Are antipsychotics an appropriate treatment for aggressive challenging behavior in patients with an intellectual disability?
Patients with an intellectual disability often display aggression and challenging behavior in response to a reduced ability to manage adversity and stress. The prevalence of such behavior is fairly common, ranging from 16% to greater than 50% dependent upon the clinical definition applied. Antipsychotic medications have been used in this patient population since the 1950s despite the fact that the aggressive behavior observed in patients with an intellectual disability may have no clear connection to psychotic illness. Antipsychotic prescribing in this population has become commonplace with 22% to 45% of hospitalized and 20% of community-based patients receiving antipsychotic therapy. This widespread use has occurred despite a scarcity of evidence to support the practice. In fact, a systematic review of this topic included 8 randomized controlled trials of antipsychotics versus placebo and concluded that these studies “provided no evidence of whether antipsychotic medication helps or h
