Analysing factors related to challenging behaviour

Medication history and current medication

The client’s medication history should detail what medication has already been tried at what dose, any side-effects, and effectiveness. Current medication should be evaluated to determine appropriateness for the client’s conditions, excessive or inadequate dosages, possible side-effects, interactions, contra-indication, and sometimes blood levels as well.
 

Side-effects

When looking into behaviour problems, it is essential that attention is focussed on the possible side-effects of any medication being used by the client. Antipsychotic medication is often prescribed for behavioural problems and these drugs often have side-effects. A side-effect can in fact be misinterpreted as a new condition, and yet another medication may then be prescribed, resulting in yet more side-effects.

The top ten reported side-effects in the general population are: muscle pain, fatigue, headache, dizziness, nausea, depression, weight gain, rash, joint pain and insomnia ⁵⁶ . These are unpleasant physical and psychological experiences caused by medication. It is conceivable that people with intellectual disabilities may respond with challenging behaviour. That may, in turn, lead to antipsychotic medication being be prescribed and the risk of even more side-effects.

Interactions

It is important to be aware of how medicines can affect each other. If someone takes several types of medication at the same time, they may not work well together. This is called a drug interaction; medicines can either block or strengthen each other or affect levels of medication in the blood.

Contra-indication

In children and the elderly, a drug may have the opposite effect to the one intended: tranquillisers may make them more agitated, for example. The doctor must be aware of this possibility.

Blood levels

It will sometimes also be necessary to check so-called blood levels (the concentration of the drug in the blood). The optimal blood level is within a certain margin. If the blood level is too low, the medicine may not have the intended effect; if it is too high, the probability of side-effects increases enormously. Pharmaco-genetic variation is also important in terms of blood levels. The absorption and metabolization of drugs, and particularly psychopharmaceuticals, can vary greatly from person to person. One person will metabolize a medicine slowly, while another does so very quickly. This is due to the presence or absence of certain enzymes in the liver, a factor that is genetically determined. The same dose can therefore produce widely varying blood levels in different people.

Use of medication

A Dutch study has shown that 57% of people with intellectual disabilities in the Netherlands use one or more medicines. ⁵⁷

Kiernan found that 48% of adults with challenging behaviour had received a prescription for an antipsychotic drug ⁵⁸ . An Australian study of 2540 people with intellectual disabilities found that 27% of respondents suffered from the side-effects of medication. ⁵⁹  According to the study conducted by De Kuijper in three organizations for people with intellectual disabilities (n = 2373), 32.2% used antipsychotic medication ⁶⁰ . In 58% of these cases, the prescriptions were given in response to behaviour problems, with psychosis or psychotic symptoms being the reason in 22.5%. The description of antipsychotics was associated with a serious intellectual disability, living in an institutional setting, and male gender.