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García MH, Petersen JM, Parker SE, Rubenstein E, Werler MM. Medication use during pregnancy among women with congenital physical disabilities. Birth Defects Res 2022; 114:785-796. [PMID: 35652163 DOI: 10.1002/bdr2.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medication use during pregnancy is common, with up to 90% of pregnant women taking at least one medication. Women with congenital physical disabilities often report co-occurring conditions during pregnancy that may warrant pharmaceutical treatment, however, research is limited. We aim to describe medication use during pregnancy including: pain, psychotropic, and antibacterial medication, among women with and without congenital physical disabilities. METHODS We used data from the Slone Birth Defects Study (1976-2015), a case-control study that collected information on pre-pregnancy health conditions and exposures among participating mothers. Women with congenital physical disabilities (n = 132) included women with spina bifida, cerebral palsy, muscular dystrophy, limb deficiencies, and other skeletal/connective tissue conditions and were matched by interview year and study site to women without congenital physical disabilities (n = 528). Proportions and difference in proportions for each medication were compared between groups. Simple proportions were also calculated for duration and multiple medication use variables. RESULTS Women with congenital physical disabilities more frequently reported use of pain (acetaminophen and opioids), psychotropic (antidepressants), and antibacterial medications during pregnancy. Women with congenital physical disabilities used pain and psychotropic medications for longer, frequent durations, and more frequently reported haven taken multiple medications during pregnancy. CONCLUSION Women with congenital physical disabilities report higher medication use during pregnancy compared to women without physical disabilities. Patterns may be attributable to co-occurring conditions or increased risk of pregnancy complications in this population. Further research is needed to describe the patterns of medication use for clinical decisions regarding treatment of pregnant women with disabilities.
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Affiliation(s)
- Michelle Huezo García
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Charlot LR, Doerfler LA, McLaren JL. Psychotropic medications use and side effects of individuals with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:852-863. [PMID: 32959471 DOI: 10.1111/jir.12777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many people with intellectual and developmental disabilities (IDD) are treated with psychotropic medications, and polypharmacy is common. Although few studies address psychotropic side effects in the population, people with IDD have been found more likely to experience side effects than others who do not have IDD. Because many individuals with IDD may not report side effects reliably, there is risk that side effects may be missed. METHODS Psychotropic use and side effects of 71 adults with IDD admitted for a 30-day crisis stay to a Systemic, Therapeutic, Assessment, Resources, and Treatment (START) Resource Center were reviewed. START is a specialised behavioural health outreach, training and crisis programme for individuals with IDD. During crisis stays, centre nurses administer the Matson Evaluation of Drug Side Effects screen, a psychometrically established psychotropic medication side effects screen developed for use with people with IDD. Data reviewed were de-identified data used to inform day-to-day practices and assess outcomes for individuals START served. RESULTS The average age was 28 years, and 56% of the sample was male. All individuals were taking at least one psychotropic, while 79% were taking three or more. The average number of psychotropics used was 3.94. Antipsychotics were the most commonly prescribed medications taken by 85% of the sample; 49% of whom were not reported to have psychosis. Although the overall number of psychotropics did not correlate with Matson Evaluation of Drug Side Effects scores, the average scale scores for all participants was high in contrast to prior studies of people with IDD not taking psychotropics, with central nervous system side effects being the most commonly reported. CONCLUSION In the present study, data for individuals experiencing a crisis were reviewed and indicated high rates of psychotropic polypharmacy and side effects rates higher than previously reported for people with IDD not taking psychotropics. Prospective study in larger samples is needed to determine if missed or under-appreciated psychotropic side effects may play a role in behavioural health challenges of some people with IDD.
