Think again

Do we really need al those neuroleptics to control behavior disturbances in the intellectuallydisabled ??. Maybe not. This is a thought provoking study that could well change our views on this topic. cientists have discovered that taking a sugar pill is more effective than routine medications in treating aggression in people with intellectual disabilities.

Until now, patients with intellectual disabilities have been prescribed antipsychotic drugs — normally given to people with a psychiatric disease like schizophrenia — to treat aggressive behaviour such as head banging. But evidence for the drugs' effectiveness has been thin.

“Antipsychotic drugs are widely used because they are cheap and at high doses they sedate people,” says Eric Emerson at Lancaster University, an expert in the behaviour of intellectually disabled people.

Peter Tyrer, based at Imperial College London, led an international research project looking at 86 people with intellectual disability at clinics across England, Wales and at one centre in Australia. Patients being treated for aggressive behaviour randomly received one of two antipsychotic drugs — respiridone or haloperidol — or a placebo.

These antipsychotics have been used for more than 40 years to treat aggression in people with intellectual disabilities. They block dopamine D2 receptors, which means that people who take them have less dopamine in the limbic pathway, depriving the part of the brain linked to addiction, reward and fear. Dopamine is a key neurotransmitter of arousal.

“The drugs dampen down all behaviours, not just aggression,” says John Taylor, president elect of the British Association for Behavioural and Cognitive Psychotherapies, “with no evidence that they specifically target aggression.” They have many other effects too. “Respiridone and haloperidol are dirty drugs,” says Tyrer, “with lots of side effects like drooling, shaking, seizures, dry mouth, weight gain, skin rashes and so on.”