A guide to psychopharmacological treatment of patients with intellectual disability in psychiatry

Abstract

Background Subjects with intellectual disability are at increased risk of having comorbid psychiatric disorders and worse response to psychotherapeutic and psychopharmacological treatment interventions. On the other hand, available data on best treatment approach in this population are scarce and lack scientific evidence due to methodological limitations. The present study aims to perform a systematic review of the literature to facilitate the use of psychotropic drugs in clinical practice and better establish future research targets in this field. Objectives To review the available psychopharmacological strategies for patients with intellectual disabilities, psychiatric disorders, and behavioural disturbances. Serve as a quick guide for clinicians working in the field of intellectual disability. Methods We conducted a selective evidence-based review of the literature using Pubmed and EMBASE databases and selected most recent and relevant papers for this review. Results There are several available psychotropic drugs for the treatment of patients with intellectual disability and comorbid psychiatric disorders, although scientific evidence is limited. Treatment should be individualized according to risk-benefit balance. Discussion Further studies are needed and new available drugs should be considered to gain knowledge in effectiveness of different therapeutic approaches available in this population.

Prevalence of co‐occurring psychiatric disorders in adults and adolescents with intellectual disability: A systematic review and meta‐analysis

“…Very little scientific research has been reported regarding the safety and efficacy of psychoactive drugs for subjects with intellectual disability (Molina‐Ruiz et al, ; Reiss & Aman, ). It is known that subjects with intellectual disability tend to develop side effects with standard doses of medication, to have side effects overshadowed and to show a worse response to psychotherapeutic and psychopharmacological treatment (Molina‐Ruiz et al, ; Reiss & Aman, ).…”

“…Very little scientific research has been reported regarding the safety and efficacy of psychoactive drugs for subjects with intellectual disability (Molina‐Ruiz et al, ; Reiss & Aman, ). It is known that subjects with intellectual disability tend to develop side effects with standard doses of medication, to have side effects overshadowed and to show a worse response to psychotherapeutic and psychopharmacological treatment (Molina‐Ruiz et al, ; Reiss & Aman, ). To improve the outcome of the treatment in this population, it was suggested to use the most effective minimal dose, to continue the psychiatric assessments, to monitor the side effects and to augment the treatment with behavioural interventions (Leon, Greenlee, Barber, Sabaawi, & Singh, ).…”

“…Comorbid psychiatric disorders in intellectual disability affect the overall management with implication in the individual's life, in their caregiver's burden, in psychopharmacological and psychological treatment, and in service providers (Maes, Broekman, Dosen, & Nauts, ; Molina‐Ruiz, Martín‐Carballeda, Asensio‐Moreno, & Montañés‐Rada, ; Morgan, Leonard, Bourke, & Jablensky, ). Epidemiological studies suggest that psychiatric disorders afflict around 17% of the general population (Steel et al, ) and 40%, approximately double, of subjects with intellectual disability (Deb, Thomas, & Bright, ; Smiley, ).…”

Successful diagnosis of attention deficit hyperactivity disorder in later life of an adult with intellectual disability: A case report

“…Potential side effects associated with stimulant medications in adults with ADHD include poor appetite with weight loss, insomnia, nervousness, a mild increase in pulse and blood pressure, increased motor activities including tics and unwanted psychiatric effects such as irritability, dysphoria and social withdrawal (Molina‐Ruiz et al, 2017; Tarrant et al, 2018). In regular follow‐ups with Mary, she has not experienced any of these side effects.…”

Adult Intellectual Disability and Psychiatry: Current Situation in Turkey and the World

“…Bu nedenle genel prensip, küçük dozlarla başlayıp, yavaş ilerlemek ve çoklu ilaç kullanımından kaçınmaktır. Genel olarak elimizdeki kanıtlar çok yetersiz olduğundan, farmakolojik müdahaleler risk-yarar analizi yaparak, kişi bazında planlanmalıdır (33) .…”