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Weiss MD, Daniolos PT, Coughlin K, Mulvaney-Day N, Cook B, Rosenblum D. A Scoping Review of the Intersectionality of Autism and Intellectual and Developmental Disability with Social Inequity on Diagnosis and Treatment of Youth. J Child Adolesc Psychopharmacol 2024. [PMID: 38957953 DOI: 10.1089/cap.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Objective: To describe how the intersectionality of race, ethnicity, and language with autism and intellectual and developmental disability (IDD) impacts mental health inequities in psychopharmacological management of youth. Method: This was a scoping review in which a series of searches were conducted in PubMed, Web of Science, Google Scholar, and manual review of the articles collected. Results: Although autism and/or IDD increases the risk for poor physical and mental health, social determinants of health such as race, ethnicity, and language account for approximately a third of poor outcomes. Minoritized children with autism/IDD experience significantly greater delays to diagnosis and misdiagnosis and are less likely to receive appropriate services. Access to psychological testing and psychosocial services is often limited by availability, skilled practitioners, a shortage of non-English-language providers or interpreters, and poor reimbursement. Conclusion: The intersectionality of autism and/or IDD with race, ethnicity, and language compounds the health inequities associated with either of these challenges independently.
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Affiliation(s)
- Margaret Danielle Weiss
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Peter T Daniolos
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Kevin Coughlin
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Norah Mulvaney-Day
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Benjamin Cook
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Debra Rosenblum
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
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Lonchampt S, Gerber F, Aubry JM, Desmeules J, Kosel M, Besson M. Prevalence of Polypharmacy and Inappropriate Medication in Adults With Intellectual Disabilities in a Hospital Setting in Switzerland. Front Psychiatry 2021; 12:614825. [PMID: 34248693 PMCID: PMC8267250 DOI: 10.3389/fpsyt.2021.614825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/18/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Polypharmacy and inappropriate prescription are frequent in vulnerable and multi-morbid populations. Adults with intellectual disability (ID) are at risk of being polymedicated because they often present with multiple comorbidities and challenging behaviors. Aim: The objective of this study was thus to evaluate the prevalence of potentially inappropriate medications (PIM) and polypharmacy in a hospital unit dedicated to adults with ID. Methods: A 10-month prospective observational study took place at a hospital unit specializing in the care of adults with ID in Geneva, Switzerland. Once a week, health and prescription data were collected and screened for PIM according to preset definitions. Results: Fourteen patients consented to participate, leading to 20 hospitalization events assessed during the study. Hospitalizations lasted 12.8 weeks on average. ID severities ranged from mild to profound, all degrees of severity being equally represented. One hundred percent of the patients were polymedicated (defined as five drugs or more prescribed simultaneously). A mean number of 9.4 drugs were prescribed per week, including 5.3 psychotropic drugs. The number of prescribed drugs remained stable throughout the hospitalizations. Antipsychotics were the most prescribed drug class (19% of all prescribed drugs), followed by benzodiazepines (13%) and laxatives (12%). A total of 114 PIM were recorded with an average of 5.7 PIM per hospitalization. Conclusions: This study showed that polypharmacy and inappropriate prescription are very common in adults with ID, even though the literature and expert positions advocate for deprescription in these patients. Specific prescribing and deprescribing guidelines are needed for that specific population.
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Affiliation(s)
- Sophie Lonchampt
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive Care, Pharmacology and Emergency, Geneva University Hospitals, Geneva, Switzerland
- Unit for Treatment and Assessment of In and Out Patients With Learning Disabilities and Autism Spectrum Disorders, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Science, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Fabienne Gerber
- Unit for Treatment and Assessment of In and Out Patients With Learning Disabilities and Autism Spectrum Disorders, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Aubry
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Faculty of Science, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive Care and Pharmacology, Geneva University Hospitals, Geneva, Switzerland
| | - Markus Kosel
- Unit for Treatment and Assessment of In and Out Patients With Learning Disabilities and Autism Spectrum Disorders, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive Care, Pharmacology and Emergency, Geneva University Hospitals, Geneva, Switzerland
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Koslowski N, Klein K, Arnold K, Kösters M, Schützwohl M, Salize HJ, Puschner B. Effectiveness of interventions for adults with mild to moderate intellectual disabilities and mental health problems: systematic review and meta-analysis. Br J Psychiatry 2016; 209:469-474. [PMID: 27198481 DOI: 10.1192/bjp.bp.114.162313] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/29/2015] [Accepted: 08/01/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is a lack of available evidence in relation to the effectiveness of interventions for adults with mild to moderate intellectual disability and mental health problems. AIMS To evaluate the efficacy of interventions for adults with mild to moderate intellectual disabilities and co-occurring mental health problems. METHOD An electronic literature search of the databases Medline, EMBASE, PsycINFO and EBM Reviews aimed at identifying randomised controlled trials (RCTs) and controlled trials testing any type of intervention (psychotherapy, biological or system level) for people with mild to moderate intellectual disabilities (IQ score 35-69) targeting comorbid mental health problems. Additionally a meta-analysis was conducted. RESULTS Twelve studies met the inclusion criteria. No significant effect was found for the predefined outcome domains behavioural problems, depression, anxiety, quality of life and functioning. The effect size for depression (d = 0.49) was moderate but non-significant. Quality of studies was moderate and heterogeneity was high. CONCLUSIONS There is no compelling evidence supporting interventions aiming at improving mental health problems in people with mild to moderate intellectual disability. The number of available trials is too low for definite conclusions. Some interventions are promising and should be evaluated further in larger and more rigorous trials.
