International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

Abstract

Intellectual disability (ID) or mental retardation or learning disability is a lifelong condition included in the group of mental disorders in all the international classification systems. It is a syndrome grouping (meta-syndrome) including a heterogeneous range of clinical conditions characterized by a deficit in cognitive functioning prior to the acquisition of skills through learning (1). Over 30% of people with ID have a comorbid psychiatric disorder, which often has its onset in childhood and persists through adolescence and adulthood (2,3).In spite of this evidence, ID and related conditions are still considered a marginal area of psychiatry. In many countries there is little or no training provision on ID during undergraduate medical training or psychiatric specialization. The World Health Organization (WHO) has recently highlighted the unmet care needs of persons with ID (4). Psychiatrists are the first health professionals in contact with this population group and there is a global gap in training and guidelines on mental health issues related to ID.Within the ID field, the assessment, differential diagnosis and treatment of problem behaviours (PBs) deserve special attention. The rate of PBs in people with ID is high (5) and their presentation is determined by many complex factors. The pathogenic contribution of organic conditions, psychiatric disorders, environmental influences, or a combination of these has to be carefully established for every single case.The prevalence of PBs in people with ID seems to be sufficiently high (5,6) to constitute a major concern in this population. Depending on the definition and methodology, rates have been reported to vary from 5.7 to 17% (7-10). Using the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities (DC-LD) (11), Cooper et al (12,13) aggression and self-injurious behaviour to be 9.8% and 4.9%, respectively, among adults (16 years and over) with ID in a community setting.It has been reported that 20-45% of people with ID are receiving psychotropic medication and 14-30% are receiving psychotropic medication to manage PBs such as aggression or self-injurious behaviours (14,15) in the absence of a diagnosed psychiatric disorder. Examples of psychotropic medications used for adults with ID are antipsychotics, antidepressants, anti-anxiety drugs (benzodiazepines, buspirone, beta-blockers), mood stabilizers (lithium, anticonvulsants), psychostimulants, and opioid antagonists. Spreat et al (16) reported that as many as two thirds of psychotropic medications prescribed to people with ID are antipsychotics.Studies suggest that PBs are not only prevalent but also persistent in people with . Totsika et al (20) found that serious physical attacks, self-injury and stereotypy were the most likely types of PBs to persist over time. It is therefore suggested that it may be necessary to start interventions as early as possible to prevent the behaviours from becoming more serious and to reduce the number of emergent behaviours. It has...

Intellectual developmental disorders: towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD‐11

“…They are frequently misdiagnosed, are associated with poor access to health care services, and involve very high costs for the health care system and for society as a whole (6)(7)(8)(9)(10). In spite of these facts, IDD are largely disregarded in the mental health sector, where Luis saLvador-CaruLLa 1,2 , Geoffrey M. reed 3 , LeiLa M. vaez-azizi 4,5 , saLLy-ann Cooper 6 , rafaeL Martinez-LeaL 1 , MarCo BerteLLi 2,7,8 , CoLLeen adnaMs 9 , sherva Cooray 10 , shouMitro deB 2,11 , LeyLa akoury-dirani 12 , satish Chandra GiriMaji 13 , GreGorio katz 14 , henry kwok 2,15 , (11,12).…”

Recognition of intellectual disabilities and autism in psychiatric inpatients diagnosed with schizophrenia and other psychotic disorders

“…Absence of such will contribute to the current overuse of psychotropic medication in this population, and the underutilization of alternate effective therapies and interventions (Deb et al, 2009;Bradley and Cheetham, 2010). Our findings have implications for the training of staff who diagnose psychiatric disorders and prescribe medications for this population and point to the need for specialised resources (e.g.…”

Prescribing psychotropic drugs to adults with an intellectual disability

“…Despite the widespread prescribing of psychotropic drugs to treat challenging behaviour in the absence of a defined mental illness, 3 there is little robust evidence to justify this practice. SSRIs are the recommended first-line drugs.…”