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Jiménez-Fernández S, Gurpegui M, de Leon J, Gutiérrez-Rojas L. Clozapine for the treatment of pediatric encephalopathy associated with nonketotic hyperglycinemia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:287-289. [PMID: 36513404 DOI: 10.1016/j.rpsmen.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Jaén University Hospital, Jaén, Spain; CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Granada, Spain.
| | - Manuel Gurpegui
- CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Granada, Spain; Granada Center for Psychiatric Studies, Granada, Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
| | - Luis Gutiérrez-Rojas
- CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Granada, Spain; Department of Psychiatry, University of Granada, Granada, Spain; Psychiatry Service, San Cecilio University Hospital, Granada, Spain
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2
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Clozapine for the treatment of pediatric encephalopathy associated with nonketotic hyperglycinemia. REVISTA DE PSIQUIATRÍA Y SALUD MENTAL 2022. [DOI: 10.1016/j.rpsm.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Henderson A, Kinnear D, Fleming M, Stanley B, Greenlaw N, Young-Southward G, Pell JP, Cooper SA. Antipsychotic and antidepressant prescribing for 704 297 children and young people with and without intellectual disabilities: record linkage study. Br J Psychiatry 2021; 218:58-62. [PMID: 33541472 DOI: 10.1192/bjp.2020.232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychotropics are overprescribed for adults with intellectual disabilities; there are few studies in children and young people. AIMS To investigate antipsychotic and antidepressant prescribing in children and young people with and without intellectual disabilities, and prescribing trends. METHOD Scotland's annual Pupil Census, which identifies pupils with and without intellectual disabilities, was record-linked to the Prescribing Information System. Antidepressant and antipsychotic data were extracted. Logistic regression was used to analyse prescribing between 2010 and 2013. RESULTS Of the 704 297 pupils, 16 142 (2.29%) had a record of intellectual disabilities. Antipsychotic and antidepressant use increased over time, and was higher in older pupils; antipsychotic use was higher in boys, and antidepressant use was higher in girls. Overall, antipsychotics were prescribed to 281 (1.74%) pupils with intellectual disabilities and 802 (0.12%) without (adjusted odds ratio 16.85, 95% CI 15.29-18.56). The higher use among those with intellectual disabilities fell each year (adjusted odds ratio 20.19 in 2010 v. 14.24 in 2013). Overall, 191 (1.18%) pupils with intellectual disabilities and 4561 (0.66%) without were prescribed antidepressants (adjusted odds ratio 2.28, 95% CI 2.03-2.56). The difference decreased each year (adjusted odds ratio 3.10 in 2010 v. 2.02 in 2013). CONCLUSIONS Significantly more pupils with intellectual disabilities are prescribed antipsychotics and antidepressants than are other pupils. Prescribing overall increased over time, but less so for pupils with intellectual disabilities; either they are not receiving the same treatment advances as other pupils, or possible overprescribing in the past is changing. More longitudinal data are required.
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Affiliation(s)
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Bethany Stanley
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Nicola Greenlaw
- Institute of Health and Wellbeing, University of Glasgow, UK
| | | | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, UK
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Clark B, Bélanger SA. ADHD in children and youth: Part 3-Assessment and treatment with comorbid ASD, ID, or prematurity. Paediatr Child Health 2019; 23:485-490. [PMID: 30681666 DOI: 10.1093/pch/pxy111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: 1) Summarize the current clinical evidence regarding ADHD,2) Establish a standard for ADHD care, and3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 3, which focuses on associated autism spectrum disorder, intellectual disability, and prematurity, include the challenges of diagnostic assessment, common presentations, the role of genetics, and treatment, including the benefits of physical activity. Recommendations are based on current guidelines, evidence from the literature, and expert consensus.
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Affiliation(s)
- Brenda Clark
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Stacey A Bélanger
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
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Kishore MT, Udipi GA, Seshadri SP. Clinical Practice Guidelines for Assessment and Management of intellectual disability. Indian J Psychiatry 2019; 61:194-210. [PMID: 30745696 PMCID: PMC6345136 DOI: 10.4103/psychiatry.indianjpsychiatry_507_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- M Thomas Kishore
- Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gautham Arunachal Udipi
- Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shekhar P Seshadri
- Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Clark B, Bélanger SA. Le TDAH chez les enfants et les adolescents, partie 3 : l’évaluation et le traitement en cas d’association au trouble du spectre de l’autisme, au handicap intellectuel ou à la prématurité. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brenda Clark
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Stacey A Bélanger
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
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8
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de Knegt NC, Lobbezoo F, Schuengel C, Evenhuis HM, Scherder EJA. Self-Reported Presence and Experience of Pain in Adults with Down Syndrome. PAIN MEDICINE 2018; 18:1247-1263. [PMID: 27694149 DOI: 10.1093/pm/pnw226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective The aim was to examine whether the presence of pain (based on physical conditions and participants' report) and self-reported pain experience in adults with Down syndrome (DS) differ from general population controls. Design Cross-sectional study of 224 adults with DS (mean age = 38.1 years, mild-severe intellectual disabilities) and 142 age-matched controls (median age = 40.5 years, mean estimated IQ = 105.7) in the Netherlands. Methods File-based medical information was evaluated. Self-reported presence and experience of pain were assessed in rest and after movement during a test session (affect with facial affective scale (FAS: 0.04-0.97), intensity assessed with numeric rating scale (NRS: 0-10). Results Compared with controls, more DS participants had physical conditions that may cause pain and/or discomfort ( p = .004, 50% vs 35%), but fewer DS participants reported pain during the test session ( p = .003, 58% vs 73%). Of the participants who indicated pain and comprehended self-reporting scales ( n = 198 FAS, n = 161 NRS), the DS group reported a higher pain affect and intensity than the controls ( p < .001, FAS: 0.75-0.85 vs 0.50-0.59, NRS: 6.00-7.94 vs 2.00-3.73). Conclusions Not all adults with DS and painful/discomforting physical conditions reported pain. Those who did indicated a higher pain experience than adults from the general population. Research into spontaneous self-report of pain, repeated pain assessment, and acute pain is needed in people with DS for more insight into pain experience and mismatches between self-report and medical information.
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Affiliation(s)
- Nanda C de Knegt
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, the Netherlands
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies and EMGO+ Institute for Health and Care Research
| | - Heleen M Evenhuis
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
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Kilburn JE, Shapiro CJ, Hardin JW. Linking implementation of evidence-based parenting programs to outcomes in early intervention. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 70:50-58. [PMID: 28889071 DOI: 10.1016/j.ridd.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/29/2017] [Accepted: 09/01/2017] [Indexed: 06/07/2023]
Abstract
In the field of early intervention, only a few studies of parenting interventions include both participant and facilitator behaviors. Fidelity and supervision (facilitator characteristics) and dosage and satisfaction (participant characteristics) were tested on the outcome of improved parenting style in a sample of 36 parents of young children with disabilities. Results indicated that the facilitator behavior of fidelity was significantly and negatively related to the program outcome of parenting style; no effect was found for the facilitator behavior of supervision. For the participant behaviors, both dosage and satisfaction had non-significant relationships with the program outcome of parenting style at follow-up. The surprising negative relationship between content fidelity and parenting style was discussed.Two possible explanations were: (1) process or quality of intervention delivery is more influential than content fidelity, which considers only adherence to the intervention manual, and (2) the developmental stage of early intervention families calls for more focus on relationships between facilitators and parents and less on content of the specific intervention.
