Considerations before prescribing

There is a scarcity of high-quality research on psychiatric disorders in people with developmental disability. In the absence of robust evidence, established psychiatric guidelines as for the general population should be followed (see Psychotropic guidelines) in conjunction with the management advice in this topic. For principles of prescribing in this context, see Key considerations when using a psychotropic drug in a person with developmental disability.

Note: Psychotropic drugs may be considered when a psychiatric condition has been diagnosed.

Psychotropic drugs may be considered when a psychiatric disorder has been diagnosed. For children, pharmacological therapy is ideally started by a clinician with expertise in using psychotropic drugs in children with developmental disability (eg psychiatrist, paediatrician).

Clearly document the psychiatric indication for therapy in the medical record for future health practitioners and treating teams.

Figure 1. Key considerations when using a psychotropic drug in a person with developmental disability.

[NB1]

Principles of use

Assess capacity and obtain informed consent before prescribing a psychotropic drug; for advice, see Consent, capacity and decision making in people with developmental disability.

Assess physical and mental health and address risk factors for psychiatric disorders where possible.

If the diagnosis is unclear, always seek specialist advice.

Only use a psychotropic drug as part of a comprehensive mental health care plan that addresses physical comorbidities and broader psychosocial concerns.

Starting a psychotropic drug

Discuss risks and benefits of psychotropic drugs, including monitoring requirements (eg need for regular blood tests) before prescribing.

Consider comorbidities and concomitant drugs when choosing a psychotropic drug to minimise interactions and adverse effects.

Ensure the rationale for the psychotropic drug is clearly documented in the person’s medical record.

Provide the person and their support people with written information about the drug.

Establish reliable methods to assess treatment response (eg daily chart of number of incidents of specified type, established baseline for evaluating effect).

Start the psychotropic drug at a low dose, and increase the dose gradually.

Trial only one drug at a time.

Monitoring a psychotropic drug

Engage support people in monitoring and reporting benefits and adverse effects of drug treatment (eg behaviour change can be a manifestation of distress related to adverse effects); see also Precautions in prescribing psychotropic drugs.

Schedule regular review of treatment adherence, response, adverse effects and the need for continuing the drug.

If response to treatment is poor, consider trialling another recommended psychotropic drug.

Stopping a psychotropic drug

Stop a psychotropic drug if it:

is not effective
has intolerable adverse effects
is no longer required.

Note: NB1: For children, pharmacological therapy is ideally started by a clinician with expertise in using psychotropic drugs in children with developmental disability (eg psychiatrist, paediatrician).