Causes of and alternatives to medication for behaviours that challenge in people with intellectual disabilities: direct care providers' perspectives

Behaviours that challenge (BtC), such as aggression and self-injury, are manifested by many people with intellectual disabilities (ID). National and international guidelines recommend non-pharmacological psychosocial intervention before considering medication to address BtC. Support staff play a pivotal role in the prescription process. Using coproduction, we developed a training programme for support staff, called SPECTROM, to give them knowledge and empower them to question inappropriate prescriptions and ask for the discontinuation of medication if appropriate and instead look for ways to help people with ID when they are distressed without relying on medication. We have presented data from two focus groups that we conducted during the development of SPECTROM: one that included support staff, and another that had service managers and trainers. In these focus groups, we explored participants’ views on the use of medication to address BtC with a particular emphasis on the causes of and alternatives to medication for BtC. Along with the participants’ views, we have also presented how we have addressed these issues in the SPECTROM resources

Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities (SPECTROM): study protocol

Introduction Psychotropic medications that are primarily licenced for the treatment of psychiatric disorders are used widely (32%–85%) among people with intellectual disabilities (ID) often for the management of problem (challenging) behaviour in the absence of a psychiatric disorder. Care staff play a pivotal role in the prescribing process. Currently, no staff training programme exists to address the issue of overprescribing of psychotropic medication in people with ID, thus highlighting an urgent need for developing a psychoeducational programme (PEP) specifically designed to address this issue. We propose to develop a PEP for care staff using the methodology described in the UK Medical Research Council guide for complex interventions. Methods and analysis The development of the PEP will involve (1) gathering information on available relevant training programmes, (2) running four focus groups with care staff and other professionals to establish the content and format of the PEP, and (3) organising a co-design event involving all relevant stakeholders to discuss the format of the PEP. A core project team will develop the PEP under guidance from the PEP Development Group which will consist of 10–12 relevant stakeholder representatives. Feedback from selected stakeholders on a draft PEP will allow us to refine the PEP before implementation. The PEP will have web-based modules supplemented by face to face training sessions. When the final draft is ready, we will field test the PEP on six to eight care staff from community care homes for people with ID. After completing the field test, we will run a focus group involving participants in the PEP to get feedback on the PEP. Ethics and dissemination Ethics approval for this study was waived by the UK Health Regulatory Authority as the study does not collect any patient related information and only include care staff outside the UK NHS. This will be the first ever such universally freely available PEP supported by training manual and slides

Translational Entanglement of Dipole-Dipole Interacting Atoms in Optical Lattices

We propose and investigate a realization of the position- and momentum-correlated Einstein-Podolsky-Rosen (EPR) states [Phys. Rev. 47, 777 (1935)] that have hitherto eluded detection. The realization involves atom pairs that are confined to adjacent sites of two mutually shifted optical lattices and are entangled via laser-induced dipole-dipole interactions. The EPR "paradox" with translational variables is then modified by lattice-diffraction effects, and can be verified to a high degree of accuracy in this scheme.Comment: 4 pages, 3 figures, to be published in PR

Entangling two Bose Einstein condensates in a double cavity system

We propose a scheme to transfer the quantum state of light fields to the collective density excitations of a Bose Einstein condensate (BEC) in a cavity. This scheme allows to entangle two BECs in a double cavity setup by transferring the quantum entanglement of two light fields produced from a nondegenerate parametric amplifier (NOPA) to the collective density excitations of the two BECs. An EPR state of the collective density excitations can be created by a judicious choice of the system parameters.Comment: 3 figure

UK psychiatrists' experience of withdrawal of antipsychotics prescribed for challenging behaviours in adults with intellectual disabilities and/or autism.

