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| ID | Type | Description | Link |
|---|---|---|---|
| TRUST/VC/AC/SG/6328-9580 | Other Grant/Funding Number | The Baily Thomas Charitable Fund | |
| 331470 | Other Identifier | IRAS |
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The overall aim of this observational study is to establish the anti-psychotic prescribing patterns across specialist intellectual disability (ID) services in England and Wales by collecting cross-sectional retrospective data at 7 annual time-points (1st July) from 2017 to 2023.
Feasibility protocol objectives:
Is it feasible to identify People with Intellectual Disabilities (PwID) who have been prescribed 2 or more anti-psychotic medications over 7 years retrospectively.
It is possible to obtain a complete data set for each patient identified and therefore be able to explore the prescribing patterns across the eight sites.
Is it feasible to quantify anti-psychotic treatment (APT) prescribing in PwID as chlorpromazine equivalent dose values across different healthcare Trusts in England and Wales.
Main objectives:
To explore yearly and overall prescribing patterns among PwID (with or without mental-health reasons (psychiatric co-morbidities)) in receipt of ≥2 forms of anti-psychotic treatment (multiple) over time?
How has multiple anti-psychotic treatment prescribing changed between 2017 and 2023 using chlorpromazine equivalent dose values, in PwID with mental health and no mental health indications?
What has been the impact of the COVID-19 pandemic (and corresponding lockdown restrictions in England and Wales) on multiple anti-psychotic treatment prescribing among PwID?
Can the NHS England Statistical Process Control tool (SPC) be utilised to track yearly anti-psychotic treatment prescribing among PwID receiving multiple forms of anti-psychotic treatment, and monitor variation between services (sites) and patient groups (e.g. psychiatric co-morbidities; challenging behaviour).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Eligible patients who have had a psychiatric review by specialist adult ID services in 2017. | Adults with an intellectual disability who are under the care of ID services in receipt of >2 oral and/or long-acting intra-muscular (IM) injectable anti-psychotic treatments (depots), who have had a psychiatric review by specialist adult ID services in 2017. | ||
| Eligible patients who have had a psychiatric review by specialist adult ID services in 2018. | Adults with an intellectual disability who are under the care of ID services in receipt of >2 oral and/or long-acting IM injectable anti-psychotic treatments (depots), who have had a psychiatric review by specialist adult ID services in 2018. | ||
| Eligible patients who have had a psychiatric review by specialist adult ID services in 2019. | Adults with an intellectual disability who are under the care of ID services in receipt of >2 oral and/or long-acting IM injectable anti-psychotic treatments (depots), who have had a psychiatric review by specialist adult ID services in 2019. | ||
| Eligible patients who have had a psychiatric review by specialist adult ID services in 2020. | Adults with an intellectual disability who are under the care of ID services in receipt of >2 oral and/or long-acting IM injectable anti-psychotic treatments (depots), who have had a psychiatric review by specialist adult ID services in 2020. | ||
| Eligible patients who have had a psychiatric review by specialist adult ID services in 2021. |
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| Measure | Description | Time Frame |
|---|---|---|
| The differences in chlorpromazine equivalent dose values in PwID prescribed multiple anti-psychotic treatment across the 7-annual timepoints and across the 8 sites. | Main objective: To explore yearly and overall prescribing patterns among PwID (with or without mental-health reasons (psychiatric co-morbidities)) in receipt of ≥2 forms of anti-psychotic treatment (multiple) over time. | 2017-2023 |