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Affiliation(s)
- L R Charlot
- Center for START Services, Institute on Disability UCED, University of New Hampshire, Concord, NH, USA
| | - L A Doerfler
- Department of Psychology, Assumption College and Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - J L McLaren
- Department of Psychiatry, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth College, Hanover, NH, USA
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MacLeod J, MacLure K. People with intellectual disabilities and their experience of medication: A narrative literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:976-991. [PMID: 32100409 DOI: 10.1111/jar.12719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with intellectual disabilities are known to have increased medical needs and are prescribed more medication than the general population. Understanding the reality of incorporating medication into their lives would help healthcare professionals provide care in more meaningful and personalised ways. AIM A narrative review of the current literature relating to people with intellectual disabilities and their experience of medication/pharmaceutical care. METHOD Electronic databases were searched for articles relating to intellectual disabilities and medication administration or pharmaceutical care. Other relevant papers identified from included article reference lists were also identified. A narrative literature was undertaken due to the heterogeneity of the identified papers. RESULTS A total of 29 studies from the literature searches were included alongside other relevant papers. CONCLUSIONS The published literature noted some aspects of the medication-related experiences of people with intellectual disabilities. However, a greater understanding of medication-related experiences is still required.
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Affiliation(s)
- Joan MacLeod
- Aberdeen City Health and Social Care Partnership, NHS Grampian and Doctoral Graduate, Robert Gordon University, Aberdeen, UK
| | - Katie MacLure
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
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Sheehan R, Hassiotis A, Strydom A, Morant N. Experiences of psychotropic medication use and decision-making for adults with intellectual disability: a multistakeholder qualitative study in the UK. BMJ Open 2019; 9:e032861. [PMID: 31780594 PMCID: PMC6887070 DOI: 10.1136/bmjopen-2019-032861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Understanding patient and carer perspectives is essential to improving the quality of medication prescribing. This study aimed to explore experiences of psychotropic medication use among people with intellectual disability (ID) and their carers, with a focus on how medication decisions are made. DESIGN Thematic analysis of data collected in individual semistructured interviews. PARTICIPANTS AND SETTING Fourteen adults with ID, 12 family carers and 12 paid carers were recruited from specialist psychiatry services, community groups, care providers and training organisations in the UK. RESULTS People with ID reported being highly compliant with psychotropic medication, based on a largely unquestioned view of medication as important and necessary, and belief in the authority of the psychiatrist. Though they sometimes experienced medication negatively, they were generally not aware of their right to be involved in medication decisions. Paid and family carers reported undertaking a number of medication-related activities. Their 'front-line' status and longevity of relationships meant that carers felt they possessed important forms of knowledge relevant to medication decisions. Both groups of carers valued decision-making in which they felt they had a voice and a genuine role. While some in each group described making joint decisions about medication with psychiatrists, lack of involvement was often described. This took three forms in participants' accounts: being uninformed of important facts, insufficiently included in discussions and lacking influence to shape decisions. Participants described efforts to democratise the decision-making process by gathering information, acting to disrupt perceived power asymmetries and attempting to prove their credibility as valid decision-making partners. CONCLUSIONS Stakeholder involvement is a key element of medication optimisation that is not always experienced in decisions about psychotropic medication for people with ID. Forms of shared decision-making could be developed to promote collaboration and offer people with ID and their carers greater involvement in medication decisions.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, UK
| | | | - André Strydom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
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Hamers PCM, Festen DAM, Hermans H. Non-pharmacological interventions for adults with intellectual disabilities and depression: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:684-700. [PMID: 29797730 DOI: 10.1111/jir.12502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Although high rates of depression symptoms are reported in adults with intellectual disabilities (IDs), there is a lack of knowledge about non-pharmacological treatment options for depression in this population. The first research question of this paper is: Which non-pharmacological interventions have been studied in adults with ID and depression? The second research question is: What were the results of these non-pharmacological interventions? METHOD Systematic review of the literature with an electronic search in six databases has been completed with hand searches. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines have been followed. Selected studies met predefined inclusion criteria. RESULTS Literature search resulted in 4267 papers of which 15 met the inclusion criteria. Five different types of non-pharmacological interventions have been studied: cognitive behavioural therapy, behavioural therapy, exercise intervention, social problem-solving skills programme and bright light therapy. CONCLUSION There are only a few studies of good quality evaluating non-pharmacological interventions for adults with ID and depression. Some of these studies, especially studies on cognitive behavioural therapy, show good results in decreasing depressive symptoms. High-quality randomised controlled trials evaluating non-pharmacological interventions with follow-up are needed.
