Rohit Shankar

Rohit Shankar
University of Plymouth | UoP · Plymouth University Peninsula Schools of Medicine and Dentistry

MBE, MBBS, FRCPsych
https://www.plymouth.ac.uk/research/cider-cornwall-intellectual-disability-equitable-research

About

233
Publications
73,387
Reads
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1,351
Citations
Additional affiliations
April 2011 - present
University of Exeter
Position
  • Hon. Clinical Associate Professor
December 2002 - present
Cornwall Partnership NHS Foundation Trust
Position
  • consultant neuropsychiatrist
Education
September 2000 - August 2002
September 1993 - April 1998
Coimbatore Medical College
Field of study
  • Medicine

Publications

Publications (233)
Article
Introduction Current medical education prepares doctors to diagnose, assess and treat individual patients yet lacks the expectation to be responsible for the care of the wider community. Learning the skills to recognise and redress the social determinants of health are increasingly being recognised as an essential part of medical education. Object...
Article
Full-text available
Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people with drug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessful surgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted to determine the treatment effects of VNS Therapy as an adj...
Article
Full-text available
Background A quarter of people with Intellectual Disability (ID) in the UK have epilepsy compared to 0.6% in the general population and die much younger. Epilepsy is associated with two - fifths of all deaths with related polypharmacy and multimorbidity. Epilepsy research on this population has been poor. This study describes real-world clinical a...
Article
Full-text available
Background People living with intellectual and developmental disabilities (IDD) have suffered disproportionately in health outcomes and general well-being during the COVID-19 pandemic. There is emerging evidence of increased psychological distress. Increased strain has also fallen on clinicians managing the psychological needs of people with IDD, i...
Article
Full-text available
Purpose : People with intellectual disabilities (ID) suffer multimorbidity, polypharmacy and excess mortality at a younger age than general population. Those with ID and epilepsy are at higher risk of worse clinical outcomes than their peers without epilepsy. In the ID population the health profile of those aged ≥40 years can be compared to those a...
Poster
Full-text available
Background A high proportion of adults with intellectual disabilities (ID) are prescribed off-licence antipsychotics in the absence of a psychiatric illness primarily for behaviours that challenge (Batch). NHS England launched an initiative, ‘Stopping over-medication of people with a learning (intellectual) disability, autism or both’ (STOMP), to...
Article
Introduction: Autism, like other neurodevelopmental disorders (NDDs), has a strong association with epilepsy. There are known common genetic pathways in both autism and epilepsy. There are also specific genetic syndromes associated with both complex epilepsy and the autism phenotype. Areas covered: This review explores the evidence for common ge...
Article
The prescribing of psychotropic medications for people with an intellectual disability has changed. In many locations across England, antidepressants have become the most widely prescribed psychotropic. In the context of the current NHS England STOMP programme to reduce inappropriate psychotropic prescribing for people with intellectual disability,...
Article
Objectives: Intellectual disability (ID) and epilepsy are independent risk factors for osteoporosis. Diverse predisposing factors influence this, for example in ID, genetics and poor nutrition and in epilepsy, anti-seizure medication (ASM). Around 25% people with ID have epilepsy, majority treatment resistant. ASMs polypharmacy is common. However,...
Article
Epilepsy is more prevalent in individuals with intellectual disability (ID) compared to the general population, and this prevalence increases with increasing severity of ID. Epilepsy affects approximately 22% of people with ID, while 25% of people with epilepsy (PWE) have an ID. 1 [AQ1: Unable to locate the 25% statistic in the given reference, ple...
Book
Mortality rates in people with epilepsy are higher than expected, and epilepsy mortality rates in the United Kingdom, United States and the world are increasing. The causes for this increase in mortality rates are not well defined, however they may include increased reporting, increased prevalence, ineffective treatment of preventable risk factors,...
Article
There are many structural problems facing the UK at present, from a weakened National Health Service to deeply ingrained inequality. These challenges extend through society to clinical practice and have an impact on current mental health research, which was in a perilous state even before the coronavirus pandemic hit. In this editorial, a group of...
Article
Full-text available
Background To identify risk factors and characteristics for the repeated attendance at an emergency department (ED) following a seizure. Methods A retrospective cohort study was conducted using non-identifiable data of individuals attending ED at least twice between 2015 and 2018, following a seizure. Data were drawn from the patient administratio...
