Nursing Care: Psychotropic Medication for Intellectual Disability

This essay delves into the complex issue of psychotropic medication use in individuals with intellectual disabilities, highlighting the challenges faced by registered nurses. It explores the prevalence of challenging behaviors in this population, often leading to the prescription of psychotropic drugs despite limited evidence of their efficacy and potential adverse effects. The essay examines the dilemmas nurses encounter in balancing the need to manage aggressive behaviors with the risks associated with these medications. It emphasizes the importance of adopting therapeutic interventions and a multidisciplinary approach, advocating for psychotropic medication as a last resort. The discussion covers the impact of intellectual disability on medication choices, the need for evidence-based practice, and the ethical considerations in patient care. The paper concludes by emphasizing the need for careful assessment, monitoring, and ongoing evaluation in managing these complex cases.

Psychotropic medication for Intellectual Disability
Dilemma for registered nurses
University
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Nursing Care Management 2
Psychotropic medication for Intellectual Disability
Dilemma for registered nurses
Abstract
Intellectual disability is a meta syndrome characterized by deficit related functioning cognitive
functioning before the full acquisition of skills. Physical traits of this state entail the occurrence of
challenging behavior display among the patients affected. There is a high rate of persons with
intellectual disabilities displaying challenging behavior and are linked to psychiatric disorders,
environmental factors and a combination of other factors. This behavior often increases risks to self-
harm and injury to both self and those around the patient. Currently, in the medical world,
management of this condition has been undertaken through the administration of psychotropic
medication. Results have shown a reduction in the levels of aggressive behaviors among patients
however this management if not indicated for psychotropic usage. The high rate of this medication
prescription has been a source for alarm as limited evidence has conclusively illustrated ist
effectiveness and safety issues which have an impact on the general quality of life for the intellectual
disability patients. This state of administration and management has portrayed a challenging for
nurses and other health care practitioners regarding its usage and management of aggressive and
challenging behaviors often portrayed. Because of limited convincing evidence, nurses must adopt
therapeutic interventions to manage these conditions and use psychotropic medication only under
clinical advice and after a multidisciplinary approach as the last management option for patients
with intellectual disability.

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Introduction
Intellectual disability entails adversity characteristics leading to poor coping and resilient
strategies manifested by challenging behavior. An estimate of about a third of persons in mental
health care institutions exhibits behavioral mechanisms that are not in compliance with that of the
mental health patients. With an increase in mental state severity, it leads to an increase of
behavioral disturbances leading to significant challenges in clinical management. Challenging
behavior is viewed as a critical risk factor that limits participation in social activities and access to
fundamental and key services (Vissers, Gilissen & Veltman, 2016). Due to this aspect, the majority of
mental health and intellectually impaired persons often face exclusion with high demand for needs
compared to the general population. Due to this urgent and necessary medication management,
psychotropic medications have been utilized to manage intellectual disability and aspects of mental
illness. Despite these, various hypotheses have been formulated concerning safety issues. This
report highlights these issues in-depth and offers an analysis of these concerns and challenges faced
by registered nurses in their medication roles and safety issues. An in-depth analysis of these
concerns is addressed in this report with the way forward for registered nurses in applying an
evidence-based approach in medication management and care for the behavioral issues among
intellectual disable persons and mental health affected patients.
Intellectual disability and behavioral mechanism
Intellectual disability has been explained in the premise of mental health disorders as a
mental and learning disability occurring for a prolonged lifetime of an individual. It is a meta
syndrome characterized by heterogeneously of various clinical states which are linked to a decline in
cognitive functioning and skills acquisition through learning processes. Intellectual disability is still
viewed as a marginal aspect of psychiatry, in many regions of the world little attention has been put
forward regarding an effective management guide of this state (Crnic et al., 2017). The World Health
Organization has formulated a list of unmet needs for persons with intellectual disability, there is a
huge global gap in terms of medical personal specialized in mental health thus putting the majority
of clinical diagnosis for clinicians and nurses to manage this mental health and intellectual disable
patients (WHO, 2019).
In this context, it is observed that differential diagnosis is fundamental for persons with
problem behaviors and challenges occurrences requiring attention. This occurrence is characterized
by a high mechanism of care. An assessment of environmental influencers, organic conditions and
psychiatric disorders for case establishment is paramount.