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Affiliation(s)
- P C M Hamers
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
| | - D A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Hermans
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
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Bowring DL, Totsika V, Hastings RP, Toogood S, McMahon M. Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability. A total population study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:604-617. [PMID: 28090687 DOI: 10.1111/jir.12359] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/15/2016] [Accepted: 11/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND There is a high prevalence of psychotropic medication use in adults with Intellectual Disabilities (ID), often in the absence of psychiatric disorder, also associated with challenging behaviour. Previous research has focused on specific sample frames or data from primary care providers. There is also a lack of consistency in the definition of challenging behaviour used. METHODS We adopted a total population sampling method. Medication data on 265 adults with ID were classified according to the Anatomical Therapeutic Chemical classification system. The Behaviour Problems Inventory - short form classified challenging behaviours. We examined the association between challenging behaviour and the use of psychotropic medication, and whether any association would still be present after accounting for socio-demographic and clinical characteristics. RESULTS 70.57% of adults with ID were prescribed at least one class of any medication (mean per person =2.62; range 0-14). Psychotropic medications were used by 37.73% of participants with antipsychotics the commonest type used by 21.89% of individuals. Polypharmacy and high dosages were common. Generalised Linear Models indicated significant associations between psychotropic medication and the presence of a psychiatric diagnosis, challenging behaviour, older age and type of residence. Male gender was additionally associated with antipsychotic medication. CONCLUSIONS The use of a total population sample identified via multiple routes is less likely to overestimate prevalence rates of medication use. Current challenging behaviour was a predictor of medication use after controlling for other variables. Data indicate that there may be differences in prescribing patterns associated with different topographies of challenging behaviours.
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Affiliation(s)
- D L Bowring
- School of Psychology, Bangor University, Bangor, Gwynedd, UK
- Community and Social Services, Health and Social Services, Jersey
| | - V Totsika
- CEDAR, University of Warwick, Coventry, UK
| | | | - S Toogood
- School of Psychology, Bangor University, Bangor, Gwynedd, UK
| | - M McMahon
- Community and Social Services, Health and Social Services, Jersey
- Centre for Disability Research, Lancaster University, Lancaster, UK
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Trollor J, Salomon C, Curtis J, Watkins A, Rosenbaum S, Samaras K, Ward PB. Positive cardiometabolic health for adults with intellectual disability: an early intervention framework. Aust J Prim Health 2016; 22:288-293. [PMID: 27444634 DOI: 10.1071/py15130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 06/05/2016] [Indexed: 12/26/2022]
Abstract
Cardiometabolic morbidity is a significant contributor to the poorer health outcomes experienced by people with intellectual disability (ID). Tailoring cardiometabolic monitoring tools developed for the general population to better fit the altered risk profiles and extra needs of people with ID may help to improve health outcomes. This paper describes a new cardiometabolic monitoring framework designed to address the extra needs of people with ID. The framework was adapted from a generalist guideline after a process of extensive consultation with the original authors and over 30 ID and cardiometabolic experts. In addition to standard cardiometabolic monitoring practice, the framework encourages clinicians to: anticipate and address barriers to care such as communication difficulties and fear of blood tests; account for socioeconomic and genetic factors altering baseline cardiometabolic risk; and carefully rationalize psychotropic prescription. Together with this framework, a toolkit of free cardiometabolic resources tailored for people with ID and formal and informal carers is included. The monitoring framework promotes a multidisciplinary and holistic approach to cardiometabolic care for people with ID.