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Affiliation(s)
- Nadine Koslowski
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Kristina Klein
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Katrin Arnold
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Markus Kösters
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Matthias Schützwohl
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Hans Joachim Salize
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
| | - Bernd Puschner
- Nadine Koslowski, MA, Kristina Klein, MA, Katrin Arnold, Dipl-Soc, Markus Kösters, PhD, Department of Psychiatry II, Ulm University; Matthias Schützwohl, PhD, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden; Hans Joachim Salize, PhD, Mental Health Services Research Group, Central Institute of Mental Health, Mannheim; Bernd Puschner, PhD, Department of Psychiatry II, Ulm University, Germany
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Scheifes A, Egberts TCG, Stolker JJ, Nijman HLI, Heerdink ER. Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:346-55. [PMID: 25882186 DOI: 10.1111/jar.12183] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability. METHODS In a treatment facility for people with mild to borderline intellectual disability and severe behavioural problems, a structured medication review was performed. Prevalence and type of drug-related problems (DRPs) and of the recommended and executed actions were calculated. RESULTS In a total of 55 patients with intellectual disability and behavioural problems, 284 medications were prescribed, in which a DRP was seen in 106 (34%). No indication/unclear indication was the most prevalent DRP (70). Almost 60% of the recommended actions were also executed. CONCLUSIONS 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.
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Affiliation(s)
- Arlette Scheifes
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Altrecht Institute for Mental Health Care, Den Dolder, The Netherlands
| | - Toine C G Egberts
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joost Jan Stolker
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Licht-Zorg, Psychiatric Care, Maarssen, The Netherlands
| | - Henk L I Nijman
- Altrecht Institute for Mental Health Care, Den Dolder, The Netherlands.,Faculty of Social Sciences, Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Eibert R Heerdink
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Altrecht Institute for Mental Health Care, Den Dolder, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
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5
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Robertson J, Hatton C, Baines S, Emerson E. Systematic Reviews of the Health or Health care of People with Intellectual Disabilities: A Systematic Review to Identify Gaps in the Evidence Base. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:455-523. [DOI: 10.1111/jar.12149] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Chris Hatton
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Susannah Baines
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Eric Emerson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
- Centre for Disability Research and Policy; University of Sydney; Sydney NSW Australia
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6
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Willner P. The neurobiology of aggression: implications for the pharmacotherapy of aggressive challenging behaviour by people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:82-92. [PMID: 24467721 DOI: 10.1111/jir.12120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
AIM The aim of this review is to summarise current understanding of the neurobiology of aggression and within this context to consider the evidence base for the pharmacotherapy of aggressive challenging behaviour by people with intellectual disabilities (ID). EVIDENCE Aggressive encounters involve a variety of psychological processes and progress has been made in understanding the brain mechanisms involved. However, the role in aggression of the neurotransmitters serotonin, dopamine and γ-aminobutyric acid is no longer as clear as it once appeared, with the result that predictions cannot be made with confidence about drug effects on aggression. There have been relatively few controlled trials of pharmacotherapy for aggression in people with ID, or, indeed, in the general population, and their outcomes have largely been negative. CONCLUSION With the possible exception of risperidone, there is no reliable evidence that antidepressant, neuroleptic or anticonvulsant drugs are effective treatments for aggression by people with ID.