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The prevalence rates of challenging behaviors for patients with intellectual disabilities are
between 5.7 to 17% signifying a key concern for the general population (Carr et al., 2016). Using the
Diagnostic Criteria for Psychiatric Disease of aggressive behavior occurrences orders for adults with
intellectual disability, a study undertaken by (Deb et al., 2010) showed that the rate of aggressive
behavior and self-harm was between 9.8% and 5% respectively among adults in the community
setting.
Evidence suggests that challenging behaviors are not only prevalent but also the occurrence
of self-attack, self-injury, and stigmatization by peers are evident (Bowring et al., 2017). This signifies
the need for early initiation of interventions to prevent these behaviors from being harmful and
adverse. Most of these behavioral displays among persons with intellectual disabilities often emerge
due to limited avenue to communicate effectively (Goodey, 2016). Incorporation of learner
behavioral mechanisms at an early age could be a breakthrough for therapists to reduce challenging
behavior occurrence and minimize the severity of the behavior occurring.
Psychotropic medications
Problematic behavior occurrence such as injury and aggression to self has been viewed as a
psychiatric disorder rather than the health-related disorder. Management of these violent and
aggressive behaviors have necessitated the application and usage of psychotropic medications to
manage these behaviors among persons with intellectual disability.
The usage of psychotropic medication is effective among psychiatric disorders states,
however, issues have arisen concerning persons exhibiting intellectual disability forms. There has
been a huge concern concerning the application of psychotropic medication management and usage
of antipsychotics especially the aspect of usage rates among intellectually disabled persons. Most of
the time, these medications are prescribed for challenging behavior rather than the management of
mental illness despite limited efficacy studies (Sheehan et al 2015).
The inherent rate of drug prescription towards the management of challenging behaviors
has been a source of concern in the health care team especially the nurses due to the inherent lack
of effectiveness from efficacy studies and occurring adverse events that have an impact on the life
quality of persons with intellectual disability.
Most often psychiatric disorders and disturbances of the emotions states are observed more
among adults with intellectual disability, these disturbances have often been misdiagnosed as typical

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for persons with intellectual disability, which is coexisting as mental health state disturbances
making a diagnostic overshadowing effect.
The application of psychotropic medication has been effective in managing psychiatric
disorders, however, issues have emerged among persons with intellectual disability thus its
application needs to be made judiciously. Its administration among the geriatric populations needs
to be applied with caution, as they can be taking multiple medications which increase the rate of
adverse effects. More often guideline advocate for start slow, go slow approach in initiating this
medication with a regular review (Gwaltney et al., 2018).
Guidelines often do not offer a prescription for the management of behavioral challenges
depicted by intellectual disability cases without the adequate justification of psychotic diseases or
spectrum disorders linked to autism. Persons with intellectual disability have shown to have high
rates of physical conditions such as cerebral palsy, epilepsy and other related cardiovascular
diseases, which often influence the medication choice process. These underlying behavioral crises
often necessitate an emergency response, especially in emergency settings. Applications of
psychotropic medication have been employed only as stabilizing augments to enhance the safety of
the patients and clinicians in the care setting.
Challenges for registered nurses
With the increasing severity of intellectual disabilities, nurses often find it difficult to manage
mental illness. The determination of the underlying etiology of behavioral challenges is often a
complex judgmental issue requiring clinical expert judgment. An essential treatment at this juncture
for managing this aggressive behavior is often the use of anti psychotropic medication, though there
is limited evidence to back up (Paton et al., 2016). In 2012, issues regarding the usage of
psychotropic medication among persons with psychotropic medication were highlighted in a review
of care report by Winterbourne View Hospital (Care, 2012). Further recommendations by NICE
(2015), has recommended that the application and usage of anti psychotropic medication can be
considered in instances where other interventions mechanisms have failed, and the risks of other
persons are high.
A study undertaken in the UK by Sheehan et al (2015), demonstrated that there is a high rate
of psychotropic medication prescription especially among persons with intellectual disability and an
independent association of antipsychotic usage and occurrence of challenging behavior needs
assessment. These results signify that these behaviors related aspects are managed using anti
psychotropic medications which are a departure from the utilization of evidence-based guidelines.

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The majority of the prescription is often undertaken without prior history knowledge of patients
having mental silliness. Further, limited evidence has demonstrated that antipsychotics can be
effective in managing behavioral issues among intellectual disability persons with autisms (Sawyer et
al., 2014), but also characterized by lack of evidence on drug administration outside this context of
autisms occurrence. Based on NICE guidelines (2015), antipsychotics drugs are meant to be
administered only by a specialist when communication therapy and psychosocial intervention are
limited. Thus in this view, the administration of these drugs calls for a multidisciplinary approach for
the provision and encouraging management strategies through an evidence-based framework to
manage challenging behavior.
Moreover, usage of these drugs has been linked to various adverse effects which often have
been observed to impair the overall quality of life (Matson & Mahan, 2010). Further reduction of
high rate usage of antipsychotic drugs among persons with an intellectual disability is seen as an
avenue in reducing the health inequalities which has been categorized as a key priority area for an
action plan (Heslop et al., 2014). A fundamental aspect regarding knowledge base on the drugs
shows that patients often lack the ability and knowledge to make a judgmental consent on the
drugs. This issue makes the clinical nurses too often obliged and administer medications without
empowering the family and patients on adequate information regarding psychotropic medication
and enabling them to make alternative avenues of treatment.
In a review by Deb et al (2010), most of the medications undertaken have great significant
risks with high adverse events; however, this information is gathered from studies that are not using
intellectually disable subjects. In this sense, there is no good quality evidence to either support or
reject the risks for persons with intellectual disability compared to those of the general population.
This shortage of convincing evidence offers challenging tasks to nurses to decide on the appropriate
way forward.
Conclusion
Intellectually disability is characterized by challenging behaviors that often resemble the
diagnosis of mental disorders. Aggressive behaviors often lead to self-harm and injury, posing the
greatest threat in managing patients leading to misdiagnosis as to relate to mental disorders.
Clinicians and nurses in the health care practice often face challenging situations concerning
managing these aggressive and challenging behaviors exhibited. The underlying mechanism of
management is often intervention therapy, however, the majority of the health care practitioners
administer psychotropic medication which evidence has shown an increased level of adverse

