A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study

Sheehan, Rory; Strydom, André; Marston, Louise; Morant, Nicola; Fiori, Federico; Santosh, Paramala; Hassiotis, Angela

doi:10.1136/bmjopen-2019-033827

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…Eight papers referenced the NICE guidelines in the introduction and/or discussion and often in support of the rationale for the research [ 2 , 17 , 28 , 35 , 37 , 45 , 61 , 62 ]. The NICE guidelines emphasize that antipsychotic medications should not be used to treat problem behaviour unless other non‐pharmacological approaches have been tried and failed and the person with ID or others are at serious risk of harm.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies describing dose reduction or cessation of psychotropic medications were identified [ 2 , 17 , 41 , 43 , 61 , 65–73 ] with one of these being a systematic review [ 17 ]. Two papers produced medication review tools for use by healthcare professionals [ 62 , 74 ].…”

Section: Resultsmentioning

confidence: 99%

“…The tool comprised measures of therapeutic benefits and adverse side effects. Seventy-nine people with ID were recruited and a total of 97 medication reviews were carried out over a 6-month study period and said it helped people with ID or their carers become more involved and promoted a collaborative decision-making process [ 62 ]. Another medication review too called “Systematic Tool to Reduce Inappropriate Prescribing” (STRIP) has also been found to be useful in identifying drug-related problems in people with ID.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…Precision medicine is currently considered the future (and in part also the best present form) of psychiatric medicine practice for both inpatients and outpatients (Hampel et al, 2023; Keshavan and Clementz, 2023). The proposed interventions that would move current practice closer to the stated goals of precision medicine are many and varied, but therapy personalisation and optimisation are among the most important ones (Sheehan et al, 2019; De Leon, 2021). Both of these goals can be achieved by the implementation of suitable therapeutic drug monitoring (TDM) practices (Mandrioli et al, 2020), with the determination of drug and metabolite levels at regular intervals, their comparison to established or tentative reference ranges for efficacy or toxicity or both, and the execution of clinical decisions on drug posology and drug choice based on those chemical-clinical correlations (CCC) (Qu et al, 2022; Mercolini et al, 2023).…”

mentioning

confidence: 99%

Microsampling for therapeutic drug monitoring in psychiatric practice

Protti

Mandrioli

Mercolini

2023

International Clinical Psychopharmacology

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Caring for Adults With Significant Levels of Intellectual Disability in Outpatient Settings: Results of a National Survey of Physicians

Campbell

Rao

Ressalam

et al. 2022

American Journal on Intellectual and Developmental Disabilities

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Between 1% and 2% of the U.S. population has an intellectual disability (ID) and often experience disparities in health care. Communication patterns and sedation use for routine medical procedures are important aspects of care for this population. We explored physicians' communication patterns and sedation use in caring for patients with significant levels of ID through a mailed survey of 1,400 physicians among seven specialties in outpatient settings (response rate = 61.0%). Among physicians who saw at least one patient with significant levels of ID in an average month, 74.8% reported usually/always communicating primarily with someone other than the patient. Among specialists, 85.5% (95% CI: 80.5%–90.5%) reported doing so, compared to 69.9% (95% CI: 64.4%–75.4%) for primary care physicians (p < 0.001). Also, 11.4% reported sedating at least one patient with significant levels of ID for a routine procedure. Three quarters of physicians reported communicating primarily with persons other than the patient usually or always—an approach that, in some instances, may not align with best medical practice. The percentage of physicians who report sedating at least one individual is associated with significant ID and the physician's volume of patients with significant ID.

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A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study

Cited by 3 publications

References 23 publications

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

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

Microsampling for therapeutic drug monitoring in psychiatric practice

Caring for Adults With Significant Levels of Intellectual Disability in Outpatient Settings: Results of a National Survey of Physicians

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