Section F Ongoing use of medication: monitoring and reviewing

Scenarios

David is in his 60s, has Down’s Syndrome and does not communicate verbally. He lives in a care home with five other adults. The care home find his behaviour challenging when he is rocking and shouting out. This appeared to become a concern after David’s parents died. David has not had any support to cope with bereavement. He has always rocked (sometimes to music) and shouted out (sometimes to express displeasure), but the behaviours increased. The care home support staff visited the GP and provided information which resulted in a prescription for an antidepressant. David was not seen by the GP and has not been seen in the last two years. The care home support staff explained to David’s siblings that the medication is to stabilise his mood, however David does not have a diagnosis of depression. His siblings do not feel that he gets on with the people living with him; their own behaviour  can make David anxious and cause him to withdraw. David’s siblings are asking for the antidepressant medication to be reduced and challenging the care home, which disagrees. They would also like their brother to receive appropriate bereavement counselling and to move to live closer to them.

A young woman, Jess, started taking an antidepressant when she was in crisis as a teenager. The medication initially seemed to help improve her low mood and anxiety, but she has continued to take it for eight years and her family are very concerned about the effects it has on her. They describe that she is sleepy all the time, very restless and the medication makes her so numb that she does not recognise her family. Jess spends lots of time in bed during the day and does not engage in many activities. Her parents’ biggest concern is her physical health and they have also noticed a reduction in her cognitive ability, which was already limited.

Paul had been taking antipsychotic medication for six years and for the past two years he also had a prescription for a sedative medication (PRN) to be given when there is an episode of challenging behaviour  that cannot be successfully managed. The PRN was used most weeks and his parents noticed that if they visited him on a day he had been given it, he was very drowsy and did not do anything for the rest of the day. They were also concerned that he did not communicate as much as he used to and he had no motivation to go out and do things. After some discussions, the family, service manager and psychiatrist agreed to stop using the PRN. They gradually withdrew the antipsychotic, while at the same time reviewed Paul’s support plan and put in place alternative support strategies. It took some time to come off the medication completely, but everyone noticed the change in Paul’s mood straight away. He was more alert, engaged with people and had more energy to do things. Over time he began to participate in activities like a music group and ball games in the park. He was happy to try new activities. Paul’s parents were really happy to see he communicated more and began to increase his use of signs and symbols. He was also receptive to new support strategies, so his challenging behaviour decreased and his quality of life increased.