Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour

Abstract

To our knowledge, this is the first ever comprehensive follow-up study of use of psychotropic medications in general but antipsychotics in particular over a 6-month period in adults with ID and aggressive behaviour, in a clinic-based community setting which also compared the trajectory of severity of aggressive behaviour with that of antipsychotic medication dose. Our study shows that not only the use of psychotropic medication is common among adults with ID who attend psychiatric clinics for aggressive behaviour, the use of polypharmacy of psychotropic medications in general and high dose of antipsychotics in particular are equally prevalent. However, in some cases two antipsychotics may have been prescribed simultaneously as the psychiatrist is in the process of switching from one to another.

Trauma and Life Events in Adults with Intellectual Disability

“…Where behaviour is framed as problematic or challenging, an individual may be viewed only as a perpetrator rather than having been a victim in the past, and so, management may be more punitive than therapeutic for example with seclusion, restraints [38,39], being moved to out of area placements [37] and medication. Anti-psychotics are used extensively with people with intellectual disabilities [40], often controversially to manage behaviour where no underlying diagnosis such as PTSD has been identified and with limited evidence base for their clinical or cost-effectiveness [41,42]. Medication also has side effects [43], and its use may mean that potentially effective treatment is delayed [44•].…”

From the EBM pyramid to the Greek temple: a new conceptual approach to Guidelines as implementation tools in mental health

“…Antipsychotics are often prescribed by family physicians in Ontario . Available studies provide insufficient evidence to support such off-label prescribing practices (Deb et al 2015). In addition, EBM neither elucidates factors that influence clinical decisions to start or continue such prescriptions nor does it assist clinicians or consumers in determining, whether the benefits of prescribing antipsychotic medications outweigh its burdens and risks (e.g., sedation and metabolic syndrome).…”

Prescribing psychotropic drugs to adults with an intellectual disability

“…16 Given the serious cardiometabolic and other adverse effects associated with many psychotropic drugs, all prescriptions for challenging behaviour should be carefully rationalised and should meet the criteria outlined in current consensus guidelines. 17,18 Where practical, psychotropic prescribing for challenging behaviour should occur under specialist supervision, and only when:…”