Article
Background There has been an increase in the development and application of serious games to support management of mental ill health, but their full impact is unclear. Aims Evaluation of the current evidence of acceptability and effectiveness of serious games in improving mental health disorders. Method A PRISMA-guided scoping review was conducte...
Article
Background Mental illness is commonly comorbid with epilepsy. In sub-Saharan Africa there exists limited access to neurological and psychiatric services predisposing to a “treatment gap” in epilepsy and mental healthcare. Aims To understand healthcare providers’ knowledge, attitudes, and management practices toward epilepsy and comorbid mental ill...
Article
Background In the United Kingdom, policy change has led to specialist intellectual disability inpatient bed reduction. Little evidence exists assessing the results for patients admitted to such units. This study evaluates the outcomes of a specialist intellectual disability inpatient unit. Method Gender/age/ethnicity/intellectual disability severi...
Preprint
Full-text available
Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people with drug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessful surgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted to determine the treatment effects of VNS Therapy as an adj...
Preprint
Full-text available
Vagus nerve stimulation (VNS) Therapy® is an adjunctive neurostimulation treatment for people with drug-resistant epilepsy (DRE) who are unwilling to undergo resective surgery, have had unsuccessful surgery or are unsuitable for surgery. A systematic review and meta-analysis were conducted to determine the treatment effects of VNS Therapy as an adj...
Article
BACKGROUND People with mild intellectual disability (ID) experience a higher prevalence of mental health (MH) problems in comparison to the general population, yet there is little consensus on the most appropriate type and nature of services for support and treatment for this specific group of individuals. OBJECTIVE The objective of this scoping re...
Article
Full-text available
Background Coronavirus disease 2019 (COVID-19) has had a disproportionate impact on people with intellectual disability (PwID). PwID are at higher risk of mental illness and receive psychotropic prescribing ‘off licence' also, to manage distress behaviour. The lockdown and reduction of multidisciplinary face-to-face appointments had an impact on ca...
Article
This seminar in epileptology addresses Learning Objective 6.1.4 of the International League against Epilepsy Curriculum: Demonstrate the ability to recognize and manage the special needs of persons with epilepsy (and Neurodevelopmental Disorders [NDDs]). The review identifies the essential competencies for neurologists working with people with epil...
Article
Background Around 25% of people with Intellectual Disability (PwID) have comorbid epilepsy with seizures in up to two-thirds being drug-resistant. Little is known of the general characteristics and prescribing practices to this population. Aim Describe and compare characteristics of two cohorts of PwID and epilepsy in two different countries to in...
Article
Full-text available
Background – Attention Deficit Hyperactivity Disorder (ADHD) is common among people with Intellectual disability (PwID). Suspecting ADHD in this clinically and cognitively complex and diverse group, given overlaps with psychiatric and behavioural presentations is difficult. Underdiagnoses and misdiagnoses leading to irrational polypharmacy and wors...
Preprint
BACKGROUND Electroencephalography (EEG) monitoring is a key tool in diagnosing and determining treatment for people with epilepsy; however, obtaining sufficient high-quality data can be a time-consuming, costly, and inconvenient process for patients and healthcare providers. Remote EEG monitoring has the potential to improve patient experience, dat...
Article
Background Oro-mucosal midazolam maleate (OMM) with suitable training to family and carers is being increasingly recognized as the treatment of choice to mitigate the development of status epilepticus in non-hospital community settings. There are no studies to describe the use, effectiveness, and suitable dosing of OMM in adults with epilepsy in co...
Article
Full-text available
Introduction Anti-seizure medications (ASMs) are commonly used to prevent recurring epileptic seizures, but around a third of people with epilepsy fail to achieve an adequate response. Vagus nerve stimulation (VNS) is clinically recommended for people with drug-resistant epilepsy (DRE) who are not suitable for surgery, but the cost-effectiveness of...
Article
Background: Ictal hypoxaemia is a feature seen in epileptic seizures, characterized by low oxygen saturations, increasing seizure prolongation risk and possibly contributing to sudden unexpected death in epilepsy (SUDEP). High flow oxygen is recommended in the management of seizures by UK’s National Institute of Health and Care excellence (NICE); h...
Article
Background UK wide Oromucosal Midazolam is used as an emergency treatment in community for seizures administered by family/carers with the right training. The Joint Epilepsy Council (JEC) UK which produced the training guidelines disbanded in 2016. Purpose Provide standards for basic epilepsy education and rescue medication (Midazolam) administrat...