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Affiliation(s)
- Julian Trollor
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, 34 Botany Street, Sydney, NSW 2052, Australia
| | - Carmela Salomon
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, 34 Botany Street, Sydney, NSW 2052, Australia
| | - Jackie Curtis
- South Eastern Sydney Local Health District, Prince of Wales Mental Health, 26 Llandaff Street, Bondi Junction, NSW 2022, Australia
| | - Andrew Watkins
- South Eastern Sydney Local Health District, Prince of Wales Mental Health, 26 Llandaff Street, Bondi Junction, NSW 2022, Australia
| | - Simon Rosenbaum
- South Eastern Sydney Local Health District, Prince of Wales Mental Health, 26 Llandaff Street, Bondi Junction, NSW 2022, Australia
| | - Katherine Samaras
- Department of Endocrinology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Wallace Wurth Building, 18 High Street, Kensington, NSW 2052, Australia
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Hartley SL, Esbensen AJ, Shalev R, Vincent LB, Mihaila I, Bussanich P. Cognitive Behavioral Therapy for Depressed Adults with Mild Intellectual Disability: A Pilot Study. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2015; 8:72-97. [PMID: 26925187 PMCID: PMC4767014 DOI: 10.1080/19315864.2015.1033573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND There is a paucity of research on psychosocial treatments for depression in adults with intellectual disability (ID). In this pilot study, we explored the efficacy of a group CBT treatment that involved a caregiver component in adults with mild ID with a depressive disorder. METHOD Sixteen adults with mild ID and a depressive disorder participated in a 10-week group CBT treatment and 8 adults with mild ID with a depressive disorder served as a treatment as usual (TAU) control group. Adults with mild ID and caregivers completed measures of depressive symptoms, behavior problems, and social skills at pre-treatment, post-treatment, and a 3-month follow-up. Adults with mild ID also completed a series of tasks to measure their understanding of the principles of cognitive therapy pre- and post-treatment. RESULTS The CBT group demonstrated significant decreases in depressive symptoms and behavior problems from pre-treatment to post-treatment and these effects were maintained at a 3-month follow-up. The CBT group demonstrated significant improvements in their ability to infer emotions and thoughts based on various situation-thought-emotion pairings from pre-treatment to post-treatment. CONCLUSIONS Findings indicate that adults with mild ID with a depressive disorder benefitted from a group CBT treatment with a caregiver component. Moreover, adults with mild ID appeared to benefit, at least in part, from the cognitive therapy components of the treatment, in addition to the behavior therapy components.
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Affiliation(s)
- Sigan L Hartley
- Univeristy of Wisconsin, Waisman Center, 1500 Highland Ave, Madison, 53705 United States
| | - Anna J Esbensen
- Cincinnati Children's Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, 3333 Burnet Ave, ML 4002, Cincinnati, 45229 United States
| | - Rebecca Shalev
- University of Wisconsin-Madison, School Psychology, Madison, United States
| | - Lori B Vincent
- university of Wisconsin-Madison, School Psychology, Madison, United States
| | - Iulia Mihaila
- University of Wisconsin-Madison, Waisman Center, Madison, United States
| | - Paige Bussanich
- University of Wisconsin-Madison, Waisman Center, Madison, United States
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Psychiatric disorders in adolescents and young adults with Down syndrome and other intellectual disabilities. J Neurodev Disord 2015; 7:9. [PMID: 25810793 PMCID: PMC4373108 DOI: 10.1186/s11689-015-9101-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 01/27/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Relative to other aspects of Down syndrome, remarkably little is known about the psychiatric problems experienced by youth and young adults with this syndrome and if these problems differ from others with intellectual disabilities. Yet adolescence and young adulthood are particularly vulnerable time periods, as they involve multiple life transitions in educational, medical, and other service systems. METHODS This study compared the psychiatric diagnoses of 49 adolescent and young adult patients with Down syndrome to 70 patients with other intellectual disabilities (IDs). The groups were similar in age, gender, and level of intellectual impairment. The 119 participants, aged 13 to 29 years (M = 21) were evaluated in one of two specialized psychiatric clinics. RESULTS In contrast to previous literature, those with Down syndrome versus other IDs had significantly higher rates of psychosis NOS or depression with psychotic features (43% versus 13%). Unlike the ID group, psychosis was predominantly seen in females with Down syndrome. Marked motoric slowing in performing routine daily activities or in expressive language was manifested in 17% of patients with Down syndrome. No group differences were found in anxiety or depressive disorders, and the ID group had significantly higher rates of bipolar and impulse control disorders. CONCLUSIONS These preliminary observations warrant further studies on genetic, neurological, and psychosocial factors that place some young people with Down syndrome or other IDs at high risk for severe psychiatric illness.