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Affiliation(s)
- Janice E Kilburn
- South Carolina First Steps to School Readiness, 1300 Sumter Street, Suite 100, Columbia, SC 29201, United States.
| | - Cheri J Shapiro
- Institute for Families in Society, University of South Carolina, Columbia, SC 29208, United States
| | - James W Hardin
- Biostatistics Collaborative Unit, Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, United States
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Abstract
Intellectual disability (ID) and language disorders are neurodevelopmental conditions arising in early childhood. Child psychiatrists are likely to encounter children with ID and language disorders because both are strongly associated with challenging behaviors and mental disorder. Because early intervention is associated with optimal outcomes, child psychiatrists must be aware of their signs and symptoms, particularly as related to delays in cognitive and adaptive function. Optimal management of both ID and language disorders requires a multidisciplinary, team-based, and family centered approach. Child psychiatrists play an important role on this team, given their expertise with contextualizing and treating challenging behaviors.
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Affiliation(s)
- Natasha Marrus
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Washington University in St Louis, 660 South Euclid Avenue, Box 8504, St Louis, MO 63110, USA.
| | - Lacey Hall
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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11
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de Knegt NC, Lobbezoo F, Schuengel C, Evenhuis HM, Scherder EJA. Pain and Cognitive Functioning in Adults with Down Syndrome. PAIN MEDICINE 2017; 18:1264-1277. [PMID: 28034975 DOI: 10.1093/pm/pnw280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective The aim of the present study was to examine whether cognitive functioning (i.e., memory and executive functioning) is related to self-reported presence of pain (i.e., affirmative answer to the question whether the individual feels pain) and experience of pain (i.e., intensity and affect) in adults with Down syndrome (DS). Design, Setting, and Subjects Cross-sectional study of 224 adults with DS (mean age = 38.1 years, mild-severe intellectual disabilities) in the Netherlands. Methods File-based medical information was evaluated. Self-reported presence and experience of pain were assessed during a test session, both in rest and after movement (affect with the facial affective scale [FAS], intensity with the numeric rating scale [NRS]). Neuropsychological tests for memory and executive functioning were used. Results Participants with lower memory scores were more likely to report the presence of pain, while controlling for age, gender, physical conditions that may cause pain, language comprehension, and vocabulary ( p = .030, 58.4% classification rate, N = 154). No statistically significant associations were found between executive functioning and self-reported presence of pain or between cognitive functioning and self-reported pain experience. Conclusions Memory seems to be related to the self-reported presence of pain in adults with DS after explicit inquiry, although the clinical use of this model is yet limited. Therefore, further research is needed for insight into the role of cognitive processes in self-report (e.g., involving aspects such as acquiescence and repeated measurements) to evaluate whether neuropsychological examination could contribute to pain assessment in DS.
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Affiliation(s)
- Nanda C de Knegt
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- MOVE Research Institute Amsterdam.,Department of Oral Kinesiology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies.,EMGO+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Heleen M Evenhuis
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
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Molina-Ruiz RM, Martín-Carballeda J, Asensio-Moreno I, Montañés-Rada F. A guide to psychopharmacological treatment of patients with intellectual disability in psychiatry. Int J Psychiatry Med 2017; 52:176-189. [PMID: 28792289 DOI: 10.1177/0091217417720896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Subjects with intellectual disability are at increased risk of having comorbid psychiatric disorders and worse response to psychotherapeutic and psychopharmacological treatment interventions. On the other hand, available data on best treatment approach in this population are scarce and lack scientific evidence due to methodological limitations. The present study aims to perform a systematic review of the literature to facilitate the use of psychotropic drugs in clinical practice and better establish future research targets in this field. Objectives To review the available psychopharmacological strategies for patients with intellectual disabilities, psychiatric disorders, and behavioural disturbances. Serve as a quick guide for clinicians working in the field of intellectual disability. Methods We conducted a selective evidence-based review of the literature using Pubmed and EMBASE databases and selected most recent and relevant papers for this review. Results There are several available psychotropic drugs for the treatment of patients with intellectual disability and comorbid psychiatric disorders, although scientific evidence is limited. Treatment should be individualized according to risk-benefit balance. Discussion Further studies are needed and new available drugs should be considered to gain knowledge in effectiveness of different therapeutic approaches available in this population.
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Affiliation(s)
- Rosa M Molina-Ruiz
- 1 Department of Psychiatry, Fundación Alcorcón University Hospital-Public Health Agency, Madrid, Spain.,2 Psychiatry Department, Universidad Rey Juan Carlos de Madrid, Madrid, Spain
| | - Julia Martín-Carballeda
- 1 Department of Psychiatry, Fundación Alcorcón University Hospital-Public Health Agency, Madrid, Spain.,2 Psychiatry Department, Universidad Rey Juan Carlos de Madrid, Madrid, Spain
| | - Inmaculada Asensio-Moreno
- 3 Department of Psychiatry, Gómez Ulla Central Defense Hospital-Public Health Agency, Ministry of Defense, Madrid, Spain
| | - Francisco Montañés-Rada
- 1 Department of Psychiatry, Fundación Alcorcón University Hospital-Public Health Agency, Madrid, Spain.,2 Psychiatry Department, Universidad Rey Juan Carlos de Madrid, Madrid, Spain
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de Winter CF, van den Berge APJ, Schoufour JD, Oppewal A, Evenhuis HM. A 3-year follow-up study on cardiovascular disease and mortality in older people with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 53-54:115-126. [PMID: 26874209 DOI: 10.1016/j.ridd.2016.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/21/2016] [Accepted: 01/28/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND With increasing longevity and a similar or increased prevalence of cardiovascular disease risk factors (as compared to the general population), people with intellectual disabilities (IDs) are at risk of developing cardiovascular disease. However, prospective studies on incidence and influencing factors of cardiovascular disease and mortality are lacking. METHODS A three year follow-up study was undertaken to study the incidence and symptoms at presentation of myocardial accident, stroke and heart failure in older people with ID. Furthermore, the predictive value of cardiovascular disease risk factors on myocardial accident, stroke and heart failure and on all-cause mortality were studied. The baseline group consisted of the 1050 participants, aged 50 years and over, in the Dutch Healthy Ageing and Intellectual Disability (HA-ID) study. Baseline measurements were conducted between November 2008 and July 2010. Three years after baseline, medical files of 790 participants were studied. RESULTS Cardiovascular disease (myocardial infarction, stroke and heart failure) occurred in 5.9% of the population during 3 year follow-up, and 32% of them died due to the condition. Incidence of myocardial infarction is 2.8 per 1000 personyears, for stroke 3.2 per 1000 personyears and for heart failure 12.5 per 1000 personyears. Incidence of these conditions is probably underestimated, due to atypical symptom presentation. The use of atypical antipsychotics and a history of heart failure were predictive for myocardial infarction. Heart failure was predicted by abdominal obesity, chronic kidney disease and a history of heart failure. A total of cardiovascular disease (myocardial infarction, stroke or heart failure) was predicted by abdominal obesity, a history of stroke and a history of heart failure. A low body-mass index, peripheral arterial disease, chronic kidney disease and inflammation were predictive for 3-year all-cause mortality. CONCLUSION Incidence of cardiovascular disease in older people with ID is similar to that in the general population. A pro-active assessment and treatment of the presented cardiovascular disease risk factors may reduce cardiovascular disease and mortality in older people with ID.