Article
Full-text available
Background The effectiveness of adjunctive perampanel has not been systematically assessed in seizure types other than its approved indications of focal seizures and primary generalised tonic–clonic seizures (PGTCS) in idiopathic generalised epilepsies (IGEs).Objective We aimed to identify and review available evidence on outcomes with perampanel i...
Preprint
BACKGROUND Healthcare is shifting towards a more person-centred model, however, people with intellectual and developmental disabilities can still experience difficulties in accessing equitable healthcare. Given these difficulties, it is important to consider how principles such as empathy and respect can be best incorporated into health and social...
Article
Background: Health care is shifting toward a more person-centered model; however, people with intellectual and developmental disabilities can still experience difficulties in accessing equitable health care. Given these difficulties, it is important to consider how humanizing principles, such as empathy and respect, can be best incorporated into h...
Article
Introduction: Individuals with intellectual disability (ID) are at significant risk of developing emotional trauma and post-traumatic stress disorder (PTSD) due to altered neuropsychological functioning, increased chance of experiencing adverse life events, difficulty expressing emotions, diagnostic overshadowing and institutional failures. Eye Mov...
Article
Full-text available
Aims Differential attainment (DA) amongst Black and Minority Ethnic (BAME) medical students and postgraduate trainees including Psychiatry trainees has been extensively documented in medical education, with non-white medical students being 2.5 times more likely to fail high-stake examinations compared to their White counterparts. The Equality Act 2...
Article
Full-text available
Background A significant number of people with autism require in-patient psychiatric care. Although the requirement to adequately meet the needs of people with autism in these settings is enshrined in UK law and supported by national guidelines, little information is available on current practice. Aims To describe characteristics of UK in-patient...
Article
Objectives. There is emerging evidence that network/computer analysis of epileptiform discharge free electroencephalograms (EEGs) can be used to detect epilepsy, improve diagnosis and resource use. Such methods are automated and can be performed on shorter recordings of EEG. We assess the evidence and its strength in the area of seizure detection f...
Conference Paper
Full-text available
bstract Objective: To assess long-term incidence of psychiatric treatment-emergent adverse events (TEAEs) and suicidal ideation/behavior during Study 311 (NCT02849626), since both have been associated with anti-seizure medications (ASMs). Background: In the US, perampanel is approved for POS (adjunctive/monotherapy) in patients aged ≥4 years, and...
Article
Background: Lithium is well described in managing certain mental illnesses including in people with intellectual disabilities (ID). It requires regular monitoring particularly of serum levels and relevant biochemistry. However, existing monitoring protocols do not provide ID-specific guidance leading to increased risk of poor-quality care. This stu...
Article
About 30% of people with epilepsy (PWE) are drug-resistant. Those with focal seizures may be suitable for epilepsy surgery. Those not amenable to resective surgery can be considered for vagus nerve stimulation (VNS). However, after operative procedures, around 50% of patients continue to experience seizures. A multi-center retrospective study asses...
Article
Challenges to de-prescribe psychotropics in people with intellectual disability: The medical view. Rohit Shankar (1), Shoumitro (Shoumi) Deb (2) (1) CIDER, University of Plymouth, Truro, UK. (2) Imperial College, London, UK. Background: A significant proportion of adults with intellectual disability are prescribed off-licence antipsychotics in th...
Article
Background: Attention-deficit hyperactivity disorder (ADHD) is higher in people with intellectual disability (ID) compared to the general population. Available limited evidence suggests this population has increased psychological problems, diagnostic overshadowing and psychotropic prescribing. This audit Identifies and analyzes real-world character...
Article
People with neurodevelopmental disorders often present with challenging behaviours and psychiatric illnesses. Diagnosis and treatment require patients, families and healthcare professionals to work closely together in partnership, acknowledging their respective areas of expertise. Good treatment outcomes should also be underpinned by robust researc...
Preprint
Purpose There has been an increase in the development and application of serious games to support management of mental ill-health but the full impact of them is unclear. This paper evaluates the current evidence of acceptability and effectiveness of serious games in improving mental health disorders. Methods A PRISMA guided scoping review was con...