BACKGROUND: A high proportion of adults with intellectual disabilities are prescribed off-licence antipsychotics in the absence of a psychiatric illness. The National Health Service in England launched an initiative in 2016, 'Stopping over-medication of people with a learning disability [intellectual disability], autism or both' (STOMP), to address this major public health concern. AIMS: To gain understanding from UK psychiatrists working with adults with intellectual disabilities on the successes and challenges of withdrawing antipsychotics for challenging behaviours. METHOD: An online questionnaire was sent to all UK psychiatrists working in the field of intellectual disability (estimated 225). RESULTS: Half of the 88 respondents stated that they started withdrawing antipsychotics over 5 years ago and 52.3% stated that they are less likely to initiate an antipsychotic since the launch of STOMP. However, since then, 46.6% are prescribing other classes of psychotropic medication instead of antipsychotics for challenging behaviours, most frequently the antidepressants. Complete antipsychotic discontinuation in over 50% of patients treated with antipsychotics was achieved by only 4.5% of respondents (n = 4); 11.4% reported deterioration in challenging behaviours in over 50% of patients on withdrawal and the same proportion (11.4%) reported no deterioration. Only 32% of respondents made the diagnosis of psychiatric illness in all their patients themselves. Family and paid carers' concern, lack of multi-agency and multidisciplinary input and unavailability of non-medical psychosocial intervention are key reported factors hampering the withdrawal attempt. CONCLUSIONS: There is an urgent need to develop national guidelines to provide a framework for systematic psychotropic drug reviews and withdrawal where possible

Entangling Two Bose-Einstein Condensates by Stimulated Bragg Scattering

We propose an experiment for entangling two spatially separated Bose-Einstein condensates by Bragg scattering of light. When Bragg scattering in two condensates is stimulated by a common probe, the resulting quasiparticles in the two condensates get entangled due to quantum communication between the condensates via probe beam. The entanglement is shown to be significant and occurs in both number and quadrature phase variables. We present two methods of detecting the generated entanglement.Comment: 4 pages, Revte

The use of medication for challenging behaviors in people with intellectual disabilities: the direct care providers’ perspective

Background Overmedication of people with intellectual disabilities, particularly when psychotropic medications are used for challenging behavior (CB) in the absence of a psychiatric disorder, is a significant public health concern. Support staff play a pivotal role in influencing the prescribing process. Staff views and attitudes toward medication use for CB are therefore of paramount importance. Method We have conducted four focus groups involving support staff (n = 8), home managers (n = 5) and trainers (n = 3), two of which primarily explored participants’ experiences and views on using medication for CB and medication withdrawal. Results Some participants felt medication use was justified, but others saw that as a form of chemical restraint. Most agreed that polypharmacy of psychotropics might lead to side effects. Some acknowledged the lack of shared decision-making involving people with intellectual disabilities and their families. There was universal anxiety about withdrawing the medication. Conclusions All agreed on the need for more medication-related information

The dusty SF history of high-z galaxies, modelling tools and future prospects

We summarize recent advances in the determination of the cosmic history of star formation and other properties of high-z galaxies, and the relevance of this information in our understanding of the formation of structures. We emphasize the importance of dust reprocessing in the high--z universe, as demonstrated in particular by IR and sub-mm data. This demand a panchromatic approach to observations and suitable modelling tools. We spend also some words on expectations from future instruments.Comment: 8 pages, to be published in "The link between stars and cosmology", 26-30 March, 2001, Puerto Vallarta, Mexico, by Kluwer, eds. M. Chavez, A. Bressan, A. Buzzoni, and D. Mayy

Low energy atomic collision with dipole interactions

We apply quantum defect theory to study low energy ground state atomic collisions including aligned dipole interactions such as those induced by an electric field. Our results show that coupled even ($l$) relative orbital angular momentum partial wave channels exhibit shape resonance structures while odd ($l$) channels do not. We analyze and interpret these resonances within the framework of multichannel quantum defect theory (MQDT).Comment: 27 pages, 17 figures, an inadvertent typo correcte

Predicting total reaction cross sections for nucleon-nucleus scattering

Nucleon total reaction and neutron total cross sections to 300 MeV for 12C and 208Pb, and for 65 MeV spanning the mass range, are predicted using coordinate space optical potentials formed by full folding of effective nucleon-nucleon interactions with realistic nuclear ground state densities. Good to excellent agreement is found with existing data.Comment: 10 pages, 4 figure