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Affiliation(s)
- C F de Winter
- Intellectual Disability Medicine, Erasmus Medical Center Rotterdam, Department of General Practice, Rotterdam, The Netherlands; Reinaerde, Den Dolder, The Netherlands.
| | - A P J van den Berge
- Intellectual Disability Medicine, Erasmus Medical Center Rotterdam, Department of General Practice, Rotterdam, The Netherlands
| | - J D Schoufour
- Intellectual Disability Medicine, Erasmus Medical Center Rotterdam, Department of General Practice, Rotterdam, The Netherlands
| | - A Oppewal
- Intellectual Disability Medicine, Erasmus Medical Center Rotterdam, Department of General Practice, Rotterdam, The Netherlands
| | - H M Evenhuis
- Intellectual Disability Medicine, Erasmus Medical Center Rotterdam, Department of General Practice, Rotterdam, The Netherlands
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de Knegt NC, Schuengel C, Evenhuis HM, Lobbezoo F, Scherder EJA. Apolipoprotein E ɛ4, Cognitive Function, and Pain Experience in Down Syndrome: A Pilot Study. Arch Clin Neuropsychol 2016; 31:389-400. [PMID: 27193365 DOI: 10.1093/arclin/acw022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The presence of apolipoprotein E (ApoE) ɛ4 allele might be related to higher pain experience due to increased risk for potentially painful physical conditions and cognitive impairment (less efficient coping with pain). This hypothesis is clinically relevant to examine in adults with Down syndrome (DS) because they are at risk for painful physical conditions, their presence of ApoE ε4 is related to cognitive impairment, and their pain experience is unclear. The present pilot study addressed the associations between ApoE genotype, cognition, and pain in DS. METHOD DNA analysis of saliva, neuropsychological tests (assessing memory and executive functioning), and self-reporting pain scales (in rest and after movement) were used with a cross-sectional design in 146 adults with DS (mean age 39.1 years, mild to moderate intellectual disabilities, 46% men, 30% ApoE ɛ4 carrier). RESULTS The difference between ApoE ɛ4 carriers and noncarriers was not statistically significant for cognitive function, pain experience, and prevalence of potentially painful conditions. Among ɛ4 carriers, the presence of potentially painful conditions was associated with worse executive functioning (p = .022, r = .39). CONCLUSIONS The clinical implication of the results is that ApoE ɛ4 in DS may play a role in pain, although the theoretical explanation via associations with pain experience and cognition remains unclear. Further research should include a large sample of adults with DS selected on diagnosed painful conditions to obtain more insight into the possible role of ApoE genotype (and its association with cognition) in the pain experience of this target group.
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Affiliation(s)
- Nanda C de Knegt
- Department of Clinical Neuropsychology, VU University, 1081 BT Amsterdam, The Netherlands
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies, VU University, 1081 BT Amsterdam, The Netherlands
| | - Heleen M Evenhuis
- Department of General Practice, Erasmus MC University Medical Centre, 3015 CE Rotterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University, 1081 BT Amsterdam, The Netherlands
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Kok L, van der Waa A, Klip H, Staal W. The effectiveness of psychosocial interventions for children with a psychiatric disorder and mild intellectual disability to borderline intellectual functioning: A systematic literature review and meta-analysis. Clin Child Psychol Psychiatry 2016; 21:156-71. [PMID: 25633367 DOI: 10.1177/1359104514567579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with intellectual disability frequently have difficulties in adapting to their environment. The extent of the experienced problems does not only depend on cognitive functioning but is influenced by other factors, such as the presence of a psychiatric disorder or other brain disorders, or adverse environmental factors. Several epidemiological studies show that children with intellectual disabilities are at an increased risk to develop psychiatric disorders. This is also true for youth with a mild intellectual disability and even those with borderline intellectual functioning (mild to borderline intellectual disability (MBID)). Psychiatric disorders are often overlooked because behavioral problems are rather attributed to the intellectual disability. Consequently, effective psychiatric interventions, which are needed to improve the level of functioning, are not applied. This review aimed to systematically evaluate the currently available, qualitatively sound research concerning the effectiveness of psychosocial interventions, specifically directed at psychiatric disorders in children with MBID. Assessed for eligibility were 1409 unique reports, and the review ultimately included only 12 reports. Review of the results and meta-analyses showed that the majority of studies suffer from multiple limitations and that methodological variations between studies are extensive. This possibly reflects the high variance of factors that may be involved in MBID. It will be important in future research to address multi-causality.
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Affiliation(s)
- Lidwien Kok
- Department of Mild Intellectual Disabilities, Karakter Child and Adolescent Psychiatry, The Netherlands
| | - Anne van der Waa
- Department of Mild Intellectual Disabilities, Karakter Child and Adolescent Psychiatry, The Netherlands
| | - Helen Klip
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands
| | - Wouter Staal
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, The Netherlands
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de Knegt NC, Lobbezoo F, Schuengel C, Evenhuis HM, Scherder EJA. Self-Reporting Tool On Pain in People with Intellectual Disabilities (STOP-ID!): a Usability Study. Augment Altern Commun 2015; 32:1-11. [DOI: 10.3109/07434618.2015.1100677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To estimate the rate of psychotropic medication use in children and adolescents with Down syndrome (DS) and to describe age-related trends. METHODS Data were obtained from electronic health records from 2010 to 2013 for a retrospective cohort of 832 children with DS, aged 5 to 21 years, including 5324 visits. The following medication classes: central nervous system (CNS) stimulants, selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha adrenergic agonists were examined. The distribution of rates of medication use across ages was assessed graphically and with the Cochran-Armitage trend test. Between-group comparisons of medication classes were conducted using χ. Repeated measures models with generalized estimating equations were used to assess changes in rates of medication use over time. RESULTS Children aged 12 to 21 years were more likely to be on any medication at some point compared with children aged 5 to 11 years (25% vs 17%, respectively, p = .003). For 5 to 11 year olds, the odds of being on a psychotropic medication increased with age for all medication classes studied. For 12 to 18 year olds, the odds of being on a CNS stimulant significantly decreased with increasing age (odds ratio: 0.73, 95% confidence intervals, 0.58-0.91), whereas the odds of being on a medication from one of the other classes was stable. CONCLUSION Changes in psychotropic medication use across the age span in children with DS suggest that the type and severity of neurobehavioral problems in this population likely also change over time. These findings will inform future research on the common mental health conditions and treatments for children with DS.