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Affiliation(s)
- Paul Willner
- Department of Psychology, Swansea University, Swansea, UK
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7
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Neurodevelopmental and psychiatric issues in Down's syndrome: assessment and intervention. Psychiatr Genet 2013; 23:95-107. [PMID: 23492931 DOI: 10.1097/ypg.0b013e32835fe426] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Down's syndrome (DS) is the most frequent genetic cause of intellectual disability and patients with DS show significant psychopathology (18-23%). Moreover, individuals with DS often show a cognitive decline associated with ageing characterized by a deterioration in memory, language and cognitive functioning. According to these relevant findings, an overview is presented of state-of-the-art knowledge of the neurocognitive, neurobiological and psychopathological profile, assessment and treatment of patients with DS. The linguistic characteristics of DS develop differently along distinct developmental trajectories. Thus, for example, morphosyntax deficit, especially in production, is more evident in adolescence than in early childhood and lexicon is usually better preserved in all ages (at least in comprehension). So far, rehabilitation is the only effective approach for improving cognitive and linguistic abilities. However, ongoing preliminary reports on other approaches such as transmagnetic stimulation or drugs suggest alternative or integrative treatment for the future. Individuals with DS show typical organization of brain structures related to some cognitive abilities, such as reduced volume in frontal and prefrontal areas, which is related to poor executive and linguistic abilities. They also frequently show psychiatric disorders such as externalizing disorders as well as depression, anxiety and obsessive-compulsive disorder. Nevertheless, as for other genetic syndrome with intellectual disability, there is a significant lack of research specifically focused on treatments of psychiatric and behavioural problems in DS. This is true both for psychosocial and for pharmacological interventions.
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8
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Zaal RJ, van der Kaaij ADM, Evenhuis HM, van den Bemt PMLA. Prescription errors in older individuals with an intellectual disability: prevalence and risk factors in the Healthy Ageing and Intellectual Disability Study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1656-1662. [PMID: 23501585 DOI: 10.1016/j.ridd.2013.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 06/01/2023]
Abstract
Prescribing pharmacotherapy for older individuals with an intellectual disability (ID) is a complex process, possibly leading to an increased risk of prescription errors. The objectives of this study were (1) to determine the prevalence of older individuals with an intellectual disability with at least one prescription error and (2) to identify potential risk factors for these prescription errors (age, gender, body mass index (BMI), frailty index, level of intellectual disability and living situation). The study population consisted of 600 older (≥ 50 years) individuals with an ID using one or more drugs who were randomly selected from the study cohort of the Healthy Ageing and Intellectual Disability (HA-ID) Study. The medication used at the time of measurement was screened for errors by a hospital pharmacist/clinical pharmacologist and a Master's student pharmacy using consensus methodology. Participants with one or more prescription errors were compared to participants without prescription errors by multivariate logistic regression to identify potential risk factors. The prevalence of individuals with one or more prescription errors was 47.5% (285 of 600 individuals; 95% confidence interval (CI) 43-52%). Relevant errors, defined as errors that actually do require a change of pharmacotherapy, were identified in 26.8% of the individuals (161 of 600 individuals; 95% CI 23-30%). Higher age (adjusted odds ratio (OR adj) 1.03; 95% CI 1.01-1.06), less severe intellectual disability (moderate: OR adj 0.48; 95% CI 0.31-0.74 and severe: OR adj 0.56; 95% CI 0.32-0.98), higher BMI (OR adj 1.04; 95% CI 1.01-1.08), higher frailty index (0.39-0.54: OR adj 2.4; 95% CI 1.21-4.77 and ≥ 0.55: OR adj 3.4; 95% CI 1.03-11.02), polypharmacy (OR adj 8.06; 95% CI 5.59-11.62) and use of medicines acting on the central nervous system (OR adj 3.34; 95% CI 2.35-4.73) were independently associated with the occurrence of prescription errors. Interventions targeted to high risk patients should be designed and implemented to improve pharmacotherapy in older individuals with an intellectual disability.
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Affiliation(s)
- Rianne J Zaal
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands.
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Bezuidenhout H, Wiysonge CS, Bentley JM. Risperidone for disruptive behaviour disorders in children with intellectual disabilities. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Heidre Bezuidenhout
- Red Cross Hospital, University of Cape Town; Western Cape Provincial Administration; 201 Bayviews Clifford Road, Seapoint Cape Town Western South Africa 8500
| | - Charles Shey Wiysonge
- University of Cape Town; Institute of Infectious Disease and Molecular Medicine & Division of Medical Microbiology; Anzio Road Observatory South Africa 7925
| | - Judith M Bentley
- University of Cape Town; Department of Psychiatry and Mental Health; 51 Washington Road Claremont Cape Town Western Cape South Africa 7708
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