; adipose tissue relative weight; sucrose preference; food intake after an administration of risperidone (0.1 mg/kg body weight).

The Cafeteria group showed a higher energy intake in relation to the Control group (p < 0.001). The consumption of energy beyond the individual needs can be understood as a hyperphagic condition. Also, the Cafeteria group reported greater weight gain (p = 0.048) and accumulation of adipose tissue (p < 0.001) with respect to the Control group. These results indicate that the cafeteria diet generated obesity in animals. The Cafeteria group showed reduced sucrose preference (p = 0.031), which is associated with the development of anhedonia-like behavior. In the food intake test, risperidone showed a greater sensitivity in Cafeteria animals, promoting a decrease in their energy intake in relation to the Control group that received risperidone (p = 0.040).

The cafeteria diet promoted hyperphagia, anhedonia-like behavior and obesity in animals. Acute risperidone administration showed greater sensitivity in the Cafeteria group, with a decrease in energy intake. The reported effects may be related to a downregulation of the dopaminergic system in the NAc region.

A high proportion of people with learning disabilities receive psychotropic medications such as antipsychotics, antidepressants, antianxiety drugs including benzodiazepines, buspirone and beta blockers, mood stabilisers such as lithium and some antiepileptic medications, psychostimulants, opioid antagonists and also vitamins and diets. Many receive these for behaviour problems for which these medications have not been indicated. Apart from a few exceptions of recent good quality randomised controlled trials (RCTs) of risperidone on the management of behaviour problems among children and adults with learning disabilities with and without autism, most of the evidence for the effectiveness of medication for the management of behaviour problems comes from non‐controlled or non‐randomised observational studies. The lack of evidence does not automatically mean that there is evidence that these medications are not effective. Current guidelines suggest that a thorough assessment of the cause and effect of the behaviour problems should be carried out before prescribing medications. A formulation should document the assessment and rationale for use of medications. Non‐medication based interventions should always be considered along with medication and where appropriate behavioural and psychological interventions should be employed either instead of or along with the medication. People with learning disabilities and their carers should be involved in the decision‐making process all along. Where necessary other relevant professionals should also be involved. At the outset the time, method and people involved with the follow‐up assessment should be determined. Follow up should involve an objective assessment of target behaviours but, more importantly, an assessment of the quality of life of the person and their carers. At each follow up a reformulation should be carried out along with consideration of non‐medication based management and the possibility of withdrawing medication. Important issues such as capacity, consent and legal issues should always be borne in mind. Medications should be used with some caution because of their adverse effects.

The purpose of this paper is to investigate the effects of combined risperidone (RIS) and pivotal response treatment (PRT) in children with autism spectrum disorder (ASD).

In all, 34 children diagnosed with ASD (mean age of 12.36 years) were randomly divided into two groups: an RIS treatment group (n=18) and an RIS plus PRT (n=16). Communication skills were evaluated with the child communication checklist (CCC).

Total score of the CCC was increased in both groups after three months compared with the score prior to treatment. The total score of the CCC was significantly higher in the combined treatment group than in the RIS group.

Treatment with RIS combined with PRT may result in a better outcome in communication skill for children with autism than RIS training alone.

This article describes a national guideline for the use of medication in the management of problem behaviours in adults with an intellectual disability. As problem behaviours in this group are common and medication is often prescribed ‘off licence’, it is important that a framework is established to direct this practice. The article details a guideline development project that is of importance because it is the only national guideline in the area. It also highlights important issues in clinical practice in the field, and addresses the current evidence base on the effectiveness of psychotropic medications in the management of problem behaviours. There is a lack of good research evidence to support use of medication for problem behaviours. Where medication is used for this purpose, it should be used with a clear rationale, following a thorough assessment of the individual, and carefully monitored, and withdrawal should always be considered. People should always be given information in a way that they understand, and they should be given choices about their treatment.

High‐secure hospital patients often have complex presentations that are marked by co‐morbidity, violence, histories of poor concordance with oral medication, and treatment resistance. The ability to give a long‐acting medication with a low propensity for extra pyramidal side effects is of potential value to clinicians treating these patients. Risperidone Long‐acting Injection (RLAI) is the first long‐acting atypical antipsychotic medication and may be potentially useful in this population. This paper aims to investigate this issue.