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Besterman AD, Hendren RL. Psychopharmacological Management of Problem Behaviors in Mowat-Wilson Syndrome. J Child Adolesc Psychopharmacol 2015; 25:656-7. [PMID: 26402313 PMCID: PMC4615772 DOI: 10.1089/cap.2015.0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Aaron D. Besterman
- Department of Psychiatry, University of California, San Francisco, California
| | - Robert L. Hendren
- Department of Psychiatry, University of California, San Francisco, California.,Division of Child and Adolescent Psychiatry University of California, San Francisco, California
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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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Hässler F, Dück A, Jung M, Reis O. Treatment of aggressive behavior problems in boys with intellectual disabilities using zuclopenthixol. J Child Adolesc Psychopharmacol 2014; 24:579-81. [PMID: 25514543 DOI: 10.1089/cap.2014.0066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Disruptive or challenging behavior problems pose a threat to children and adolescents with intellectual disabilities and their caregivers. Psychopharmacological treatment is mostly studied with new-generation antipsychotics and has been criticized for adverse side effects. This study examined the effect of the classic antipsychotic zuclopenthixol. METHODS A total of 39 boys (ages 8.0-17.11 years) with learning disabilities were included and examined for a response to zuclopenthixol during a 6 week period of open label treatment. Doses started low and were adapted individually. From responders, zuclopenthixol was randomly withdrawn for 12 weeks. Responses to withdrawal were observed by external raters using the Modified Overt Aggression Scale. RESULTS Of all patients included into the study, 15 were not randomized because of insufficient therapeutic effect, adverse event, or noncompliance. Kaplan-Meier estimations showed less aggressive behavior problems for the continuing subgroup (n=9) than in the placebo group (n=15). Individual doses stayed <10 mg/day. CONCLUSIONS Zuclopenthixol proved to be effective in reducing challenging behavior in boys even at low doses.
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Affiliation(s)
- Frank Hässler
- 1 Department of Child and Adolescent Psychiatry, University Medicine of Rostock , Rostock, Germany
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21
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Aman MG, Smith T, Arnold LE, Corbett-Dick P, Tumuluru R, Hollway JA, Hyman SL, Mendoza-Burcham M, Pan X, Mruzek DW, Lecavalier L, Levato L, Silverman LB, Handen B. A review of atomoxetine effects in young people with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1412-24. [PMID: 24732041 PMCID: PMC4532325 DOI: 10.1016/j.ridd.2014.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/25/2014] [Accepted: 03/06/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED This review summarizes the pharmacokinetic characteristics, pharmacodynamic properties, common side effects, and clinical advantages and disadvantages associated with atomoxetine (ATX) treatment in typically developing children and adults with ADHD. Then the clinical research to date in developmental disabilities (DD), including autism spectrum disorders (ASD), is summarized and reviewed. Of the 11 relevant reports available, only two were placebo-controlled randomized clinical trials, and both focused on a single DD population (ASD). All trials but one indicated clinical improvement in ADHD symptoms with ATX, although it was difficult to judge the magnitude and validity of reported improvement in the absence of placebo controls. Effects of ATX on co-occurring behavioral and cognitive symptoms were much less consistent. Appetite decrease, nausea, and irritability were the most common adverse events reported among children with DD; clinicians should be aware that, as with stimulants, irritability appears to occur much more commonly in persons with DD than in typically developing individuals. Splitting the dose initially, starting below the recommended starting dose, and titrating slowly may prevent or ameliorate side effects. Patience is needed for the slow build-up of benefit. CONCLUSIONS ATX holds promise for managing ADHD symptoms in DD, but properly controlled, randomized clinical trials of atomoxetine in intellectual disability and ASD are sorely needed. Clinicians and researchers should be vigilant for the emergence of irritability with ATX treatment. Effects of ATX on cognition in DD are virtually unstudied.
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Affiliation(s)
- Michael G Aman
- The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States.
| | - Tristram Smith
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - L Eugene Arnold
- The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States
| | - Patricia Corbett-Dick
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - Rameshwari Tumuluru
- Department of Psychiatry at the Western Psychiatric Institute and Clinic, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Jill A Hollway
- The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States
| | - Susan L Hyman
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - Marissa Mendoza-Burcham
- Department of Psychiatry at the Western Psychiatric Institute and Clinic, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Xueliang Pan
- Center for Biostatistics, Ohio State University, 2012 Kenny Road, Columbus, OH 43221, United States
| | - Daniel W Mruzek
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - Luc Lecavalier
- The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States
| | - Lynne Levato
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - Laura B Silverman
- Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - Benjamin Handen
- Department of Psychiatry at the Western Psychiatric Institute and Clinic, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
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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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Iasevoli F, Buonaguro EF, Marconi M, Di Giovambattista E, Rapagnani MP, De Berardis D, Martinotti G, Mazza M, Balletta R, Serroni N, Di Giannantonio M, de Bartolomeis A, Valchera A. Efficacy and clinical determinants of antipsychotic polypharmacy in psychotic patients experiencing an acute relapse and admitted to hospital stay: results from a cross-sectional and a subsequent longitudinal pilot study. ISRN PHARMACOLOGY 2014; 2014:762127. [PMID: 24592333 PMCID: PMC3921985 DOI: 10.1155/2014/762127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 10/30/2013] [Indexed: 06/03/2023]
Abstract
Background. Antipsychotic polypharmacy is used in several psychiatric disorders, despite poor evidence existing to support this practice. Aim. We evaluated whether psychotic patients in acute relapse exposed to antipsychotic polypharmacy (AP + AP) showed different demographic, clinical, or psychopathological features compared to those exposed to one antipsychotic (AP) and whether AP + AP patients showed significantly higher improvement compared to AP patients after a 4-week treatment. Methods. Inpatients were subdivided into AP + AP and AP ones. In the cross-sectional step, patients were compared according to demographics, clinical variables, and scores on rating scales. In the longitudinal step, patients remained for 4 weeks under admission medications and were compared for clinical improvement. Results. AP + AP patients were more frequently diagnosed with schizophrenia and mental retardation as a comorbid illness. AP + AP patients were more frequently under first-generation antipsychotics and had worse clinical presentation. After 4 weeks of treatment, both AP + AP and AP patients improved compared to the baseline. However, AP patients scored significantly less than AP + AP patients at the Clinical Global Impression Scale at the 4-week time point but not at the baseline, indicating a treatment-specific improvement. Conclusions. Antipsychotic polypharmacy may be offered to specific types of psychotic patients. However, efficacy of this strategy is limited at best.
