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Antipsychotics no better than placebo for aggression in the intellectually disabled

January 04, 2008

Professor Declan Murphy and Professor Nick Bouras, at the Institute of Psychiatry at King's were contributing authors, alongside Lead Researcher Professor Peter Tyrer of Imperial College London and 8 other universities on new research into whether antipsychotic drugs are effective when prescribed to people with learning disabilities to curb aggressive behaviour.

The study looked at 86 patients with learning disabilities and it was found that the drugs were no more effective than being given none at all and should not be used to treat aggression.  Researchers concluded that it was more important to address the underlying causes of aggression. 

Aggressive challenging behaviour is frequently reported in adults with intellectual disability, and it is commonly treated with anti-psychotic drugs.  In the UK 200,000 people with learning difficulties are given anti-psychotic drugs, even though as the Lancet reported, there are side effects which can include the risk of cardio vascular strain, impotence and weight gain.  Previous studies have reported no evidence of whether antipsychotic medication helps or harms adults with intellectual disability and challenging behaviour.

The patients were studied in 10 inpatient and community settings in England, Wales and Australia with one group being given haloperidol, a first-generation antipsychotic drug, a second group got risperidone, a second-generation version, whilst a third received a placebo pill.  Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects and carer uplift (positive feelings about the disabled person) and burden, were recorded at 4, 12 and 26 weeks.

The researchers found that aggression had decreased substantially with all three treatments by 4 weeks, but patients receiving the placebo pill had the greatest change.    The authors concluded: "Our trial shows that aggressive challenging behaviour in people with intellectual disability decreases whether or not active medication is given...The routine prescription of antipsychotic drugs early in the management of aggressive challenging behaviour, even in low doses, should no longer be regarded as a satisfactory form of care."

The paper by Tyrer P, et al entitled "Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomized controlled trial" has been published in the January issue of the Lancet (Lancet 2008; 371: 57-63).

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