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Weiss MD, Daniolos PT, Coughlin K, Mulvaney-Day N, Cook B, Rosenblum D. A Scoping Review of the Intersectionality of Autism and Intellectual and Developmental Disability with Social Inequity on Diagnosis and Treatment of Youth. J Child Adolesc Psychopharmacol 2024. [PMID: 38957953 DOI: 10.1089/cap.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Objective: To describe how the intersectionality of race, ethnicity, and language with autism and intellectual and developmental disability (IDD) impacts mental health inequities in psychopharmacological management of youth. Method: This was a scoping review in which a series of searches were conducted in PubMed, Web of Science, Google Scholar, and manual review of the articles collected. Results: Although autism and/or IDD increases the risk for poor physical and mental health, social determinants of health such as race, ethnicity, and language account for approximately a third of poor outcomes. Minoritized children with autism/IDD experience significantly greater delays to diagnosis and misdiagnosis and are less likely to receive appropriate services. Access to psychological testing and psychosocial services is often limited by availability, skilled practitioners, a shortage of non-English-language providers or interpreters, and poor reimbursement. Conclusion: The intersectionality of autism and/or IDD with race, ethnicity, and language compounds the health inequities associated with either of these challenges independently.
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Affiliation(s)
- Margaret Danielle Weiss
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Peter T Daniolos
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Kevin Coughlin
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Norah Mulvaney-Day
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Benjamin Cook
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Debra Rosenblum
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
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Friedman C, Luxama CM. Mental and Behavioral Health, and Crisis Services for People with Intellectual and Developmental Disabilities in Medicaid Home- and Community-Based Services. J Autism Dev Disord 2024:10.1007/s10803-024-06441-z. [PMID: 38951311 DOI: 10.1007/s10803-024-06441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/03/2024]
Abstract
People with intellectual and developmental disabilities (IDD) often have higher rates of comorbid mental health conditions compared to the general population. Yet, many people with IDD also have unmet needs for mental and behavioral health services. The aim of this study was to examine how states provided mental and behavior health, and crisis services to people with IDD in their Home- and Community-Based Services (HCBS) programs, the largest funding mechanism for Long-Term Services and Supports (LTSS) for people with IDD in the United States. We analyzed fiscal year (2021) Medicaid HCBS waivers for people with IDD from across the United States to examine if and how they provided mental and behavior health, and crisis services. States projected spending $968.9 million for mental and behavior health, and crisis services for 190,299 people with IDD. Applied behavior analysis services were provided at greater rates than positive behavior supports and other forms of behavior interventions. While most states provided mental and behavior health, and crisis services in their waivers, there were vast inconsistencies in how they did so, across states, waivers, and services. HCBS are a crucial safety net to ensure people with IDD, especially those who also have mental health disabilities, can live and thrive in their communities.
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Affiliation(s)
- Carli Friedman
- The Council on Quality and Leadership (CQL), 100 West Road, Suite 300, Towson, MD, 21204, USA.
| | - Carine M Luxama
- College of Nursing and Health Services, University of Massachusetts at Boston, 100 Morrissey Blvd, Boston, MA, 02125, USA
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Shukla M. Primary care identification of mental health issues in adults with learning disabilities requires screening measures, practitioner training, collaboration and raising awareness in this population. Evid Based Nurs 2024; 27:95. [PMID: 37940363 DOI: 10.1136/ebnurs-2023-103812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
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Marquis S, Marquis NE, Lunsky Y, McGrail KM, Baumbusch J. A retrospective cohort study of prescription drug use among youth with intellectual/developmental disabilities in British Columbia. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 38773818 DOI: 10.1111/jir.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/22/2024] [Accepted: 04/24/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND People with intellectual/developmental disabilities (IDD) are known to have high rates of prescription drug use, particularly for psychotropic medications. This is of concern due to the many side effects associated with these medications and because of the risks of polypharmacy. In this paper we compare the most commonly dispensed drugs and all psychotropic medications for youth with IDD compared with youth without IDD. METHODS Using population-level administrative health data over a 10-year period, this study examined medications dispensed to youth with an IDD aged 15-24 years compared with youth without an IDD. The most common medications dispensed and the number of youth they were dispensed to were determined. As well a wide variety of psychotropic medications were examined. RESULTS There were a total of 20 591 youth with IDD and 1 293 791 youth without IDD identified. Youth with IDD had higher odds of being dispensed pain medications, amoxicillin, salbutamol, levothyroxine and all the psychotropic medications (antidepressants, antipsychotics, anxiolytics, anti-adrenergic agents, mood stabilisers and stimulants). For youth with IDD, 6558 (31.85%) were dispensed two or more different psychotropic medications within a year, compared with 75 963 (5.87%) of youth without IDD. DISCUSSION Compared to youth without IDD, youth with IDD had significantly higher odds of being dispensed most of the prescription medications studied, including all of the psychotropic medications. They were also twice as likely to be dispensed two or more medications from different classes of psychotropic drugs within the same year. These findings have important implications for the health of people with IDD and for their health care providers.