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Affiliation(s)
- Felice Iasevoli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University “Federico II” of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Elisabetta F. Buonaguro
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University “Federico II” of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Massimo Marconi
- Hermanas Hospitalarias, Villa San Giuseppe Hospital, 63100 Ascoli Piceno, Italy
| | | | | | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4, 64100 Teramo, Italy
- Department of Neurosciences and Imaging, University “G. d'Annunzio” of Chieti, 66013 Chieti, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, University “G. d'Annunzio” of Chieti, 66013 Chieti, Italy
| | - Monica Mazza
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67010 L'Aquila, Italy
| | - Raffaele Balletta
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University “Federico II” of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Nicola Serroni
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4, 64100 Teramo, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, University “G. d'Annunzio” of Chieti, 66013 Chieti, Italy
| | - Andrea de Bartolomeis
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University “Federico II” of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Alessandro Valchera
- Hermanas Hospitalarias, Villa San Giuseppe Hospital, 63100 Ascoli Piceno, Italy
- FORIPSI, 00199 Rome, Italy
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Hsu YC, Chien IC, Tan HKL, Lin CH, Cheng SW, Chou YJ, Chou P. Trends, correlates, and disease patterns of antipsychotic use among children and adolescents in Taiwan. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1889-96. [PMID: 23653092 DOI: 10.1007/s00127-013-0702-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 04/27/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE We used Taiwan's population-based National Health Insurance database to investigate the trends, correlates, and disease patterns of antipsychotic use among children and adolescents. METHODS The National Health Research Institutes provided a database of 1,000,000 random subjects for study. We chose subjects who were aged 18 years or younger during 1997-2005. In this sample, subjects who were given at least one antipsychotic prescription, including first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs), were identified. Trends, prevalence, and associated factors of antipsychotic use were determined. The proportion of antipsychotic use for psychiatric and medical disorders was also analyzed. RESULTS The 1-year prevalence of SGA use increased from 0.00 % in 1997 to 0.09 % in 2005, whereas the 1-year prevalence of FGA use ranged from 2.24 to 3.43 % during this same period, with no significant change. Age and male gender were associated with higher SGA use. Among SGA users, the greatest proportion suffered from psychiatric disorders, including tics, hyperkinetic syndrome of childhood, schizophrenia, affective disorders, and autism. Among FGA users, a larger proportion was for medical conditions, including diseases of the digestive and respiratory systems. CONCLUSION The prevalence of pediatric SGA use increased greatly from 1997 to 2005. Among pediatric subjects using antipsychotics, SGAs were mostly used for psychiatric disorders, whereas FGAs were mostly prescribed for medical conditions. Future research will focus on indication, dosage, frequency, duration, adverse effects, and off-label use of antipsychotics in the pediatric population.
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Affiliation(s)
- Yuan-Chang Hsu
- Taoyuan Mental Hospital, Department of Health, No. 71, Longshow Street, Taoyuan, 33058, Taiwan
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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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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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Scheifes A, de Jong D, Stolker JJ, Nijman HLI, Egberts TCG, Heerdink ER. Prevalence and characteristics of psychotropic drug use in institutionalized children and adolescents with mild intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3159-3167. [PMID: 23886758 DOI: 10.1016/j.ridd.2013.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 06/02/2023]
Abstract
Psychotropic drugs are a cornerstone in the treatment of psychopathology and/or behavioral problems in children with intellectual disability (ID), despite concerns about efficacy and safety. Studies on the prevalence of psychotropic drug use have mainly been focused on adults with ID or children without ID. Therefore the aim of this cross sectional study was to assess the prevalence and characteristics of psychotropic drug use in children with mild ID who were institutionalized in specialized inpatient treatment facilities in The Netherlands. Demographic data, psychiatric diagnoses, the nature of the behavioral problems, level of intellectual functioning, and medication data were extracted from medical records using a standardized data collection form. Adjusted relative risks (ARR) for the association between patient characteristics and psychotropic drug use were estimated with Cox regression analysis. Of the 472 included children, 29.4% (n=139) used any psychotropic drug, of which 15.3% (n=72) used antipsychotics (mainly risperidone), and 14.8% (n=70) used psychostimulants (mainly methylphenidate). Age, sex, and behavioral problems were associated with psychotropic drug use. Boys had a 1.7 (95%CI 1.1-2.4) higher probability of using psychotropic drugs, compared to girls adjusted for age and behavioral problems. Having any behavioral problem was associated with psychotropic drug use with an ARR of 2.1 (95%CI 1.3-3.3), adjusted for sex and age. The high prevalence of psychotropic drug use in children with ID is worrisome because of the lack of evidence of effectiveness (especially for behavioral problems) at this young age, and the potential of adverse drug reactions.
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Affiliation(s)
- Arlette Scheifes
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, PO Box 80082, 3508 TB, Utrecht, The Netherlands; Altrecht Institute for Mental Health Care, Vuurvlinder 4, 3734 AB, Den Dolder, The Netherlands.
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Doan T, Ware R, McPherson L, van Dooren K, Bain C, Carrington S, Einfeld S, Tonge B, Lennox N. Psychotropic medication use in adolescents with intellectual disability living in the community. Pharmacoepidemiol Drug Saf 2013; 23:69-76. [DOI: 10.1002/pds.3484] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 06/09/2013] [Accepted: 06/19/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Tan Doan
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne Victoria Australia
| | - Robert Ware
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine; The University of Queensland; Brisbane Queensland Australia
- School of Population Health; The University of Queensland; Brisbane Queensland Australia
| | - Lyn McPherson
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Kate van Dooren
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Christopher Bain
- Genetics and Population Health Division; Queensland Institute of Medical Research; Brisbane Queensland Australia
- National Centre for Epidemiology and Population Health; The Australian National University; Canberra Australian Capital Territory Australia
| | - Suzanne Carrington
- Faculty of Education; Queensland University of Technology; Brisbane Queensland Australia
| | - Stewart Einfeld
- Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
- Brain and Mind Research Institute; The University of Sydney; Sydney New South Wales Australia
| | - Bruce Tonge
- Monash Medical Centre; Monash University; Melbourne Victoria Australia
| | - Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine; The University of Queensland; Brisbane Queensland Australia
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Psychotropic drugs and their impact on the treatment of paediatric dental patients. Eur Arch Paediatr Dent 2013; 14:197-206. [DOI: 10.1007/s40368-013-0053-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/12/2012] [Indexed: 10/26/2022]
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Ageranioti-Bélanger S, Brunet S, D'Anjou G, Tellier G, Boivin J, Gauthier M. Behaviour disorders in children with an intellectual disability. Paediatr Child Health 2013; 17:84-8. [PMID: 23372399 DOI: 10.1093/pch/17.2.84] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2011] [Indexed: 11/13/2022] Open
Abstract
Behaviour disorders are frequent in children with an intellectual disability, regardless of the underlying etiology. They are often disabling, and can create problems in everyday life and can mask, or reveal, an organic or psychiatric illness. Such behaviours are often chronic and more than one may be present in the same individual. This is further complicated by the fact that parents often do not seek help for the problem, perhaps believing that it is due to the child's disability and cannot be treated. The present review describes some general concepts dealing with the management of behaviour disorders commonly seen in children and youth with an intellectual disability, and gives a high level overview of behaviours commonly problematic in this patient population including sleep disturbances, agitated and aggressive behaviours, and self-injury behaviour. In general, while pharmacological treatment is possible, behavioural intervention is a more effective and better tolerated form of treatment.
