Controversy Related to the Use of Sedative Medications

Running head: SEDATIVE MEDICATIONS 1
Controversy Related to the Use of Sedative Medications
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SEDATIVE MEDICATIONS 2
Controversy Related to the Use of Sedative Medications
Introduction
Psychiatric specialists prescribe sedative medicines to persons with intellectual
disabilities (ID) to manage a comorbid mental disorder or challenging behaviors, including
aggressive tendencies, self-harm habits, property destruction, and pica (Hercelinskyj &
Alexander, 2019). Such challenging situations can give caregivers difficulty in providing
mental health care. Often, with or without the presence of multiple psychiatric problems or
symptoms or challenging behaviours, overuse of sedative medicines can occur albeit in some
cases, these drugs can be justified and included in the treatment plan. Also, the overuse of
such sedative medicines, for example psychotropic drugs, is not supported within mental
health services, including across Australian states and territories. Generally, however, using
sedative medicines to manage problem behaviours is considered controversial and is
described as being highly coercive and linked to substantial side effects on caregivers and
patients.
Controversy Related to the Use of Psychotropic Medications to Control Behaviours and
Manage Symptoms for People who Experience Mental Illness.
Psychotropic medications refer to any medicines that can affect the mind, feelings as
well as behaviour, and they include antidepressants, benzodiazepines besides antipsychotics.
Crucial reasons for the concerns on psychotropic prescription for managing problem behavior
include poly-pharmacy – using higher than prescribed dosage; adverse side effects that could
be difficult to evaluate, and inappropriate medicine consumption to offset the harmful side
effects; overall little or no statistics to support the effectiveness, efficacy, and safety of
psychotropic drugs to alleviate challenging behavior such as violence; expired license use of
psychiatric drugs; and coercive medication or prescribing medicines regardless of whether a

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patient consents or not that often happens among persons with ID (Deb, 2020; Niven et al.,
2017). Thus, understanding the various concerns in detail is crucial for health practice.
a) Side Effects of Psychotropic Medicines
Poor control of the drugs’ side effects can hinder effective treatment, impair quality of
life, as well as cause several harmful health consequences in people with ID (Roughead et al.,
2017). In Australia, estimates from the 2010 National Psychosis Survey were that over 80%
of the population on psychotropic drugs experience side effects. Also, one in three lives with
moderate to severe impairments because of drug-associated side effects (Roughead et al.,
2017). More than 60% of people on antipsychotic drugs also experienced side effects such as
poor memory and losing attentiveness, and agitation, which exacerbate challenging behavior.
Similarly, individuals who practiced poly-pharmacy testified that they experienced
more side effects than people on a single antipsychotic medicine (McLaughlin-Beltz, 2015).
Another study cited that risperidone alone reduced auto-aggressive behaviour, but when
mixed with citalopram, elevated self-harm and aggressive behaviours were observed (Häβler
et al., 2014). Treating such side effects is debilitating, and can impact the quality of life if not
well-managed (Roughead et al., 2017; O’Dwyer et al., 2018).
A clinical practice guideline for the management of mental illnesses recommended for
Australia and New Zealand shows distinct differences in terms of the side effects resulting
from old generation psychotropic drugs and new generation psychotropic medications. For
instance, evidence shows that young persons are specifically vulnerable to the adverse effects
of psychiatric medications, unless the young individual has an acute mental disease, and
needs immediate medical attention (Galletly et al., 2016). Mental health specialists
recommend and prefer second-generation antipsychotic (SGA) medicines to first-generation
antipsychotics (FGA) because the former can be tolerated better than the latter, and have
better extrapyramidal side effects characteristics (Pillay, B.Sc. et al., 2017). However, SGAs

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can still cause serious adverse effects such as metabolic besides cardiac problems. In terms of
efficacy and contraindications, each individual with a mental illness is affected differently
(Galletly et al., 2016). A close therapeutic relationship should exist between a person with
mental illness or challenging behavior and the clinicians for the best possible care.
b) Extensive Use of Psychotropic Medicines
In their findings, Sheehan et al. (2015) found out that more people with ID have been
managed with psychotropic medicines exceeding the actual number of people with a recorded
psychiatric disease in the United Kingdom. Psychotropic prescriptions are also given to
individuals without documented severe mental disorders but have experience of challenging
behavior like the destruction of property and aggressive habits (Valdovinos et al., 2016;
Sheehan et al., 2015). Equally, sometimes prescriptions are made without true psychiatric
diagnoses, and this is a primary concern, in situations where consumers size keeps increasing
(Finkelhor & Johnson, 2015). In other instances, chances of using other antipsychotic drugs
are high, for example, in people with multiple psychological problems such as ID, autism,
and dementia, among others, which will usually indicate the departing of practice from
evidence-based clinical protocols (Sheehan et al., 2015). Such prescriptions also open doors
for unnecessary medicines that may come with adverse health outcomes and a burden to
healthcare. For instance, some of these medications referred to as off-label psychotropic
practice can be prescribed for use other than their licensed purpose (Sheehan et al., 2015; Van
der Plaat et al., 2019).
Another concern is that little, or no evidence exists that can guide the making of
changes required in the dispensing of psychotropic drugs for individuals with challenging
behaviour (Sheehan et al., 2015). In another study, Sheehan (2018) highlights that
psychotropic drug use for ID populations raises complicated problems, not least due to the
absence of evidence, which exists on the topic. However, psychotropic medications can only