Psychotropic medications use and side effects of individuals with intellectual and developmental disabilities

Charlot, Lauren R.; Doerfler, Leonard A.; McLaren, Jennifer

doi:10.1111/jir.12777

Cited by 11 publications

(4 citation statements)

References 35 publications

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“…CAP PDs reported that their residents saw a slightly increased number of patients with ASD; however, patient numbers did not change for ID. Overall, the observed gaps in CAP and GEN training are concerning, since skilled psychiatrists are needed to work with both children and adults with ASD/ID, given persistently elevated psychiatric comorbidity (Lever & Geurts, 2016), sensitivity to medication side effects (Charlot et al, 2020), and, for ASD, the challenge of delayed diagnosis (Fusar-Poli et al, 2022). Deficits in ASD/ID training may lead graduating psychiatry residents to feel inadequately prepared and poorly motivated to routinely treat these patients (Werner et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Psychiatry training in autism spectrum disorder and intellectual disability: Ongoing gaps and emerging opportunities

Marrus

Koth

Hellings

et al. 2022

Autism

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Autism spectrum disorder and intellectual disability are associated with psychiatric comorbidities, yet a 2009 study of US child and adolescent psychiatry program directors indicated that psychiatry residents receive insufficient training in autism spectrum disorder/intellectual disability. This follow-up study surveyed child and adolescent psychiatry and general psychiatry program directors to assess (1) the current extent of residency training in autism spectrum disorder/intellectual disability, (2) program director perceptions of educational topics and resident competency in autism spectrum disorder/intellectual disability, and (3) preferred resources to strengthen autism spectrum disorder/intellectual disability training. As in 2009, many child and adolescent psychiatry program directors reported few lecture hours, although current child and adolescent psychiatry residents saw slightly more patients with autism spectrum disorder but not intellectual disability. General psychiatry program directors reported fewer lecture hours in autism spectrum disorder/intellectual disability and fewer patients with autism spectrum disorder than child and adolescent psychiatry program directors. Both child and adolescent psychiatry and general psychiatry program directors recognized the importance of a range of educational topics in autism spectrum disorder/intellectual disability. Child and adolescent psychiatry program directors reported higher resident competency, and lecture hours and patients seen moderately correlated with resident competency. Program directors indicated that online videos and other resources would help improve autism spectrum disorder/intellectual disability training in their programs. Collectively, these findings suggest minimal improvements in autism spectrum disorder/intellectual disability training over the past decade and highlight the urgent need to advance psychiatry training in this field through dissemination of resources. Lay abstract Children, adolescents, and adults with autism spectrum disorder and intellectual disability experience high rates of co-occurring psychiatric conditions throughout their lifetime. However, there is a shortage of psychiatrists to treat these populations. We evaluated how much education psychiatrists-in-training receive on how to care for individuals with autism spectrum disorder/intellectual disability. We found that in many psychiatry programs, residents receive limited training experiences in autism spectrum disorder/intellectual disability involving lectures and patient contact and that psychiatry program directors would benefit from more resources to strengthen education in autism spectrum disorder/intellectual disability.

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Section: Discussionmentioning

confidence: 99%

Psychiatry training in autism spectrum disorder and intellectual disability: Ongoing gaps and emerging opportunities

Marrus

Koth

Hellings

et al. 2022

Autism

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“…However, BtC is often treated with antipsychotics and prescribed long-term in the absence of a valid psychiatric diagnosis [ 12 , 13 ] despite the lack of evidence for its long-term effectiveness for BtC [ 14 , 15 , 16 , 17 ]. Moreover, PwID are vulnerable to the side effects of antipsychotics, especially neurological side effects, such as movement disorders; sedation/sleepiness; and metabolic side effects, such as obesity and diabetes [ 15 , 18 , 19 , 20 ]. Therefore, it is important to balance the pros and cons of antipsychotic use carefully and to discontinue them when there is no longer a valid indication, especially in the case of BtC [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Withdrawing Antipsychotics for Challenging Behaviours in Adults with Intellectual Disabilities: Experiences and Views of Experts by Experience