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Martens MA, Seyfer DL, Andridge RR, Foster JEA, Chowdhury M, McClure KE, Coury DL. Parent report of antidepressant, anxiolytic, and antipsychotic medication use in individuals with Williams syndrome: effectiveness and adverse effects. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:2106-2121. [PMID: 22776821 DOI: 10.1016/j.ridd.2012.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 06/11/2012] [Accepted: 06/11/2012] [Indexed: 06/01/2023]
Abstract
Williams syndrome (WS) is a neurodevelopmental genetic disorder characterized in part by anxiety and behavioral difficulties. We examine the effectiveness and adverse effects of antidepressant, anxiolytic, and antipsychotic medications in individuals with WS. A total of 513 parents/caregivers completed a survey of psychotropic medication usage regarding their child or adult with WS. Twenty-four percent (24%) of the individuals had been prescribed an SSRI medication, while 12% had been prescribed another type of antidepressant or anxiolytic. Overall, 81% of respondents indicated that SSRI medications were either "Helpful" or "Somewhat Helpful", with paroxetine reported to be the least helpful. Sixty-four percent (64%) of survey participants reported that non-SSRI antidepressants and anxiolytics were either "Helpful" or "Somewhat Helpful" in treating symptoms of anxiety. Side effects for the antidepressants and anxiolytics were typically neurological in nature. Ten percent (10%) of the survey participants reported taking an antipsychotic medication, with risperidone and quetiapine described as more helpful than aripiprazole. Medication effectiveness may be related to the impact on serotonin levels. These findings call for further studies of medication usage in WS in order to improve their quality of life.
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Affiliation(s)
- Marilee A Martens
- The Nisonger Center, The Ohio State University, Columbus, OH 43210, USA.
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Mullen S. Use of antipsychotics and psychostimulants for challenging behaviors in the intellectually disabled. Ment Health Clin 2012. [DOI: 10.9740/mhc.n115492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sandra Mullen
- Clinical Pharmacist – Psychiatry, Clinical Assistant Professor – Pharmacy, Clinical Assistant Professor – Psychiatry, Virginia Commonwealth University Health System, Virginia Treatment Center for Children
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Hässler F, Thome J. [Mental retardation and ADHD]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2012; 40:83-93; quiz 93-4. [PMID: 22354492 DOI: 10.1024/1422-4917/a000155] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hyperactivity syndromes and disorders (ADHD and HKD) include the symptoms of overactivity, inattention, and impulsivity, which occur in many other mental disorders as well, including mental retardation (MR). It is not surprising that symptoms of ADHD occur significantly higher in children with learning disabilities. Dekker and Koot (2003) found a prevalence of 14.8 % for ADHD in Dutch children attending special schools, and Emerson (2003) reported rates of 8.7 % for HKD in children with global learning disability, representing a 10-fold increased risk compared to the prevalence of hyperactivity (0.9 %) in the general population sample. Yet only very few studies have been published concerning ADHD in children with mental retardation. Several features distinguish the diagnoses of ADHD and MR. In contrast to the limited knowledge about the differences and similarities of ADHD and MR, many studies considered stimulant medication as a pharmacological management strategy for children suffering from ADHD, MR, or both. According to these studies, psychostimulants may improve the target symptoms of hyperactivity, impulsivity, disinhibition, and inattention, albeit with caveats: ADHD symptoms in patients with MR may be less responsive to medical treatment than in patients without MR. Moreover, people with MR may be more susceptible to side effects.
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Affiliation(s)
- Frank Hässler
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universität Rostock.
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Intelligenzminderung. PSYCHIATRIE UND PSYCHOTHERAPIE DES KINDES- UND JUGENDALTERS 2012. [PMCID: PMC7123948 DOI: 10.1007/978-3-642-19846-5_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Schwachsinn Der Gebrauch des Terminus »Schwachsinn« ist wegen seines globalen und wenig präzisen Charakters und durch seine historisch und umgangssprachlich bedingte sozial diskriminierende Tönung inzwischen in der wissenschaftlichen Literatur zu Recht weitgehend aufgegeben worden. In der Rechtsprechung speziell in der Forensik ist Schwachsinn als eine schuldausschließende bzw. schuldminderende juristische Kategorie ein nach wie vor gebräuchlicher Begriff.
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Treatment effects of stimulant medication in young boys with fragile X syndrome. J Neurodev Disord 2011; 3:175-84. [PMID: 21671049 PMCID: PMC3261280 DOI: 10.1007/s11689-011-9085-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 05/24/2011] [Indexed: 11/03/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common inherited form of intellectual disability and is caused by a CGG repeat expansion at Xq27.3 on the FMR1 gene. The majority of young boys with FXS display poor attention and hyperactivity that is disproportionate to their cognitive disability, and approximately 70% meet diagnostic criteria for attention-deficit/hyperactivity disorder. Psychopharmacology is employed with 82% of young males 5-17 years of age, with stimulant medication as the most common medication prescribed. This study evaluated the effects of stimulant medication on the academic performance, attention, motor activity, and psychophysiological arousal of boys with FXS, as well as the concordance of effects within individuals. Participants in this study included 12 boys with FXS who were treated with stimulants. Participants completed videotaped academic testing on two consecutive days and were randomly assigned to be off stimulants for 1 day and on stimulants the other day. On each day, multiple measures including academic performance, behavior regulation, and psychophysiological arousal were collected. Approximately 75% of participants performed better on attention and academic measures, and 70% showed improved physiological regulation while on stimulant medication. A high degree of concordance among measures was found. Lower intelligence quotient (IQ), but not age, correlated with greater improvements in in-seat behavior. IQ and age did not relate to on-task behaviors. The frequency and magnitude of response to stimulant medication in boys with FXS is higher than those reported for most children with non-specific intellectual disabilities and autism spectrum disorder.
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McKinney C, Renk K. Atypical antipsychotic medications in the management of disruptive behaviors in children: Safety guidelines and recommendations. Clin Psychol Rev 2011; 31:465-71. [DOI: 10.1016/j.cpr.2010.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 11/04/2010] [Accepted: 11/10/2010] [Indexed: 11/30/2022]
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Hässler F, Reis O. Pharmacotherapy of disruptive behavior in mentally retarded subjects: A review of the current literature. ACTA ACUST UNITED AC 2011; 16:265-72. [PMID: 20981765 DOI: 10.1002/ddrr.119] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The review presented here describes the state of the art of pharmacological treatment of aggression in subjects with mental retardation (MR) summing up results for both, children and adults. In general, psychopharmacological treatment of disruptive behavior in individuals with MR is similar to the treatment in subjects without MR. Compared to individuals without MR medication should "start lower and go slower." For children and adults results were similar but were obtained by somewhat different medications. There is evidence for the conventional antipsychotic zuclopenthixol having positive effects on disruptive behavior. Most studies described the atypical antipsychotic risperidone to control severe self-injurious behavior and other behavior problems in a variety of diagnoses. Anticonvulsants, antidepressants, and anxiolytic medications are reported as effective as well for the treatment of individuals with disruptive behavior. Aggression-related behavior often gets treated with stimulants or with stimulants combined with atypical neuroleptics.
