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Tvp19 11omslag kijk verder

Tijdschrift voor Psychiatrie 56 (2014) 12, 807 - 815

Essay

The new draft law on care and coercion. Concerning the use and the reduction of antipsychotics without a valid indication in people with intellectual disabilities

S. Kapitein, J. Wieland

background In the Netherlands, many people with an intellectual disability and challenging behavior are still prescribed antipsychotic medication, often for many years and in high doses. According to the new draft law on care and coercion, prescribing antipsychotics, without a valid indication, for people with an intellectual disability, will be regarded as coercion. The effect for clinical practice will be that such antipsychotic medication will have to be re-assessed and, in many cases, reduced and stopped.
aim To comment on the effectiveness, the side effects and futility of prescribing antipsychotics to people with an intellectual disability and challenging behavior in order to arrive at recommendations about the evaluation of antipsychotics and, if possible, about the reduction of antipsychotics for intellectually challenged people who do not really require such medication.
method Practical recommendations are made based on recent literature and clinical experience.
results Thorough evaluation and – when possible – the reduction of antipsychotics for people with an intellectual disability requires psychiatrists to invest time and energy in diagnosis and stability of patients, to invest in the patient’s environment and to opt for a controlled reduction of antipsychotics.
conclusion The new draft law on care and coercion highlights the urgent need for guidelines concerning the reduction of antipsychotics for people with an intellectual disability when there is no clear indication that such a step will benefit the patient.

keywords antipsychotics, challenging behaviour, intellectual disability, law on care and coercion