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Affiliation(s)
- S Marquis
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Y Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - K M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
| | - J Baumbusch
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Marquis S, Marquis NE, Lunsky Y, McGrail KM, Baumbusch J. Prescriptions for Antipsychotics: Youth with Intellectual/Developmental Disabilities Compared to Youth without Intellectual/Developmental Disabilities. J Autism Dev Disord 2024:10.1007/s10803-024-06344-z. [PMID: 38678514 DOI: 10.1007/s10803-024-06344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE The purpose of this study was to compare antipsychotic use by youth with intellectual/developmental disabilities to youth without IDD as they transitioned from pediatric to adult health care services. In addition, antipsychotic use was compared between youth with different types of IDD (autism, Fetal Alcohol Syndrome, Down syndrome and 'other'). METHODS Population level administrative health data was used to compare the dispensing of antipsychotics for youth aged 15 to 24 years with and without IDD, between 2010 and 2019. Because antipsychotics are associated with metabolic syndrome and type 2 diabetes, we also examined the dispensing data for metformin. In addition, we examined dispensed antipsychotics between different types of IDD. For both dispensing of antipsychotics and metformin, we used multi-variable logistic regression to derive adjusted odds ratios. RESULTS There were 20,591 youth with IDD and 1,293,791 youth without IDD. Youth with IDD had significantly higher odds of being dispensed an antipsychotic (7.13 (6.82, 7.44)), even when a diagnosis of a psychotic illness was included in the regression. Higher odds were found in all age groups. Youth with IDD also had significantly higher odds of being dispensed metformin (3.739 (3.323, 4.208)) compared to youth without IDD. Youth with autism, FAS and 'other' types of IDD diagnoses all had higher odds of being dispensed an antipsychotic compared to youth with Down syndrome. CONCLUSION Compared to youth without IDD, youth with IDD were more frequently dispensed antipsychotics and metformin. These findings have important implications for the health of youth with IDD.
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Affiliation(s)
- Sandra Marquis
- School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - N Esmé Marquis
- School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, 1025 Queen St West, Toronto, ONT, M6J 1H4, Canada.