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Häβler F, Thome J, Reis O. Polypharmacy in the treatment of subjects with intellectual disability. J Neural Transm (Vienna) 2014; 122 Suppl 1:S93-100. [DOI: 10.1007/s00702-014-1219-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/08/2014] [Indexed: 02/02/2023]
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Stortz JN, Lake JK, Cobigo V, Ouellette-Kuntz HMJ, Lunsky Y. Lessons learned from our elders: how to study polypharmacy in populations with intellectual and developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:60-77. [PMID: 24635692 DOI: 10.1352/1934-9556-52.1.60] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Polypharmacy is the concurrent use of multiple medications, including both psychotropic and non-psychotropic drugs. Although it may sometimes be clinically indicated, polypharmacy can have a number of negative consequences, including medication nonadherence, adverse drug reactions, and undesirable drug-drug interactions. The objective of this paper was to gain a better understanding of how to study polypharmacy among people with intellectual and developmental disabilities (IDD). To do this, we reviewed literature on polypharmacy among the elderly and people with IDD to inform future research approaches and methods on polypharmacy in people with IDD. Results identified significant variability in methods used to study polypharmacy, including definitions of polypharmacy, samples studied, analytic strategies, and variables included in the analyses. Four valuable methodological lessons to strengthen future polypharmacy research in individuals with IDD emerged. These included the use of consistent definitions of polypharmacy, the implementation of population-based sampling strategies, the development of clinical guidelines, and the importance of studying associated variables.
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Wu CS, Desarkar P, Palucka A, Lunsky Y, Liu SK. Acute inpatient treatment, hospitalization course and direct costs in bipolar patients with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4062-4072. [PMID: 24051362 DOI: 10.1016/j.ridd.2013.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/20/2013] [Indexed: 06/02/2023]
Abstract
To explore the impacts of intellectual disability (ID) on psychotropic medication use, length of hospital stay (LOS) and direct hospitalization costs during inpatient treatment for acute bipolar episodes, all 17,899 index hospitalizations due to acute bipolar episodes between 1998 and 2007 in Taiwan were identified from a total population health insurance claims database, amongst which 544 subjects had a concomitant diagnosis of ID. Pattern of psychotropic medication use, LOS, discharge outcome and direct costs during hospitalization were compared between bipolar patients with ID and without ID and multivariate models controlling for major cost confounders were used to explore the impacts of ID on LOS, discharge outcome and inpatient costs. The results indicated that, compared to bipolar patients without ID, bipolar patients with ID were younger, had longer LOS and received significantly lower daily equivalent dosages of antipsychotics, mood stabilizers, lithium and benzodiazepines. Significantly more bipolar patients with ID could not be discharged successfully. The longer LOS possibly reflected slower clinical stabilization, conservative use of medications and difficulty in community placement. The lower average daily reimbursements indicated that treatment of bipolar patients with ID were under-funded, whereas the higher total direct costs resulting from prolonged LOS placed greater economic straint on healthcare system. The findings support that bipolar patients with ID are clinically unique but relatively under-supported during acute hospitalization. Modifying current pharmacological intervention, health care resources allocation and community supporting structure is paramount to reducing LOS and improving hospitalization outcome.
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Affiliation(s)
- Chi-Shin Wu
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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McDonnell A, Anker R. Behaviour Management Versus Behaviour Change: A Useful Distinction? ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979509799103098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lunsky Y, Elserafi J. Antipsychotic medication prescription patterns in adults with developmental disabilities who have experienced psychiatric crisis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:32-38. [PMID: 22093645 DOI: 10.1016/j.ridd.2011.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/01/2011] [Indexed: 05/31/2023]
Abstract
Antipsychotic medication rates are high in adults with developmental disability. This study considered rates of antipsychotic use in 743 adults with developmental disability who had experienced a psychiatric crisis. Nearly half (49%) of these adults were prescribed antipsychotics. Polypharmacy was common with 22% of those prescribed antipsychotics taking 2 or more antipsychotics at once. Predictors of multiple antipsychotic use included gender, residence, psychiatric diagnosis and previous hospitalizations. Implications of medication prescriptions to this vulnerable population are discussed.
