Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems

Scheifes, Arlette; Egberts, Toine C. G.; Stolker, Joost J.; Nijman, Henk; Heerdink, Eibert R.

doi:10.1111/jar.12183

Cited by 35 publications

(57 citation statements)

References 32 publications

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“…There is also significant variation in the reported prevalence of psychotropic polypharmacy, with prevalence rates reported from 22% to 40% (O'Dwyer et al 2017;Lunsky and Modi 2018). This is consistent with the range of reported psychotropic prescribing rates in the literature varying from 25% to 89% (Deb et al 2015; Scheifes et al 2016;Bowring et al 2017b). The high degree of reported variance in psychotropic prescribing rates and polypharmacy in general is a consequence of the heterogeneity of polypharmacy definitions (Masnoon et al 2017), weak analytical approaches (Stortz et al 2014) and convenience or clinic sampling being used in most studies (Haider et al 2014;Stortz et al 2014;Bowring et al 2017b).…”

Section: Introductionsupporting

confidence: 71%

“…Given we found no significant relationship with a psychiatric diagnosis over the life course, it is theoretically possible that these classifications of drugs are prescribed in higher doses in response to other factors such as challenging behaviour. This 'off label' prescribing is a well-documented phenomenon with adults with ID (Gomes et al 2019;Perry et al 2018;Bowring et al 2017b;Scheifes et al 2016;Sheehan et al 2015;Deb 2015;Doan et al 2013).…”

Section: Discussionmentioning

confidence: 99%

“…The varying evidence in the literature demonstrates a further need to focus on designing prospective studies that examine the prevalence and predictors of polypharmacy and psychotropic polypharmacy using standardised definitions. Nevertheless, there are more immediate modifiable factors that can be addressed such as undertaking medication reviews (Scheifes et al 2016;Nabhanizadeh et al 2019) and identifying medication combinations that potentially result in drug-drug interactions in adults who are exposed to polypharmacy. The interruption of prescribing cascades is an important and actionable opportunity to improve the health, well-being and quality of life of people with an ID (Rochon and Gurwitz 2017).…”

Section: Implications For Practicementioning

confidence: 99%

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Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross‐sectional total population study

McMahon

Hatton

Bowring

2020

J intellect Disabil Res

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Background Adults with intellectual disability (ID) are prescribed high levels of medication, with polypharmacy and psychotropic polypharmacy common. However, reported rates vary between studies, and there has been an over-reliance on obtaining data from convenience samples. The objective of this study was to determine the prevalence of medication use and polypharmacy in a population-level sample of adults with IDs. Factors associated with polypharmacy and psychotropic polypharmacy are explored. Methods We used a total population sample of 217 adults with IDs known to services in Jersey (sampling frame n = 285). The Anatomical Therapeutic Chemical classification system was used to categorise medications that participants were currently taking on a regular basis. We examined associations of polypharmacy and psychotropic polypharmacy with socioeconomic status, health and demographic variables using univariate and multivariate analyses. Results A total of 83.4% of participants were prescribed medication, with high doses common. Of the participants, 38.2% were exposed to

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Section: Introductionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Implications For Practicementioning

confidence: 99%

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Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross‐sectional total population study

McMahon

Hatton

Bowring

2020

J intellect Disabil Res

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“…Research has indicated that individuals with ID and CB are prescribed with more psychotropic medications than those without CB [60][61][62][63][64][65][66][67], despite little evidence of clinical benefit [68][69][70] where mental health issues are not present. There are significant side effects of these medications with weight gain, somnolence, metabolic syndromes, and behavioural impacts being reported [66,[70][71][72][73][74]. High rates of psychotropic medication use (49% [23]; 38% [60]) are a major issue for people with ID and CB, and medication reduction should be a priority area for services.…”

Section: The Association Between Cb and Psychotropic Medicationmentioning

confidence: 99%

“…Fourthly, we represented the additional use of psychotropic medication as an outcome of CB and have included the effects of psychotropic medication as feeding back into additional vulnerability for CB. The physical and behavioural side effects described above [66,[70][71][72][73][74] may also have a cyclical impact on biological vulnerabilities for CB, hence we have included a feedback loop into biological vulnerabilty factors.…”

Section: A Revised Framework Model For Cbmentioning

confidence: 99%

Prevalence of Challenging Behaviour in Adults with Intellectual Disabilities, Correlates, and Association with Mental Health

Bowring

Painter

Hastings

2019

Curr Dev Disord Rep

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Purpose of Review To summarise findings about the prevalence and correlates of challenging behaviour in adults with intellectual disabilities from robust research. We also describe findings on the interplay between challenging behaviour and mental health. Recent Findings Recent studies that have utilised psychometrically evaluated tools, with clear operational definitions, show similar findings on the prevalence of challenging behaviour of about 1 in every 5-6 adults known to services. We describe common correlates identified such as communication impairments, severity of intellectual disability, and living in institutional settings or congregate care. We also describe the complex and multifaceted relationship between challenging behaviour and mental health. Summary Based on recent studies, we propose a revised framework model to help understand challenging behaviour. We propose a number of areas where more research is required, particularly the development of risk tools clinicians can utilise in practice. Keywords Intellectual disability. Challenging behaviour. Prevalence. Correlates. Risk factors. Mental health This article is part of the Topical Collection on Intellectual Disabilities

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Pain interventions in adults with intellectual disability: A scoping review and pharmacological considerations

Lonchampt

Gerber²,

Aubry³

et al. 2020

European Journal of Pain

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Background and Objective Having to deal on a daily routine with prescriptions in adults with intellectual disability (ID), we systematically reviewed the literature on the specificities of pain interventions in that population, focusing on medication and trying to gather practical information on appropriate pain treatments. Given the scarcity of the literature on the topic, we also discussed the pharmacological considerations to be taken into account when prescribing analgesic drugs in that vulnerable population. Databases and Data Treatment Articles on pain and ID were searched in the Medline and Google scholar electronic databases using the key words "Intellectual Disability," "Developmental Disability" and specific keywords for pharmacological and non‐pharmacological pain interventions. Preset outcomes about pharmacological treatment specificity, efficacy and safety were then collected. Results One hundred and fifty‐two articles were found and 16 were retained based on our inclusion and exclusion criteria. Of the 16 articles, five were topical reviews. Among the 11 remaining articles, five discussed pharmacological interventions, four considered non‐pharmacological interventions and two discussed both. As anticipated, the literature matching our specific outcomes about the pharmacological treatment of pain was scarce and for the most part not designed to answer the questions of specificity, efficacy and safety of pain treatment in adults with ID. Conclusion The specificity of analgesic treatments in adults with ID is a totally unexplored domain. In the absence of clinical guidelines, pharmacological facts—such as inter‐individual variability in drug response, pharmacokinetic and pharmacodynamic interactions, frequent co‐morbidities and ease of administration—must be systematically integrated, when prescribing in the population of adults with ID. Significance This review synthesizes the state of research on pain interventions in adults with ID and is one of the rare articles addressing the specificities of analgesic prescriptions in this population.

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Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems

Abstract: This high prevalence of DRPs is worrying. The structured medication review is a valuable instrument to optimize pharmacotherapy and to support psychiatrists in adequate prescribing of both psychotropic and somatic drugs.

Cited by 35 publications

References 32 publications

Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross‐sectional total population study

Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross‐sectional total population study

Prevalence of Challenging Behaviour in Adults with Intellectual Disabilities, Correlates, and Association with Mental Health

Pain interventions in adults with intellectual disability: A scoping review and pharmacological considerations

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