A Critical Appraisal of Recent Drug Research in Mental Retardation: The Coldwater Studies

Aman, Michael G.; Singh, Nirbhay N.

doi:10.1111/j.1365-2788.1986.tb01315.x

Cited by 14 publications

(8 citation statements)

References 22 publications

(15 reference statements)

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“…Even where a given behaviour problem was manifested, only a minority of people were administered a major tranquillizer, a fact which accounts for the non-significant associations between administration of a drug and report of the behaviour problem. In a 'low fiinctioning' group, defined as those requiring significant staff assistance with almost all functional skills, though not necessarily with profound intellectual disability and multiple impairments, a figure of 36% prescription of major tranquillizers has been reported, though this sample lived in community residential facilities in the USA, not in family homes (Aman & Singh, 1986). The present figures approximate to others (Aman et al, 1985) in which sample members did live at home.…”

Section: Major Tranquillizersmentioning

confidence: 48%

“…Nevertheless, '...a growing feeling in the field against the use of psychotropic medication ... an anti-drug sentiment' (Aman & Singh, 1986, p. 203) has evolved over the past decade. This critical reaction refiects several concerns, notably: (1) the legitimacy of extrapolating from treatment of adult psychiatric disorders to behaviour problems in children (and adults) with intellectual disability (Kieman, 1990); (2) limited evidence of success in achieving behavioural control (Aman & Singh, 1986);…”

Section: Major Tranquillizersmentioning

confidence: 99%

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The administration of psychotropic and anticonvulsant drugs to children with profound intellectual disability and multiple impairments*

Hogg

1992

J intellect Disabil Res

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A national (England and Wales) postal survey of families with a son or daughter with profound intellectual disability and multiple physical and sensory impairments who lived at home was undertaken. A section ofthe questionnaire dealt widi prescription of major tranquillizers, drugs with a sedative function, anticonvulsants and stimulants, while among other variables information was also collected on sex, age, behaviour problems, sleep difficulties and epilepsy. Of children and adults: 5.3 and 7.9%, respectively, were receiving major tranquillizers; 28.5 and 24.5%, respectively, were prescribed drugs with a sedative function; and 53.4 and 52.7% were in receipt of anticonvulsants, with no individuals in receipt of stimulants. Only 1–5% ofthe total sample received major tranquillizers, drugs with a sedative function and anticonvulsants, though 18.9% were prescribed drugs from two classes, notably drugs with a sedative function and anticonvulsants. In all, 66.3% ofthe combined child and adult samples received at least one drug from the classes investigated. No sex bias in prescribing was found. Receipt of major tranquillizers bore some relation to reported behaviour problems, while administration of sedatives and anticonvulsants were related respectively to reports of sleep problems and occurrence of epilepsy.

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Section: Major Tranquillizersmentioning

confidence: 48%

Section: Major Tranquillizersmentioning

confidence: 99%

The administration of psychotropic and anticonvulsant drugs to children with profound intellectual disability and multiple impairments*

Hogg

1992

J intellect Disabil Res

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“…A wide variety of trial designs were evident, encompassing pragmatic trials [ 33 , 50 , 51 ] to randomized placebo-controlled trials [ 52 , 53 ]. Four review articles were also included [ 11 , 42 , 54 , 55 ]. This section describes studies reporting the effectiveness of psychotropic medication to reduce behavioural and/or psychiatric symptoms and reporting of adverse effects; with discontinuation or reduction of psychotropic medication explored in research question 5.…”

Section: Resultsmentioning

confidence: 99%

Management of psychotropic medications in adults with intellectual disability: a scoping review

et al. 2022

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Background/objective(s) Psychotropic medications are commonly prescribed among adults with intellectual disability, often in the absence of a psychiatric diagnosis. The aim of this scoping review is to provide an overview of the extent, range, and nature of the available research on medication use and practices and medication management in people with intellectual disability taking psychotropic medications for behaviours that challenge. Materials and methods A scoping review of research studies (qualitative, quantitative, and mixed design) and Grey Literature (English) was carried out. Databases included: Ovid MEDLINE, Embase, CINAHL, JBI Evidence Synthesis, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Scopus. A three-step search strategy was followed, with results screened by two independent reviewers. Data was extracted independently by two reviewers using a data extraction tool with results mapped and presented using a narrative form supported by tables and diagrams to the research questions. Results Following the removal of duplicates, records were screened, full texts assessed, and 49 studies were included. Medication outcomes included reduced repetitive, stereotypic, and/or aggressive behaviours. High dosing/prescribing in the setting of an absent/unclear clinical indication was associated with worsening of symptoms for which psychotropics were prescribed. While psychotropics had a role in managing behaviours that challenge, reducing or discontinuing psychotropics is sometimes warranted. Study designs were frequently pragmatic resulting in small sample sizes and heterogeneous cohorts receiving different doses and combinations of medications. Access to multidisciplinary teams, guidelines, medication reviews, staff training, and enhanced roles for carers in decision-making were warranted to optimize psychotropic use. Conclusions These findings can inform prescribing interventions and highlight the need for timely and comprehensive patient outcome data, especially on long-term use of high doses of psychotropics and what happens when reduce or stop prescribing these doses. KEY MESSAGES Psychotropic medications are frequently prescribed for people with intellectual disabilities, often at high doses and these medications are associated with both positive and negative patient outcomes. Work to rationalize psychotropic use has been reported with interventions aiming to reduce polypharmacy or deprescribe a single psychotropic medicine. These interventions had mixed success and risk of relapse was documented in some studies. Limitations in sample size and heterogenous patient cohorts make it challenging to understand the risks and benefits associated with reducing or stopping psychotropic medicines. Patient, carer, and clinician partnerships...

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“…It is important to note that 34"4% of the total publications in the psychopharmacology of the mentally handicapped between 1978 and 1985 were by Breuning and some state governments had been influenced by these publications to amend their guidelines on medication. Aman & Singh (1986) reviewed Breuning's findings which were: (1) that neuroleptics interfered with behaviour therapy; (2) that IQ increased when such drugs were stopped; (3) that drugs undermined all rehabilitative programmes; and (4) that they interfered with adaptive behaviour. Aman & Singh questioned these findings 'despite what initially appeared to be an unusual level of methodological elegance.…”

Section: Ben Sacks (Gharing Gross and Westminster Medical School) Addrementioning

confidence: 99%

Part Ii

1987

J intellect Disabil Res

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A Critical Appraisal of Recent Drug Research in Mental Retardation: The Coldwater Studies

Cited by 14 publications

References 22 publications

The administration of psychotropic and anticonvulsant drugs to children with profound intellectual disability and multiple impairments*

The administration of psychotropic and anticonvulsant drugs to children with profound intellectual disability and multiple impairments*

Management of psychotropic medications in adults with intellectual disability: a scoping review

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