Kuijper

Haan

Shankar

2022

IJERPH

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People with intellectual disabilities (PwID) are frequently prescribed long-term antipsychotics for behaviours that challenge (BtC) despite the lack of proven effectiveness and the increased risks for side effects of these medications in this population. National and international good clinical practice guidelines recommend deprescribing antipsychotics for BtC, which is often not successful due to environmental and other factors. The involvement of all stakeholders, including PwID, is crucial for deprescribing. However, studies showed that PwID and/or their families are often not involved in decision-making regarding the (de)prescribing of antipsychotics despite their desire to get involved. Moreover, studies on the views of PwID regarding their experiences of withdrawing from antipsychotics are lacking. The aim of this study was to gain insight into the views of PwID by investigating their experiences of discontinuation of long-term prescribed antipsychotics for BtC. A qualitative study was set up. Seven experts by experience with mild intellectual disabilities were interviewed. After six interviews, data saturation was achieved. Interviews were transcribed verbatim. Using phenomenological analysis, themes on lived experiences were extracted. Each consecutive interview was analysed. The four main themes extracted from the interviews were the quality of treatment, knowledge and information about psychotropics and the process of withdrawal, support from the participants’ environment and the coping style of the interviewees themselves.

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“…Polypharmacy, in turn, may be associated with added medical problems that provoke challenging behaviours (Charlot et al ., 2011). Additionally, people with IDD appear to suffer high rates of medication side effects, in some cases more so than others without a developmental disability (Charlot et al ., 2020; Sheehan et al ., 2017). Other studies highlight very high rates of emergency psychiatric service use among a subset of the population (Beasley et al ., 2018; Iannuzzi et al ., 2021; Lauer et al ., 2021).…”

Section: Introductionmentioning

confidence: 99%

Psychiatric diagnostic dilemmas among people with intellectual and developmental disabilities

Charlot

Hodge

Holland

et al. 2022

J intellect Disabil Res

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Background Research regarding the accuracy of co‐morbid psychiatric diagnoses in individuals with intellectual and developmental disabilities (IDD) is sparse. Yet correct diagnostic assignment is vital so that effective and appropriate treatment can be implemented, especially for the large numbers of individuals requiring expensive and restrictive behavioural health crisis services. Method A retrospective review of de‐identified data from multidisciplinary specialty team assessments completed for 50 individuals with ID (IntellectualDisability) with and without ASD and unresolved behavioural health challenges was conducted. The accuracy and reliability of the psychiatric diagnoses upon referral were compared with the diagnoses after the comprehensive team evaluation, and within‐individual diagnostic agreement was calculated. The agreement between the Mood and Anxiety Semi‐Structured interview tool (MASS) and the full team evaluation was also calculated. The influence of demographic and clinical characteristics on diagnostic agreement was explored. Results The most common chief complaints upon referral were aggression to others and self‐injurious behaviour. Individuals were taking a median of six medications (interquartile range: 5 to 7); 80% were taking an antipsychotic medication. The most common medical conditions were constipation (70%) and gastroesophageal reflux disease (52%). Measures of interrater reliability of the referral diagnoses with the team assessment were below 0.5 (kappa range: −0.04 to 0.39), with the exception of ruling out dementia (kappa = 0.85). The interrater reliability estimates for the MASS evaluations for depression and anxiety were higher (kappa = 0.69 and 0.64) and reflected higher sensitivity and PPV. The odds of any referral diagnosis being confirmed by team evaluation were low: 0.25 (range: 0 to 0.67). The level of diagnostic agreement for each patient was not significantly attributable to demographic or clinical characteristics, although effect sizes indicate a possible positive relationship to age and the number of prescribed psychotropic medications at referral. Conclusion Individuals in the current study had serious psychiatric and behavioural problems despite psychiatric care in their communities. The majority of psychiatric diagnoses provided upon referral were not supported by the multidisciplinary specialty team's assessment. In addition to possible diagnostic inaccuracy, the group in the study suffered from multiple medical co‐morbidities and were exposed to polypharmacy. Results emphasise the importance of multidisciplinary evaluation by clinicians with expertise in neurodevelopmental disabilities when people with ID with and without ASD have complex behavioural health needs that are unresponsive to usual care. In addition, based on agreement with the full team evaluation, the MASS shows promise as an assessment tool, especially with regards to identifying anxiety and depression.

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Psychotropic medications use and side effects of individuals with intellectual and developmental disabilities

Cited by 11 publications

References 35 publications

Psychiatry training in autism spectrum disorder and intellectual disability: Ongoing gaps and emerging opportunities

Psychiatry training in autism spectrum disorder and intellectual disability: Ongoing gaps and emerging opportunities

Withdrawing Antipsychotics for Challenging Behaviours in Adults with Intellectual Disabilities: Experiences and Views of Experts by Experience

Psychiatric diagnostic dilemmas among people with intellectual and developmental disabilities

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