Clinical audit of psychotropic medication use at a South African intellectual disability hospital

Individuals with intellectual disability (ID) are often prescribed psychotropic medications at disproportionately high rates, particularly for managing psychiatric symptoms or behaviours that challenge (BTC). International guidelines emphasise cautious, evidence-based use and the prioritisation of non-pharmacological interventions.

This audit evaluated prescribing practices at a specialist psychiatric hospital in South Africa to determine the extent of alignment with internationally recommended standards for psychotropic use in individuals with ID.

Outpatient department (OPD) of an advanced psychiatric care institution in Cape Town.

A retrospective folder and prescription review was conducted for 103 patients with ID who were newly referred between January 2018 and August 2019. Prescribing decisions at the first visit and 6-month follow-up were assessed against guidance from the World Psychiatric Association (WPA) and National Institute for Health and Care Excellence (NICE).

Psychotropic medications were prescribed to 88% of patients. Antipsychotics were the most frequently used agents, comprising over half of all prescriptions, often for BTC in the absence of a psychotic disorder. While certain elements of guideline-based care were evident - such as use of low effective doses - gaps were noted in documentation of rationale, review scheduling, side-effect monitoring and consistent use of behavioural strategies. These areas highlight opportunities for strengthening practice.

This audit emphasises the complexity of psychotropic prescribing for individuals with ID and the need for structured, multidisciplinary approaches to ensure safe and appropriate medication use.

Embedding standard protocols and regular reviews into clinical workflows may support better adherence to international best-practice standards.