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Affiliation(s)
- Frank Hässler
- Department of Child and Adolescent Neuropsychiatry, University of Rostock, Rostock, Germany.
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Fernández-Jaén A, Fernández-Mayoralas DM, Calleja Pérez B, Muñoz Jareño N, Campos Díaz MDR. Atomoxetine for attention deficit hyperactivity disorder in mental retardation. Pediatr Neurol 2010; 43:341-7. [PMID: 20933178 DOI: 10.1016/j.pediatrneurol.2010.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 05/12/2010] [Accepted: 06/07/2010] [Indexed: 11/16/2022]
Abstract
The study objective was to assess the efficacy and tolerability of atomoxetine in the treatment of attention deficit hyperactivity disorder symptoms in patients with mental retardation. In a 16-week, open-label, prospective study, 48 children with mental retardation and attention deficit hyperactivity disorder were recruited; the patients received atomoxetine, with a single final dose of 1.2 mg/kg per day reached at 3 weeks. The measure of efficacy was scores on Clinical Global Impression Severity scale (CGI-S), Conners, and Attention Deficit Hyperactivity Disorder Rating Scale ADHDRS-IV. A statistically significant difference was documented between the mean CGI-S scores before and after treatment: baseline CGI-S = 5.31 (S.D. = 0.85); post-treatment CGI-S = 4.13 (S.D. = 0.97), with a difference of 1.18 points (S.D. = 0.84) and a 95% confidence interval for the difference of 0.92-1.43 (P < 0.001). A statistically significant reduction (P < 0.01) was observed with respect to all the variables of the ADHDRS-IV and Conners scales. Slightly less than one third of the patients (31%) presented adverse events, the majority of which were mild, with irritability being the most frequent event. Atomoxetine appears to be to useful in improving attention deficit hyperactivity disorder symptoms in mentally retarded patients. Larger, randomized, controlled, double-blind studies are required to confirm the efficacy observed in this first study.
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Affiliation(s)
- Alberto Fernández-Jaén
- Neuropediatrics Section, Quiron University Hospital, C/ Diego de Velázquez 1,Pozuelo de Alarcón, Madrid, Spain.
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Torrioli M, Vernacotola S, Setini C, Bevilacqua F, Martinelli D, Snape M, Hutchison JA, Di Raimo FR, Tabolacci E, Neri G. Treatment with valproic acid ameliorates ADHD symptoms in fragile X syndrome boys. Am J Med Genet A 2010; 152A:1420-7. [PMID: 20503316 DOI: 10.1002/ajmg.a.33484] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fragile X syndrome (FXS) is the leading cause of inherited mental retardation, due to expansion and methylation of the CGG sequence at the 5' UTR of the FMR1 gene. Around 90% of affected boys present with attention deficit hyperactivity disorder (ADHD), while this percentage is lower in FXS girls (35-47%). Treatment of these behavioral symptoms is critical for many families. In an attempt at identifying drugs capable of restoring the activity of the FMR1 gene, we investigated the use of valproic acid (VPA), a well-known antiepileptic drug, also used as a mood stabilizer and in migraine therapy. It is described as an inhibitor of histone deacetylase (HDAC) and, possibly, as a DNA demethylating agent. In an in vitro study we observed that treatment of lymphoblastoid cells from FXS patients with VPA caused a modest reactivation of FMR1 transcription and increased levels of histone acetylation, confirming the histone hyperacetylating effect, but not its putative DNA demethylating activity. On the basis of these findings, we decided to evaluate the in vivo efficacy of VPA on ADHD symptoms in FXS patients. We observed an improvement in the adaptive behavior, defined as the performance of daily activities required for personal and social competence, due to a significant reduction in hyperactivity after VPA treatment. This treatment could be considered as an alternative to that with stimulants, whose efficacy in patients with FXS needs to be confirmed by further studies.
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Affiliation(s)
- Mariagiulia Torrioli
- Università Cattolica del Sacro Cuore, Cattedra di Neuropsichiatria Infantile, Rome, Italy
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de Kuijper G, Hoekstra P, Visser F, Scholte FA, Penning C, Evenhuis H. Use of antipsychotic drugs in individuals with intellectual disability (ID) in the Netherlands: prevalence and reasons for prescription. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:659-67. [PMID: 20426795 DOI: 10.1111/j.1365-2788.2010.01275.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND We investigated antipsychotic drug prescription practice of Dutch ID physicians, studying prevalence of antipsychotic drug use, reasons for prescription and the relationship between these reasons and patient characteristics. METHODS A cross-sectional study of medical and pharmaceutical records in a population living in residential settings of three care providers for persons with IDs in the Netherlands (n = 2373). RESULTS Prevalence of antipsychotic drug use was 32.2% (95% CI 30.1-33.9). Behavioural problems were the reason for prescription of antipsychotic drugs in 58% of cases and psychotic disorder or psychotic symptoms in 22.5%. In 11.7% the diagnosis of psychotic disorder was specified according to DSM-IV criteria. In 18.5% the reason for prescription was not noted in the medical record. Behavioural problems as reason for prescription was associated with profound and severe ID, living in a central location and male sex. Psychotic disorder specified according to DSM-IV as indication for prescription was negatively associated with profound and severe ID and with presence of an additional mental disorder. Absence of a noted reason for prescription was associated with female sex and with the presence of an additional mental disorder. DISCUSSION Current prevalence and reason for prescription of antipsychotic drugs are similar with outcomes of previous studies. Our results show the continuing lack of evidence-based psychopharmacological treatment in mental health care for persons with IDs.
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Affiliation(s)
- Gerda de Kuijper
- Vanboeijen, Centre for the Intellectually Disabled, Assen, The Netherlands.