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Affiliation(s)
- Yona Lunsky
- Dual Diagnosis Program, Centre for Addiction and Mental Health, West Toronto, ON, Canada.
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Leunissen CLF, de la Parra NM, Tan IY, Rentmeester TW, Vader CI, Veendrick-Meekes MJBM, Aldenkamp AP. Antiepileptic drugs with mood stabilizing properties and their relation with psychotropic drug use in institutionalized epilepsy patients with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:2660-2668. [PMID: 21752594 DOI: 10.1016/j.ridd.2011.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 06/13/2011] [Accepted: 06/15/2011] [Indexed: 05/31/2023]
Abstract
A large number of patients with epilepsy and intellectual disability take medication, amongst which antiepileptic and psychotropic drugs, often simultaneously. Certain antiepileptic drugs have mood-stabilizing properties, e.g. carbamazepine, valproic acid and lamotrigine. The aim of this study was to investigate whether the use of these mood-stabilizers is associated with a different use of psychotropic drugs in a population of institutionalized epilepsy patients with intellectual disability. We performed a retrospective, cohort study of adults with intellectual disability and epilepsy at the long-stay department of an epilepsy centre in The Netherlands. 246 residents were included. In patients using lamotrigine we found a statistically significant lower use of antidepressants. We also found significant less prescriptions of anxiolytics in patients using AEDs with mood-stabilizing properties (carbamazepine, valproic acid and lamotrigine). When considering the effect of gender, we found that male patients took significantly more antipsychotics. Most important, we found an inverse relation between the drug load of carbamazepine and/or valproic acid and/or lamotrigine and the use of psychotropic drugs. In a population of institutionalized epilepsy patients with intellectual disability, higher drug loads of mood-stabilizing antiepileptic drugs correspond with less use of psychotropic drugs.
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Cabrera MAS, Dellaroza MSG, Trelha CS, Paccola LBB, da Cruz Domiciano Perdigão S, de Barros Pinto ME, Silva TJG, de Oliveira DG. Psychoactive Drugs as Risk Factors for Functional Decline Among Noninstitutionalized Dependent Elderly People. J Am Med Dir Assoc 2010; 11:519-22. [DOI: 10.1016/j.jamda.2009.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 12/07/2009] [Indexed: 12/17/2022]
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Yen CF, Lin JD, Loh CH, Shi L, Hsu SW. Determinants of prescription drug use by adolescents with intellectual disabilities in Taiwan. RESEARCH IN DEVELOPMENTAL DISABILITIES 2009; 30:1354-1366. [PMID: 19577427 DOI: 10.1016/j.ridd.2009.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 06/05/2009] [Indexed: 05/28/2023]
Abstract
Direct family caregivers of population-based adolescents with intellectual disabilities in Taiwan were surveyed regarding their perceptions of the use of prescribed medication and its relationship with health-related behaviors, medical care and preventive health utilization of people with intellectual disabilities. Cross-sectional data on 1419 adolescents 12-17 years of age was collected from the 2007 National Survey on Healthy Behaviors and Preventive Health Utilizations of People with Intellectual Disabilities in Taiwan. Multiple logistic regression models were used to examine risk profiles in relation to the use of prescribed medication and other relevant variables: participant characteristics, health-related behaviors, medical care and preventive health utilization. The results indicate that 47.1% of subjects were accompanied by other impairments, the morbidity prevalence was 16.5% and 23.8% of subjects were reported to have used prescribed medication regularly in the past 6 months. The main reasons for medication use were epilepsy (36.9%), psychiatric problems (24.2%) and gastrointestinal problems (6.3%). A large majority of caregivers reported that the subject's health status was excellent (15.4%), good (38%) or fair (38%), and only 6.5% were reported to be in bad health. Finally, data were analyzed using a logistic regression model to identify possible reasons for drug use. The following factors correlate with the regular use of prescribed medication by adolescents with intellectual disabilities: Down syndrome, possession of a Major Illness Card, a history of smoking, an additional impairment, reported health status, outpatient care and acceptance of other specific medical examinations. Our principal conclusion was that these data indicate a need for more education on a variety of issues, including predisposition, healthy behavior, medical care and preventive health utilization issues as they relate to prescribed medication use, and assessment of the long-term effects of drug use on people with intellectual disabilities.