This was a retrospective, naturalistic study to investigate the use and effectiveness, using hard outcome measures, of RLAI in the four UK high‐secure psychiatric hospitals. Hospital pharmacy databases at Ashworth, Broadmoor, Carstairs and Rampton hospitals were used to identify all patients who had been prescribed RLAI. Anonymised data were then obtained from the pharmacy databases and case notes which were then pooled.

A total of 159 patients were prescribed RLAI, most of whom had schizophrenia. The mean length of treatment with RLAI was 65 weeks (range two to 260 weeks) and the mean maximum dose was 43.2 mg every two weeks (range 25‐75 mg every two weeks). No serious adverse effects were reported. In total, 42 per cent (67) patients responded to RLAI in as much as that they either remained on it in the long‐term or were discharged to conditions of lower security whilst taking it. As there was no control group, it is not possible to determine if RLAI was a significant factor in such discharges to conditions of lower security. Of those patients who failed to respond to RLAI, 44 per cent were subsequently treated with clozapine.

This pragmatic multi‐centre study of a small but complex patient group demonstrated that RLAI was effective in 42 per cent of patients and was well‐tolerated.

One in 14 people over 65 years suffer from dementia in the UK. Over 25 per cent are receiving antipsychotics, which cause increases in mortality and cerebrovascular events. The need for a reduction and the use of alternative supportive strategies has been advocated. Risperidone at six‐week intervals is the only antipsychotic licensed for treatment with regular review. The majority of management occurs at primary care level and in care homes. The purpose of this paper is to investigate antipsychotic prescribing practices and patient review in these settings.

In total, two surveys comprising questions addressing prescribing practices were developed and distributed electronically to all GP practices and care homes in Coventry and Warwickshire, West Midlands, England.

The majority of GPs (75 per cent) reported only “occasional” discontinuation of antipsychotics due to concerns at reducing drugs on their own, expectations of regulation from secondary care and resistance from care home staff. Poor reduction levels were reported in care homes, attributing low numbers to reluctance among GPs. History of cardiovascular risk factors did not appear to influence withdrawal. Only 40 per cent of GP practices maintained sole use of risperidone. At least six‐monthly reviews were reported by 63 per cent of GPs and 64 per cent of care homes, with very few conducting reviews at least three‐monthly. The importance of non‐pharmacological alternatives was emphasized, yet access was limited and highly resource‐dependent.

This study reveals the perspectives of staff delivering healthcare for people with dementia and behavioural and psychological symptoms of dementia (BPSD). Potentially inappropriate antipsychotic principles were reported. A lack of communication and uncertainty of roles was evident. The development of understandable guidelines for healthcare workers and care home staff managing behavioural issues in patients with dementia is necessary.

The management of individuals with autism spectrum disorders (ASDs) requires a multimodal approach of behavioural, educational and pharmacological treatments. At present, there are no available drugs to treat the core symptoms of ASDs and therefore a wide range of psychotropic medications are used in the management of problems behaviours, co-occurring psychiatric disorders and other associated features. The purpose of this paper is to map the literature on pharmacological treatment in persons with ASD in order to identify those most commonly used, choice criteria, and safety.

A systematic mapping of the recent literature was undertaken on the basis of the following questions: What are the most frequently used psychoactive compounds in ASD? What are the criteria guiding the choice of a specific compound? How effective and safe is every psychoactive drug used in ASD? The literature search was conducted through search engines available on Medline, Medmatrix, NHS Evidence, Web of Science and the Cochrane Library.

Many psychotropic medications have been studied in ASDs, but few have strong evidence to support their use. Most commonly prescribed medications, in order of frequency, are antipsychotics, antidepressants, anticonvulsants and stimulants, many of them without definitive studies guiding their usage. Recent animal studies can be useful models for understanding the common pathogenic pathways leading to ASDs, and have the potential to offer new biologically focused treatment options.

This is a practice review paper applying recent evidence from the literature.

Rabbit syndrome (RS) is an antipsychoticinduced rhythmic motion of the mouth/lips resembling the chewing movements of a rabbit. The movement consists of a vertical-only motion, at about 5 Hz, with no involvement of the tongue. Long-term exposure to typical antipsychotics has clearly been associated with RS, but little is known of the risk of RS due to exposure to newer atypical antipsychotics. There have been isolated reports of RS in patients treated with the atypical agents risperidone, aripiprazole, olanzapine, and clozapine. We present the case history of a 44-year old female patient treated for paranoid schizophrenia for 22 years and RS during her last 10-month clozapine treatment. Background information from the literature is also discussed.

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.