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Tsiouris JA. Pharmacotherapy for aggressive behaviours in persons with intellectual disabilities: treatment or mistreatment? JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:1-16. [PMID: 20122096 DOI: 10.1111/j.1365-2788.2009.01232.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Antipsychotic medications have been used extensively to treat aggressive behaviours in persons with intellectual disabilities (ID) when the main psychiatric diagnoses given to them in the past were schizophrenia, childhood psychoses and ID with behaviour problems. Today, antipsychotics are still estimated to comprise 30-50% of all the psychotropics prescribed for persons with ID, although the prevalence of psychotic disorders is only 3% in this population. The overuse of antipsychotics in persons with ID could be justified if their aggressive behaviours were associated with mostly psychotic disorders and not other psychiatric disorders or factors and if the anti-aggressive properties of the antipsychotics have been supported by basic research or reviews of clinical studies. Is that so? This article explores these questions. METHODS The literature on aggressive behaviours, their associations with psychiatric disorders and other contributing factors and the past and current treatment options for aggressive behaviours in persons with and without ID was reviewed. Also, the literature on basic research regarding the brain receptors implicated in aggressive behaviours and the basic research and clinical studies on the anti-aggressive properties of antipsychotics was reviewed. RESULTS Aggressive behaviours in persons with ID serve different functions and many factors contribute to their initiation, maintenance and exacerbations or attenuation including most of the psychiatric and personality disorders. Genetic disorders, early victimisation, non-enriched and restrictive environments during childhood or later on and traumatic brain injury, which are common in persons with ID, have been associated with aggressive behaviours and with mostly non-psychotic disorders in persons with and without ID. If the factors above and the knowledge derived from studies of domestic violence and premeditated aggression in persons without ID are considered and applied during the evaluation of the most severe aggressive behaviours in persons with ID, more appropriate and effective treatment than antipsychotics can be implemented. Basic research implicates mostly the GABA and the serotonin pre-post synaptic brain receptors influence the initiation, modulation or inhibition of aggression in animals. The anti-aggressive properties of the antipsychotics have not been supported by reviews of clinical studies and basic research is absent. Antipsychotics are the indicated treatment only for psychiatric disorders and for aggressive behaviours associated with psychotic disorders and psychotic features as activation of dopamine receptor leads to defensive aggression. CONCLUSIONS Most of the persons with ID and aggressive behaviours do not have a diagnosis of psychotic disorder and there is lack of strong evidence supporting the anti-aggressive properties of the antipsychotics. The overuse of antipsychotics in this population may be explained by the old, faulty notion that aggressive behaviour in persons with ID is mostly associated with psychotic disorders. Given the discrediting of this notion, the use of antipsychotics in persons with ID may, in some cases, be considered mistreatment rather than proper treatment. In order to reverse the practice of over-prescribing antipsychotics for aggressive behaviours in persons with ID, basic research information on aggression must be disseminated, the search for the 'quick fix' must be abandoned and the promotion of antipsychotics as anti-aggressive drugs must be discouraged. Matching the treatment with the variables contributing to the aggressive behaviours, seeking a long-term rather than a short-term solution and avoiding the promotion of only one type of treatment for all types of aggression might change the current practice and improve the quality of life for many persons with ID.
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Affiliation(s)
- J A Tsiouris
- NYS Institute for Basic Research, George A. Jervis Clinic, Staten Island, New York, USA.
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Abstract
PURPOSE OF REVIEW This review focuses on the risk factors for increased mental health problems, and the types of psychopathology and their therapeutic management, in young people with intellectual disabilities. RECENT FINDINGS Recent studies indicate that this population presents significantly more emotional and behavioural problems than their peers without intellectual disabilities. These problems are not adequately detected and treated by mental health professionals; the children's families are overburdened, psychosocially and economically disadvantaged and in need of specialist support and counselling. SUMMARY The mental health needs of children and adolescents with intellectual disabilities are multiple, complex, persistent and costly, and for various reasons they are not adequately met. Prevention of mental health problems or early recognition through better screening followed by appropriate treatment are essential, in order to ensure better psychosocial adaptation of young people with intellectual disabilities. Inequalities in the provision of services must be addressed, and families helped through support and counselling, along with psychotherapeutic and psychopharmacological interventions for the children, as appropriate.
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Affiliation(s)
- Gerasimos Kolaitis
- Department of Child Psychiatry, Athens University Medical School, Aghia Sophia Children's Hospital, Athens, Greece.
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Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) affects 3%-5% of typical school-age children. However, considerably higher rates of ADHD (15%-25%) are observed in children with intellectual disability and autism. Studies of psychostimulants in the latter two populations have found poorer response rates compared to typically developing children. In addition, evidence suggests that children with developmental disabilities experience higher rates of adverse events. Guanfacine, an alpha2-adrenergic receptor agonist, has shown some promise as an alternative to psychostimulants. METHODS The present study involved a double-blind, placebo-controlled, crossover trial of guanfacine in 11 children (ages 5-9 years) with developmental disabilities and symptoms of inattention/overactivity. The 6-week trial involved a maximum dose of 3 mg/day of guanfacine. RESULTS Significant benefits were observed on the Hyperactivity subscale of the parent and teacher Aberrant Behavior Checklist (ABC) and Global Improvement Ratings. No gains were noted on other ABC subscales. Five of the 11 subjects (45%) were judged to be responders based on a 50% decrease in the ABC Hyperactivity subscale score between the placebo and guanfacine conditions. Several side effects were reported, including drowsiness and irritability. CONCLUSION While guanfacine appears to be an alternative to psychostimulants among children with developmental disabilities, clinicians need to remain vigilant to the possibility of side effects.
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Affiliation(s)
- Benjamin L Handen
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Gothelf D, Goraly O, Avni S, Stawski M, Hartmann I, Basel-Vanagaite L, Apter A. Psychiatric morbidity with focus on obsessive-compulsive disorder in an Israeli cohort of adolescents with mild to moderate mental retardation. J Neural Transm (Vienna) 2008; 115:929-36. [PMID: 18351287 DOI: 10.1007/s00702-008-0037-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 02/26/2008] [Indexed: 10/22/2022]
Abstract
The study evaluated the prevalence of DSM-IV-TR-defined psychiatric disorders in adolescents with mental retardation, with a focus on obsessive-compulsive disorder (OCD), for which data at present are sparse. Eighty-seven adolescents with mild to moderate mental retardation attending the Israeli special-education system were screened for psychiatric disorders in general and obsessive-compulsive symptoms in particular. Sixty-one percent had at least one psychiatric disorder. Of the 13 participants receiving antipsychotic medication, none had an underlying psychotic disorder and most had anxiety or depressive disorders. OCD was detected in 11% of participants and was characterized by high rates of psychiatric comorbidities. The severity of autistic symptoms predicted 39% of the variance in the severity of OCD symptoms. Adolescents with mild to moderate mental retardation have high rates of psychiatric morbidities that are often inappropriately treated. OCD is prevalent in this population and is strongly associated with autistic symptoms. Further studies are required in adolescents with mental retardation to better delineate psychiatric morbidities and their appropriate treatment in this at-risk population.
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Affiliation(s)
- Doron Gothelf
- The Behavioral Neurogenetics Center, Feinberg Department of Child Psychiatry, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
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Abstract
PURPOSE OF REVIEW The present article reviews the increasing literature on comorbidity, treatment and use of health service resources for children and adolescents with autism spectrum disorders and intellectual disability from January 2006 to January 2007. RECENT FINDINGS Children and adolescents with autism spectrum disorders and intellectual disability have a high prevalence of attention-deficit/hyperactive disorder, mood disorders, catatonia and repetitive behaviours compared with children without autism. Psychopharmacology is effective in reducing symptoms of behavioural problems and attention-deficit/hyperactive disorder, although further studies are required. Autism spectrum disorders are recognized to occur with Smith-Lemli-Optiz syndrome and 22q11.2 deletion syndrome. Children and adolescents with autism spectrum disorders have a high use of mental health services. SUMMARY There is increasing evidence of the comorbidity of psychiatric and behavioural disorders in young people with autism spectrum disorders and intellectual disability responding to established treatments. This high morbidity results in increased healthcare expenditure compared with children without autism and intellectual disability.
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Affiliation(s)
- Jane McCarthy
- South London & Maudsley NHS Foundation Trust, London, UK.
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