Article
Introduction The SUDEP and Seizure Safety Checklist (“Checklist”) is a risk factors Checklist based around a person with epilepsy (PWE) demographics, seizure, physical, psychological, and lifestyle issues. The Checklist provides a cumulative picture of current risk when applied to a PWE. This study compares and contrasts risk factors of PWE in prim...
Technical Report
Full-text available
Foreword Epilepsy is more common in people with a learning disability and/or autism than the general population. It is more likely to be difficult to control too. Seizures can have a profound impact on a person’s ability to live and enjoy their life. It also impacts on their level of learning disability and functional interaction with others. Poo...
Research Proposal
Full-text available
The objective of this review is to develop a synthesis of qualitative and quantitative research to: i) Identify the factors and constructs that impact differential attainment; ii) Rank them based on the recognised level of influence from identified literature; iii) Explore these factors and constructs to identify those that are facilitators and tho...
Article
Full-text available
Background A quarter of people with intellectual disability (ID) have epilepsy, compared to approximately one in a hundred across the general population. Evidence for the safe and effective prescibing of anti‐epileptic drugs (AEDs) for those with ID is however limited. Aims of Study This study seeks to strengthen the research evidence around Eslic...
Article
Full-text available
Differential attainment exists in all professions and is a manifestation of systemic factors creating an unequal environment where individual careers and aspirations may be thwarted. Although this inequality which affects some groups of students unfairly, has been recognised over the last 2 decades, it remains a significant issue. This scoping revi...
Article
Full-text available
The approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evi...
Article
Introduction Having a diagnosis of Down syndrome (DS) is associated with intellectual disability (ID), pervasive developmental disorders and Alzheimer’s dementia (AD). The association between these conditions has not been well evaluated. This paper looks to examine the current evidence pertaining to the relationship between dementia in people with...
Article
Full-text available
Background Rapid spread of coronavirus disease 2019 (COVID-19) has affected people with intellectual disability disproportionately. Existing data does not provide enough information to understand factors associated with increased deaths in those with intellectual disability. Establishing who is at high risk is important in developing prevention str...
Article
Full-text available
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 addres...
Article
Full-text available
Background Valproate (VPA) is a known teratogen associated with greater risk of major congenital malformations and other neurodevelopmental sequelae than all other licensed antiepileptic medicines. To reduce the potential for VPA‐related teratogenicity the European Medicines Agency issued recommendations in 2018. Over two‐thirds of women/girls with...
Article
Full-text available
Purpose People with Intellectual Disability (ID) and epilepsy are more likely to experience psychiatric conditions, challenging behaviour (CB), treatment resistance and adverse effects of anti-seizure medications (ASM) than those without. This population receives care from various professionals, depending on local care pathways. This study evaluate...
Article
Introduction ADHD causes significant distress and functional impairment in multiple domains of daily life. Therefore, diagnosis and treatment are important to improve the quality of life of people. The pharmacotherapy for ADHD is well established but needs systematic evaluation in Intellectual Disability (ID) populations. Areas covered This paper...
Article
Introduction People with learning disabilities in the United Kingdom are being incarcerated in hospital settings due to lack of suitable community care and support. Factors influencing discharge from institutional/hospital care to enable successful community living have not been explored systematically. Method A systematic review using the PRISMA...
Article
Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emot...
Article
Full-text available
Background There has been a recent rise in antidepressant prescriptions. After the episode for which it was prescribed, the patient should ideally be supported in withdrawing the medication. There is increasing evidence for withdrawal symptoms (sometimes called discontinuation symptoms) occurring on ceasing treatment, sometimes having severe or pro...
Article
Background Epilepsy prevalence is over 20% for those with ID. It is difficult to diagnose and treat and more likely to be treatment resistant. The evidence informing prescribing is sparse, particularly for new drugs such as Perampanel (PMP). Aims of the Study This study seeks to strengthen the research evidence regarding PMP for people with ID by...
Article
Purpose This study identifies epilepsy-related characteristics and SUDEP risk factors in people with epilepsy (PWE) attending an urban community ID service in the UK where managing epilepsy is not part of the service remit, to understand the care provided to this vulnerable population. Methods An electronic database search in a north London commun...
Article
Full-text available
The dibenzazepines particularly carbamazepine are associated with known adverse effects (AEs) and drug to drug interactions. Eslicarbazepine acetate (ESL) is structurally distinct from other members of the dibenzazepine family and has the advantage of once daily dosing. Observational and trial data report successful switching from older dibenzazepi...