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Affiliation(s)
- Chia-Feng Yen
- Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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Thomson A, Maltezos S, Paliokosta E, Xenitidis K. Risperidone for attention-deficit hyperactivity disorder in people with intellectual disabilities. Cochrane Database Syst Rev 2009; 2009:CD007011. [PMID: 19370667 PMCID: PMC7387848 DOI: 10.1002/14651858.cd007011.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is increasingly recognised as occurring in people with intellectual disability (ID), although treatment of ADHD in this population has not ben tested widely. Risperidone has been used to treat ADHD in people with ID, although the evidence for its effectiveness is unclear. OBJECTIVES To examine the effectiveness of risperidone for the treatment of attention deficit hyperactivity disorder in people with intellectual disabilities. SEARCH STRATEGY In February 2009, MEDLINE, PsycINFO, EMBASE, AMED, ISI Web of Science and WorldCat Dissertations were searched using an extensive list of synonyms for ADHD and ID. CENTRAL, CCDPLP, Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register, clinicaltrials.gov were searched, pharmaceutical companies and experts in the field were contacted. Reference lists of review articles were examined and citation searches were performed in ISI Web of Knowledge. SELECTION CRITERIA All randomised controlled trials (RCTs), both published and unpublished, in any language, in which children or adults with ADHD and ID were treated with risperidone. DATA COLLECTION AND ANALYSIS Data collection and analyses were planned but not performed due to a lack of suitable studies. MAIN RESULTS Eleven studies were considered but none were suitable for inclusion. AUTHORS' CONCLUSIONS There is no evidence from RCTs that risperidone is effective for the treatment of ADHD in people with ID. Prescribing in this population can only be based on open-label studies or extrapolation from research in people with autism and disruptive behaviour disorders; however these studies have not investigated people with ID separately so there are reservations regarding the applicability of these findings. Research into effectiveness and tolerability is urgently needed.
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Affiliation(s)
- Alex Thomson
- Section of Brain Maturation (P050), Kings College London, Institute of Psychiatry, De Crespigny Park, London, UK, SE5 8AF.
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Parish SL, Moss K, Richman EL. Perspectives on health care of adults with developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2008; 46:411-426. [PMID: 19006428 DOI: 10.1352/2008.46:411-426] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A focus group study was conducted with individuals with developmental disabilities to understand their perspectives on their health status, health promotion behaviors, and health care services they receive. The majority of participants reported good to excellent health, and all had some form of medical insurance. However, participants reported notable gaps in dental and reproductive health care and age-specific cancer screening. Some adults had good access to medical care, particularly those with a family member or friend who served as their health advocate. Some adults had a sound understanding of their health and health care needs. Program and policy implications are discussed and recommendations are presented to ensure adequate health care for adults with disabilities, including health advocacy training for caregivers.
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Affiliation(s)
- Susan L Parish
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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A review of empirical evidence of somatic treatment options for the MI/DD population. Psychiatr Q 2008; 79:265-73. [PMID: 18726159 DOI: 10.1007/s11126-008-9077-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
Abstract
This article reviews recent evidence in the literature for the use of psychotropic and other somatic treatments in the management of patients with mental retardation (MR). The search methodology included peer-reviewed English language publications in PubMed and PsychINFO with the words Mental Retardation, Intellectual Disability, Developmental Disability and Mental Disorders/Drug Therapy or Antipsychotic medications, Psychiatric Somatic therapies, Neuroleptic Drugs, Antidepressants and Electroconvulsive Therapy from 1998 to 2008. The review revealed few randomized controlled trials on the medications frequently prescribed for patients with MR. Three RCTs of Risperidone in children, one combining adults and children and one with adults only are discussed. There was one RCT involving Quetiapine and one on Citalopram. There is little evidence to support the scope of psychotropic medication use in the MR population though the field is advancing. The contribution of psychiatric illness to challenging behaviors is not systematically addressed in the literature.
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