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reactions. The fundamental principles of using this medication entail application as the last approach
when behavioral mechanisms have failed. Limiting its usage on severe aggression is key to alleviate
the underlying behavioral problems. A lot of empirical evidence conducted has not demonstrated an
explicit usage of the medication administration of psychotropic medication, as studies are coupled
with flaws. Psychotropic medications have shown regular management of challenging behaviors
among persons with intellectual disabilities; however, they are not their intended indication in the
nursing and clinical care practice. This has led to immense challenges to the nurses and health care
practitioners on how to use for patients exhibiting aggressive and challenging behavior as they pose
significant risks when received at emergency care settings due to the inherent harm they pose.

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References
Bowring, D. L., Totsika, V., Hastings, R. P., Toogood, S., & Griffith, G. M. (2017). Challenging
behaviours in adults with an intellectual disability: A total population study and exploration of
risk indices. British Journal of Clinical Psychology, 56(1), 16-32.
Care, T. (2012). A national response to Winterbourne View Hospital. final report, Department of
Health Review.
Carr, A., Linehan, C., O'Reilly, G., Walsh, P. N., & McEvoy, J. (Eds.). (2016). The handbook of
intellectual disability and clinical psychology practice. Routledge.
Crnic, K. A., Neece, C. L., McIntyre, L. L., Blacher, J., & Baker, B. L. (2017). Intellectual disability and
developmental risk: Promoting intervention to improve child and family well‐being. Child
Development, 88(2), 436-445.
Deb, S., Kwok, H., Bertelli, M., SALVADOR‐CARULLA, L. U. I. S., Bradley, E., Torr, J., ... & Guideline
Development Group of the WPA Section on Psychiatry of Intellectual Disability. (2010).
International guide to prescribing psychotropic medication for the management of problem
behaviours in adults with intellectual disabilities. World Psychiatry, 8(3), 181-186.URL.
https://doi.org/10.1002/j.2051-5545.2009.tb00248.x
Goodey, C. F. (2016). A history of intelligence and'intellectual disability': The shaping of psychology in
early modern europe. Routledge.
Gwaltney, A. (2018). Use of Psychotropic Medication in Foster Care and Related Outcomes.
Heslop, P., Blair, P., Fleming, P., Hoghton, M., Marriott, A., & Russ, L. (2013). Confidential Inquiry into
premature deaths of people with learning disabilities (CIPOLD). Bristol: Norah Fry Research
Centre.
Matson, J. L., & Mahan, S. (2010). Antipsychotic drug side effects for persons with intellectual
disability. Research in developmental disabilities, 31(6), 1570-1576.
NICE-National Institute for Health and Care Excellence (2015). Challenging behaviour and learning
disabilities: prevention and interventions for people with learning disabilities whose behaviour
challenges. NICE Guideline 11 (NG11). URL.https://www.nice.org.uk/guidance/ng11

Nursing Care Management 9
Paton, C., Flynn, A., Shingleton‐Smith, A., McIntyre, S., Bhaumik, S., Rasmussen, J., ... & Barnes, T.
(2011). Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual
disability services. Journal of Intellectual Disability Research, 55(7), 665-674.
Sawyer, A., Lake, J. K., Lunsky, Y., Liu, S. K., & Desarkar, P. (2014). Psychopharmacological treatment
of challenging behaviours in adults with autism and intellectual disabilities: A systematic
review. Research in autism spectrum disorders, 8(7), 803-813.
Sheehan, R., Hassiotis, A., Walters, K., Osborn, D., Strydom, A., & Horsfall, L. (2015). Mental illness,
challenging behaviour, and psychotropic drug prescribing in people with intellectual disability:
UK population based cohort study. Bmj, 351, h4326. doi: https://doi.org/10.1136/bmj.h4326
Vissers, L. E., Gilissen, C., & Veltman, J. A. (2016). Genetic studies in intellectual disability and related
disorders. Nature Reviews Genetics, 17(1), 9-18.
WHO-World Health Organization. (2019). Global status report on alcohol and health 2018. World
Health Organization.