Mental Health Needs of Children and Young People with Learning Disabilities by Raghu Raghavan

Author:Raghu Raghavan
Language: eng
Format: epub
ISBN: 978-1-908993-79-3
Publisher: Pavilion Publishing
Published: 2013-08-01T04:00:00+00:00

Hyperprolactinaemia can result in several side effects such as: amenorrhoea and oligomenorrhoea, erectile dysfunction, hirsutism and galactorrhoea. The effect of increased prolactin levels on growth (including bone mineral density) and sexual maturation is not known (Morgan & Taylor, 2007). Children and adolescents may be at greater risk of certain side effects (eg. enuresis) than adults (Aman et al, 2005). Weight gain is greater in children and adolescents than in adults (Correll & Carlson, 2006) and they appear more sensitive than adults to extra pyramidal side effects (Correll, 2008).

The possible increased risk of adverse side effects necessitates ongoing review in order to ensure the fewest number of drugs are used and the lowest possible dose that will satisfactorily control symptoms. Using higher than the recommended British National Formulary doses of antipsychotics does not appear to increase efficacy (Royal College of Psychiatrists, 2006).

Monitoring use of medication

Practitioners should monitor young patients at baseline and at regular three to six monthly intervals for height, weight, possible sexual side effects, behavioural change, extra pyramidal symptoms, bowel habit, blood pressure and pulse. Blood testing can be difficult but, if a child is more than 10 centile points above the expected weight then fasting blood glucose and lipid concentrations should be measured following a discussion on risk-benefit analysis with carers. This will help prevent health problems associated with excessive weight, such as type 2 diabetes. Urinary glucose testing may be done if a blood test is not possible. It is not clear how frequently metabolic syndrome – dyslipidaemia, glucose intolerance, hypertension and abdominal obesity – occurs in children and adolescents, but hyperlipidaemia is common in Smith-Magenis syndrome and, therefore, second generation antipsychotics are best avoided in this condition.

A history of epilepsy should always be sought as this condition affects approximately a third of children with moderate to profound intellectual disability and antipsychotic medications are known to lower the convulsive threshold, especially clozapine. Seizures triggered by psychotropic drugs are a dose-dependent adverse effect. Communication problems can make it difficult for children to draw attention to early manifestations of side effects and hence suffer more severely from unwanted effects. Clozapine can be used in refractory cases of schizophrenia (Gogtay & Rapoport, 2008) but requires careful blood count monitoring for possible bone marrow suppression. The risks that go with using these drugs must be balanced against the unquestionable benefits from treatment for the vast majority of people when used appropriately (Cullen, 2008).

Anticholinergic drugs to treat the movement disorders and the side effects arising from the use of antipsychotic drugs should be considered in the following circumstances: prescribing of high doses; a previous history of extra-pyramidal reactions; and when unwanted effects are not adequately controlled despite decreasing the dosage of antipsychotic medication. They have no effect on akathisia, may have an effect on mood and can precipitate an episode of intestinal obstruction in people with learning disabilities who suffer from severe constipation.

Aggressive behaviour

A variety of approaches have been adopted in meeting the needs of children with learning disabilities who exhibit severe physical aggression.

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