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Nimmons D, Bazo-Alvarez JC, Avgerinou C, Hayes J, Osborn D, Cooper C, Petersen I, Walters K. Exploring the co-occurrence of depression, anxiety and insomnia symptoms, diagnoses and treatments in primary care: observational study using UK primary care data. BJPsych Open 2024; 10:e76. [PMID: 38634320 PMCID: PMC11060065 DOI: 10.1192/bjo.2024.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/23/2024] [Accepted: 02/04/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Depression, anxiety and insomnia often co-occur. However, there is a lack of research regarding how they cluster and how this is related to medication used to treat them. AIMS To describe the frequencies and associations between depression, anxiety and insomnia, and treatment for these conditions in primary care. METHOD A retrospective cohort study using UK electronic primary care records. We included individuals aged between 18 and 99 years old with one or more records suggesting they had a diagnosis, symptom or drug treatment for anxiety, depression or insomnia between 2015 and 2017. We report the conditional probabilities of having different combinations of diagnoses, symptoms and treatments recorded. RESULTS There were 1 325 960 records indicative of depression, anxiety or insomnia, for 739 834 individuals. Depression was the most common condition (n = 106 117 records), and SSRIs were the most commonly prescribed medication (n = 347 751 records). Overall, individuals with a record of anxiety were most likely to have co-occurring symptoms and diagnoses of other mental health conditions. For example, of the individuals with a record of generalised anxiety disorder (GAD), 24% also had a diagnosis of depression. In contrast, only 0.6% of those who had a diagnosis of depression had a diagnosis or symptom of GAD. Prescribing of more than one psychotropic medication within the same year was common. For example, of those who were prescribed an SNRI (serotonin-norepinephrine reuptake inhibitor), 40% were also prescribed an SSRI (selective serotonin reuptake inhibitor). CONCLUSIONS The conditional probabilities of co-occurring anxiety, depression and insomnia symptoms, diagnoses and treatments are high.
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Affiliation(s)
- Danielle Nimmons
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Christina Avgerinou
- Research Department of Primary Care and Population Health, University College London, UK
| | - Joseph Hayes
- Division of Psychiatry, University College London, UK
| | - David Osborn
- Division of Psychiatry, University College London, UK
| | - Claudia Cooper
- Centre of Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, UK
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Ahlers-Dannen KE, Yang J, Spicer MM, Fu D, DeVore A, Fisher RA. A splice acceptor variant in RGS6 associated with intellectual disability, microcephaly, and cataracts disproportionately promotes expression of a subset of RGS6 isoforms. J Hum Genet 2024; 69:145-152. [PMID: 38332109 DOI: 10.1038/s10038-024-01220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Abstract
Intellectual disability (ID) is associated with an increased risk of developing psychiatric disorders, suggesting a common underlying genetic factor. Importantly, altered signaling and/or expression of regulator of G protein signaling 6 (RGS6) is associated with ID and numerous psychiatric disorders. RGS6 is highly conserved and undergoes complex alternative mRNA splicing producing ~36 protein isoforms with high sequence similarity historically necessitating a global approach in functional studies. However, our recent analysis in mice revealed RGS6 is most highly expressed in CNS with RGS6L(+GGL) isoforms predominating. A previously reported genetic variant in intron 17 of RGS6 (c.1369-1G>C), associated with ID, may provide further clues into RGS6L(+GGL) isoform functional delineation. This variant was predicted to alter a highly conserved canonical 3' acceptor site creating an alternative branch point within exon 18 (included in a subset of RGS6L(+GGL) transcripts) and a frameshift forming an early stop codon. We previously identified this alternative splice site and demonstrated its use generates RGS6Lζ(+GGL) isoforms. Here, we show that the c.1369-1G>C variant disrupts the canonical, preferred (>90%) intron 17 splice site and leads to the exclusive use of the alternate exon 18 splice site, inducing disproportionate expression of a subset of isoforms, particularly RGS6Lζ(+GGL). Furthermore, RGS6 global knockout mice do not exhibit ID. Thus, ID caused by the c.1369-1G>C variant likely results from altered RGS6 isoform expression, rather than RGS6 isoform loss. In summary, these studies highlight the importance of proper RGS6 splicing and identify a previously unrecognized role of G protein signaling in ID.
