We examined the prevalence and patterns of psychotropic medication use among adults with mental retardation living in community settings. The sample included 97 adults who were receiving psychotrophic medication and for whom the use of psychotropic medication is not federally regulated or monitored. Variables included demographics, diagnoses psychotropic medications, and challenging behavior. Sixty two percent of the clients had no psychiatric diagnosis documented in the confidential folder and 31 had no psychiatric or psychological evaluation documented in the confidential folder. Neuroleptics were prescribed for 89 of the clients and continuous use ranged from 2 months to 28 years. Five percent of the clients were receiving interclass polypharmacy and 46 were receiving interclass polypharmacy (two to five medications excluding anticonvulsants). Medication reduction programs were reported for 5 of the clients and 9 participated in an interdisciplinary medication review and monitoring process. Eighteen percent of the prescribing physicians provided a written list of potential side effects to the client or an appropriate representative of the client, and 7 ensured that the written list was signed by the client or an appropriate representative of the client. While challenging behavior was reported for 85 of the clients, only 7 had a formal behavior management plan, and behaviors were measured systematically in terms of frequency or intensity for 17 of the clients. The results of the study revealed a notable absence of recognized guidelines for use of psychotropic medication for the 97 clients examined. Implications regarding Hawaii's system of care for persons with mental retardation, psychiatric diagnoses, and challenging behavior are addressed.
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