| The differences in chlorpromazine equivalent dose values in PwID prescribed multiple anti-psychotic treatment, with mental health indications, compared to those with no mental health indications between 2017 and 2023. | Main objective: How has multiple anti-psychotic treatment prescribing changed between 2017 and 2023 using chlorpromazine equivalent dose values, in PwID with mental health and no mental health indications? | 2017-2023 |
| The differences in chlorpromazine equivalent dose values in PwID prescribed multiple anti-psychotic treatment before, during and after the COVID-19 pandemic. | Main objective: What has been the impact of the COVID-19 pandemic (and corresponding lockdown restrictions in England and Wales) on multiple anti-psychotic treatment prescribing among PwID? | 2017-2023 |
| SPC will be used to compare trends in multiple APT prescribing within/across participating healthcare trusts and utilised to track yearly oral/depots anti-psychotic treatment prescribing and monitor variation between services & patient groups. | Main objective: Can the SPC be utilised to track yearly anti-psychotic treatment prescribing among PwID receiving multiple forms of anti-psychotic treatment, and monitor variation between services (sites) and patient groups (e.g. psychiatric co-morbidities; challenging behaviour)? | 2017-2023 |
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| Measure | Description | Time Frame |
|---|---|---|
| Number (%) of PwID successfully identified who have been prescribed more than 2 anti-psychotic medications yearly over 7. | Feasibility objective: Is it feasible to identify PwID who have been prescribed 2 or more anti-psychotic medications over 7 years retrospectively? | Through study completion, an average of 6 months |
Inclusion Criteria:
Exclusion Criteria:
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Adults with Intellectual Disabilities under the care of ID services in receipt of >2 oral and/or long-acting IM injectable anti-psychotic treatments (depots).
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Professor Shankar | Contact | +44 (0) 1752 439831 | rohit.shankar@plymouth.ac.uk | |
| Emily Stanyard | Contact | +44 (0) 1752 439831 | emily.stanyard@plymouth.ac.uk |
| Name | Affiliation | Role |
|---|---|---|
| Professor Shankar | University of Plymouth | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cheshire and Wirral Partnership NHS Foundation Trust | Recruiting | Chester | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35249557 | Background | Branford D, Shankar R. Antidepressant prescribing for adult people with an intellectual disability living in England. Br J Psychiatry. 2022 Aug;221(2):488-493. doi: 10.1192/bjp.2022.34. | |
| 35431024 | Background | Howkins J, Hassiotis A, Bradley E, Levitas A, Sappok T, Sinai A, Thakur A, Shankar R. International clinician perspectives on pandemic-associated stress in supporting people with intellectual and developmental disabilities. BJPsych Open. 2022 Apr 18;8(3):e84. doi: 10.1192/bjo.2022.49. |
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| ID | Term |
|---|---|
| D008607 | Intellectual Disability |
| D007859 | Learning Disabilities |
| ID | Term |
|---|---|
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
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Adults with an intellectual disability who are under the care of ID services in receipt of >2 oral and/or long-acting IM injectable anti-psychotic treatments (depots), who have had a psychiatric review by specialist adult ID services in 2021.
| Eligible patients who have had a psychiatric review by specialist adult ID services in 2022. | Adults with an intellectual disability who are under the care of ID services in receipt of >2 oral and/or long-acting IM injectable anti-psychotic treatments (depots), who have had a psychiatric review by specialist adult ID services in 2022. |
| Eligible patients who have had a psychiatric review by specialist adult ID services in 2023. | Adults with an intellectual disability who are under the care of ID services in receipt of >2 oral and/or long-acting IM injectable anti-psychotic treatments (depots), who have had a psychiatric review by specialist adult ID services in 2023. |
| Number (%) of PwID with a complete data set. |