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Affiliation(s)
- K E Ahlers-Dannen
- Department of Neuroscience and Pharmacology, The Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - J Yang
- Department of Neuroscience and Pharmacology, The Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - M M Spicer
- Department of Neuroscience and Pharmacology, The Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - D Fu
- Department of Neuroscience and Pharmacology, The Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - A DeVore
- Department of Neuroscience and Pharmacology, The Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - R A Fisher
- Department of Neuroscience and Pharmacology, The Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
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Cortese S, Besag FMC, Clark B, Hollis C, Kilgariff J, Moreno C, Nicholls D, Wilkinson P, Woodbury-Smith M, Sharma A. Common pitfalls, and how to avoid them, in child and adolescent psychopharmacology: Part II. J Psychopharmacol 2024; 38:318-323. [PMID: 38494873 PMCID: PMC11010553 DOI: 10.1177/02698811241239596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
As Faculty of the British Association for Psychopharmacology course on child and adolescent psychopharmacology, we present here what we deem are the most common pitfalls, and how to avoid them, in child and adolescent psychopharmacology. In this paper, we specifically addressed common pitfalls in the pharmacological treatment of autism and intellectual disability, eating disorders, neuropsychiatric correlates of epilepsy, and psychosis. Pitfalls in relation to the treatment of other disorders are addressed in a separate paper (Part I).
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Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA
- Department of Precision and Regenerative Medicine-Jonic Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Frank MC Besag
- UCL School of Pharmacy, London, UK
- East London Foundation NHS Trust, Bedfordshire, UK
| | - Bruce Clark
- National Specialist Clinic for Young People with OCD, BDD and Related Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chris Hollis
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen’s Medical Centre, Nottingham, UK
- National Institute of Mental Health (NIHR) MindTech Medtech Co-operative, Institute of Mental Health, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Mental Health & Technology Theme, Institute of Mental Health, Nottingham, UK
| | - Joe Kilgariff
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen’s Medical Centre, Nottingham, UK
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
- NIHR ARC Northwest London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Aditya Sharma
- Academic Psychiatry, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Specialist Adolescent Mood Disorders Service (SAMS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Bartel RL, Knight JR, Worsham W, Bilder DA. Discordance Between Psychiatric Diagnoses and Medication Use in Children and Adults With Autism Presenting in Crisis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:150-161. [PMID: 38680982 PMCID: PMC11046722 DOI: 10.1176/appi.focus.20230027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Autistic individuals experience high rates of behavioral crises that present to healthcare providers for medication management. Co-occurring psychiatric conditions and psychotropic medication use are common among this patient population. Particularly for those with limited expressive language, evaluating for the presence of psychiatric and medical conditions that could contribute to distress is a critical component of crisis management. A records review study was completed on 126 autistic individuals for whom medical decision-making support was requested from The Huntsman Mental Health Institute Neurobehavior Consultation Service. Crisis manifestations and historical information were provided by the parent or caregiver through an online questionnaire. Nearly all individuals presented with behavioral (96.8%) and emotional (96.8%) symptoms; 97.6% received at least one co-occurring psychiatric diagnosis. Additionally, 75.4% of parents or caregivers endorsed the presence of a medical condition that they believed could be contributing to the crisis presentation. Most individuals (92.1%) were prescribed at least one psychotropic medication; 69.8% were taking an antipsychotic, suggesting a history of treatment resistance. The alignment between psychotropic medications and psychiatric diagnoses was evaluated in the context of prior studies and reviews on psychiatric management in autistic and neurotypical populations. Several individuals were taking a combination of medications that included both indicated and contraindicated medications for the psychiatric disorder diagnosed, likely contributing to treatment resistance. Identifying discordance between psychotropic medication use and psychiatric conditions present offers an opportunity to pursue better treatment outcomes for autistic individuals, particularly for those experiencing treatment-resistant agitation.
