PSYCHOTROPIC MEDICATION
The most prevalent form of intervention remains medication; psychiatric drugs are used in the treatment of all forms of mental illness and there is a strong evidence base to support its appropriate use (Gates 2003; Hardy & Bouras 2002; Pilgrim 2005). There is also evidence to support the use of these drugs for behavior problems that are not necessarily connected to a mental health problem with people with learning disabilities (Crabbe 1994). For this reason, it is virtually unheard of for a person with a learning disability who presents behavior difficulties and/or mental health problems not to be on a type of medication mentioned in Table 1. However, such medication regimes are very often used alongside another type of therapeutic intervention.
Table 1 Therapeutic interventions that are commonly used to treat mental health problems in people with learning disabilities
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Psychotropic medication and interventions and the disorders that they are most likely to be used for:
• anti-psychotic medication – behavioral difficulties and psychosis
• anti-depressant medication – depression
• mood-stabilizing agents – bipolar affective disorder
• anxiolytic medication – acute anxiety
• electroconvulsive therapy – severe depression or mania
Psychodynamic interventions and/or psychotherapy may be used to help with:
• behavioral approaches
• cognitive approaches
• counselling
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For example, a service user may have had some anxiety difficulties which seem to have occurred since the death of his mother; a common recommendation would for an introduction to a form of anxiolytic medication to help with the anxiety in the short term and long term for the service user to receive bereavement counselling or a similar psychodynamic intervention. The anxiolytic would help the service user to become relaxed enough to be able to benefit from the counselling sessions. Alternatively, this same service user may be prescribed an anti-depressant to help him overcome his loss; this can also be used in conjunction with counselling and it would not be unusual for these treatments to co-exist.
It is important at this stage to acknowledge differences in terminology used to describe types of medication in the fi eld of psychiatry that, in essence, often refer to the same. Pilgrim (2005) recognizes that the psychiatric profession has tended to describe these drugs in relation to their impact on a diagnosed mental disorder, such as anti-depressants for depression and anti-psychotics for psychosis. However, before the Second World War, this was not the case and drugs were seen as ‘suppressors of symptoms’ and would aim to manage the condition rather than cure it. These were referred to as ‘sedatives’ or ‘tranquilizers’, with the most sedating being described as ‘major tranquilizers’. The term used today by the medical profession for this group of drugs is ‘psychotropic medication’; other names that pertain to a specific type of medication will be discussed under the following subheadings.
