Understanding the use of psychotropic medicines and how data can be used to support staff to manage them

Psychotropic medications are ones that affect the mind and include types such as antidepressants, antiepileptics, antipsychotics, anxiolytics and hypnotics. Antipsychotics are a type of psychotropic medicine used to manage mental health challenges that cause psychotic experiences, such as hallucinations. 

Here is a breakdown of the types of medications mentioned and the function they serve: 

Understanding the risks 

Antipsychotics can cause many possible adverse side effects such as weight gain, development of diabetes, movement disorders, heart conditions and disordered hormone levels. Therefore, to ensure best practice and regulatory requirements are upheld alongside the safety and wellbeing of residents, careful assessment should be undertaken prior to starting these medicines, and the individual monitored closely for the development of any adverse side effects. In addition, some antipsychotic medicines also have drug-specific adverse effects. For example, there is a risk of serious blood disorders with clozapine and therefore it is recommended for use only when other management options have failed. 

These types of medicines can be broadly grouped into two categories: first and second generation. It’s important to understand these differences, as first and second-generation antipsychotics work in different ways and therefore carry different potential side effect profiles. 

For example, first generation antipsychotics are more likely to cause movement disorders and sedation, whereas second generation antipsychotics are more likely to cause weight gain, high blood sugar levels and high cholesterol. 

Guidance on the use of antipsychotic medicines for behaviours that challenge in learning disability and autism 

Over the years there have been some instances where antipsychotic medications have been used ‘off-label’ for people with learning disabilities and autism – in other words, used for intentions different from those which the medication is designed.  

Guidance released by NICE emphasised the importance of working with the individual and involving them as much as possible. Initial assessment of behaviour that challenges should include a clear description of that behaviour, including aspects like:  

• Severity, frequency and duration 

• Impact on self and others 

• How personal or environmental factors are involved in developing or maintaining the behaviour 

• The role of other individuals during this process 

Behaviour that challenges often indicates unmet needs and attempts should be made to identify and address these.  Physical and mental health conditions should be considered, and risk assessment should be carried out including harm to self, harm to others and harm from others through abuse, neglect or exploitation. 

This assessment should guide the creation of a behavioural support plan to attempt to prevent or reduce the occurrence of unsafe situations as a result of behaviours that challenge.  These proactive strategies are preferred over reactive strategies using interventions to make a person or situation safe as challenges occur.  Reactive strategies should only be used in combination with proactive strategies, as a last resort, and should be the least restrictive possible. Risk assessments should be undertaken for these, particularly for the more restrictive measures such as physical restraint and as required medication use. 

Antipsychotic medication should only be considered for behaviour that challenges if other interventions through the behavioural support plan have been unsuccessful within an agreed timeframe, treatment for coexisting mental or physical health problems has been unsuccessful or the risk to self or others is very severe. They should initially be prescribed and monitored by a specialist.  Only a single medicine should be prescribed, and this should be started on a low dose and built up if necessary.  Other interventions should be continued through the behavioural support plan alongside this. 

A plan for the use of medication 

A clear reason should be given for why the antipsychotic medication is prescribed, the target behaviour, and a clear way to measure its effectiveness. There should be a clear plan on how long it should be taken for and a strategy for review and withdrawal. 

Its use should be reviewed at around three weeks and six weeks after the initial administration, to check for side effects and effectiveness. If there has been no benefit by week six, then the antipsychotic medication should be withdrawn. If, however, there has been a positive response, its use should be reviewed with the individual and their multi-disciplinary team after three months, then at least every six months, alongside all other prescribed medication. 

How data can help you make the decision 

The medication management data available in systems like ATLAS eMAR has the potential to improve monitoring by giving real-time information in prescribing and administration. It could help monitor the use of these medications against the guidance detailed above. Furthermore, it can be used to flag specific training needs. In homes where the group reporting data is showing a high use of antipsychotic medications, it would be beneficial for staff to complete specialist training modules on these medications and how to offer appropriate care to those who require them, to judge if they are actually required. 

And because of the many safeguarding checks in place that greatly reduce the risk of errors in medication administration, if these types of medications are deemed necessary, then ATLAS eMAR can provide you with the confidence that they will not be given in error, in the wrong dosage or at the wrong time.