Feasibility objective: Is it possible to obtain a complete data set for each patient identified and therefore be able to explore the prescribing patterns across the eight sites? |
| Through study completion, an average of 6 months |
| Number (%) for whom it was feasible to quantify oral and depots anti-psychotic treatment prescribing in PwID as chlorpromazine equivalent dose values across different healthcare trusts in England and Wales. | Feasibility objective: Is it feasible to quantify anti-psychotic treatment (oral and long-acting IM injectables (depots) prescribing in PwID as chlorpromazine equivalent dose values across different healthcare Trusts in England and Wales? | Through study completion, an average of 6 months |
| Coventry and Warwickshire Partnership NHS Trust | Not yet recruiting | Coventry | United Kingdom |
|
| Hertfordshire Partnership University NHS Foundation Trust | Not yet recruiting | Hatfield | United Kingdom |
|
| Leicestershire Partnership NHS Trust | Recruiting | Leicester | United Kingdom |
|
| Central and North West London NHS Foundation Trust | Recruiting | London | United Kingdom |
|
| North East London NHS Foundation Trust | Not yet recruiting | London | United Kingdom |
|
| Cornwall Partnership NHS Foundation Trust | Not yet recruiting | Redruth | United Kingdom |
|
| Swansea Bay University Health Board | Recruiting | Swansea | United Kingdom |
|
| 33118913 | Background | Tromans S, Kinney M, Chester V, Alexander R, Roy A, Sander JW, Dudson H, Shankar R. Priority concerns for people with intellectual and developmental disabilities during the COVID-19 pandemic. BJPsych Open. 2020 Oct 29;6(6):e128. doi: 10.1192/bjo.2020.122. |
| 34865678 | Background | Naqvi D, Perera B, Mitchell S, Sheehan R, Shankar R. COVID-19 pandemic impact on psychotropic prescribing for adults with intellectual disability: an observational study in English specialist community services. BJPsych Open. 2021 Dec 6;8(1):e7. doi: 10.1192/bjo.2021.1064. |
| 27460622 | Background | Leucht S, Samara M, Heres S, Davis JM. Dose Equivalents for Antipsychotic Drugs: The DDD Method. Schizophr Bull. 2016 Jul;42 Suppl 1(Suppl 1):S90-4. doi: 10.1093/schbul/sbv167. |
| 23845387 | Background | Patel MX, Arista IA, Taylor M, Barnes TR. How to compare doses of different antipsychotics: a systematic review of methods. Schizophr Res. 2013 Sep;149(1-3):141-8. doi: 10.1016/j.schres.2013.06.030. Epub 2013 Jul 8. |
| 31192534 | Background | Shankar R, Wilcock M, Deb S, Goodey R, Corson E, Pretorius C, Praed G, Pell A, Vujkovic D, Wilkinson E, Laugharne R, Axby S, Sheehan R, Alexander R. A structured programme to withdraw antipsychotics among adults with intellectual disabilities: The Cornwall experience. J Appl Res Intellect Disabil. 2019 Nov;32(6):1389-1400. doi: 10.1111/jar.12635. Epub 2019 Jun 13. |
| Background | Mehta H, Glover G. Psychotropic drugs and people with learning disabilities or autism, 2019. Public Health England. |
| Background | National Health Service. Stopping over medication of people with a learning disability, autism or both (STOMP). NHS England " Stopping over medication of people with a learning disability, autism or both (STOMP) [Accessed 15th December 2023). |
| Background | Taylor DM, Barnes TR and Young AH. The Maudsley prescribing guidelines in psychiatry. 13th ed. West Sussex: Wiley-Blackwell; 2018. |
| Background | National Health Service. Statistical process control tool. https://www.england.nhs.uk/statisticalprocess-control-tool/ [Accessed 15th December 2023]. |
| 40416595 | Derived | Stanyard E, Neilens H, Allgar V, Bailey M, Musicha C, Purandare K, Perera B, Roy A, Sawhney I, Watkins L, Jaydeokar S, Lennard S, Mitchell S, McGowan P, Laugharne R, Tromans SJ, Shankar R. A novel way to understand and communicate the burden of AntiPsycHotic prescribing for adults across specialist Intellectual Disability services in England and Wales: the APHID feasibility study protocol. Front Health Serv. 2025 May 9;5:1393805. doi: 10.3389/frhs.2025.1393805. eCollection 2025. |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D065886 | Neurodevelopmental Disorders |
| D001523 | Mental Disorders |
| D003147 | Communication Disorders |