Effects of controlled discontinuation of long‐term used antipsychotics for behavioural symptoms in individuals with intellectual disability

Abstract

Background Antipsychotics are frequently and often long-term used for challenging behaviour in persons with intellectual disability (ID), but the evidence base for this is meagre. As these agents may cause harmful side effects, discontinuation should be considered. Previous studies regarding discontinuation of long-term used antipsychotics mostly were uncontrolled and involved small numbers. The primary objective was to investigate the effects of controlled discontinuation of antipsychotics prescribed for challenging behaviour. Secondary objectives were to compare the results of two discontinuation time schedules, to compare groups of participants who had and had not achieved complete discontinuation, and to identify patient and medication characteristics that might predict the outcomes. Our hypothesis was that discontinuation of antipsychotics used for behavioural symptoms would not lead to worsening in behaviour. Methods This was a multi-centre parallel-group study comparing two discontinuation schedules of 14 and 28 weeks. Allocation to the two discontinuation schedules took place in a 1:1 ratio. Antipsychot-

Aetiology Based Diagnosis and Treatment Selection in Intellectually Disabled People with Challenging Behaviours

“…This is affirmed by the results of the only placebo controlled study with haloperidol and risperidone showing the largest effect on challenging behaviours of placebo [109]. Furthermore, controlled discontinuation of antipsychotics prescribed for behavioural symptoms over multiple years has demonstrated improved behavioural functioning and amelioration of metabolic parameters [110][111][112]. In fact, challenging behaviours may even be the first and only manifestation of motor or autonomic side effects of psychotropics e.g.…”

Primary Care for Adults on the Autism Spectrum

“…For antipsychotics prescribed for challenging behavior in adults with intellectual disability, discontinuing them is associated with improved behavioral function. 54 Although autism-specific data are not available, studies suggest that the use of antipsychotic medication is not cost-effective for adults with intellectual disability. Despite weak evidence to support the practice, long-term antipsychotic medications are frequently prescribed for autistic individuals.…”

Discontinuing Psychotropic Drugs from Participants in Randomized Controlled Trials: A Systematic Review

“…Similarly, 12 of 80 trials commented on environmental influences on discontinuation such as “caregiver distress and shortness of available staff time” [23]), but only 2 (discontinuing APs from residents with intellectual disability) assessed such variables, reaching opposite conclusions: “[C]hanges in environmental circumstances were of no influence on completion or non-completion of ... discontinuation” [24] and “[D]ifferences [between successfully or unsuccessfully drug-reduced participants] were apparent ... mainly in staff and environmental characteristics” [25]. …”