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Affiliation(s)
- Roxanne L Bartel
- Department of Psychiatry, Huntsman Mental Health Institute (Bartel, Bilder); and School of Medicine (Knight), University of Utah, Salt Lake City; Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Worsham)
| | - Jacob R Knight
- Department of Psychiatry, Huntsman Mental Health Institute (Bartel, Bilder); and School of Medicine (Knight), University of Utah, Salt Lake City; Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Worsham)
| | - Whitney Worsham
- Department of Psychiatry, Huntsman Mental Health Institute (Bartel, Bilder); and School of Medicine (Knight), University of Utah, Salt Lake City; Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Worsham)
| | - Deborah A Bilder
- Department of Psychiatry, Huntsman Mental Health Institute (Bartel, Bilder); and School of Medicine (Knight), University of Utah, Salt Lake City; Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Worsham)
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Sappok T, Barrett B, Lutter S. A brief version of the Scale of Emotional Development - Short. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:340-357. [PMID: 38183318 DOI: 10.1111/jir.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/03/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The Scale of Emotional Development - Short (SED-S) captures the level of emotional development in persons with a disorder of intellectual development (DID) with 200 items on five developmental levels. The study aims to develop a brief version of the SED-S. METHODS Based on item analysis (proportions, χ2 -test, Spearman's ρ and corrected item-total correlation), a brief version of the SED-S was developed in a sample of 224 adults with a DID (n1 ) and validated in a second independent matched sample (n2 = 223). RESULTS Item reliability ranged per item set from Cronbach's α = 0.835 to 0.924. Weighted kappa resulted in κω = 0.743 (P < 0.001, 95% confidence interval = 0.690-0.802). Overall agreement of the brief version with the original SED-S was PO = 0.7. The brief version of the SED-S showed weaknesses in distinguishing level 2 from the adjacent levels. CONCLUSIONS The brief version of the SED-S showed good reliability and moderate to good validity results. Items of phase 2 and, to some degree, of phase 5 should be revised to further improve the psychometric properties of the scale.
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Affiliation(s)
- T Sappok
- University Clinic for People with Neurodevelopmental Disorders, Mara, University Hospital OWL, Bielefeld University, Bielefeld, Germany
| | - B Barrett
- St. Lukas-Klinik, Liebenau Kliniken, Liebenau, Germany
| | - S Lutter
- Lebenswissenschaftliche Fakultät - Institute for Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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11
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Muralidhar M, Spector A, Hui EK, Liu L, Ali A. A systematic review of psychosocial interventions for people with intellectual disabilities and dementia. Aging Ment Health 2024; 28:385-395. [PMID: 37811724 DOI: 10.1080/13607863.2023.2265322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES As the life expectancy of individuals with intellectual disabilities (ID) continues to increase, there is an increased risk of developing dementia. While psychosocial interventions are gaining prominence, evidence is limited for people with both dementia and ID. This review discusses the effectiveness of direct psychosocial interventions and adaptations to facilitate delivery within this population. METHODS The review followed the PRISMA guidelines. Five electronic databases, grey literature, and reference lists of included articles were searched for relevant studies. 10 eligible studies were appraised and analysed by narrative synthesis. RESULTS Ten distinct interventions were identified and categorised based on their purpose and delivery. All interventions were beneficial in improving a range of outcomes, though some studies were of low quality and most had small samples. Common adaptations included simplification of tasks and material, higher staff-to-client ratio, and alternative communication methods. CONCLUSION There is emerging evidence for several psychosocial interventions for people with ID and dementia, though further research is required on effectiveness and generalisability. The adaptations discussed may guide implementation into routine care and contribute to current policies and guidelines on improving ID and dementia care.
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Affiliation(s)
| | - Aimee Spector
- Clinical, Educational and Health Psychology, Division of Psychology and Language Science, University College London (UCL), London, UK
| | - Esther K Hui
- Division of Psychiatry, University College London (UCL), London, UK
| | - Lisa Liu
- Division of Psychiatry, University College London (UCL), London, UK
| | - Afia Ali
- Division of Psychiatry, University College London (UCL), London, UK
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12
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Odalović M, Gorman A, Paul A, McCallion P, Burke É, MacLachlan M, McCarron M, Henman MC, Moran M, O'Connell J, Walsh M, Shankar R, Ryan C, O'Dwyer M. Psychotropic medicines' prevalence, patterns and effects on cognitive and physical function in older adults with intellectual disability in Ireland: longitudinal cohort study, 2009-2020. BJPsych Open 2024; 10:e39. [PMID: 38297892 PMCID: PMC10897684 DOI: 10.1192/bjo.2023.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The frequent prescribing of psychotropics and high prevalence of polypharmacy among older adults with intellectual disabilities require close monitoring. AIMS To describe change in prevalence, predictors and health outcomes of psychotropic use during the four waves (2009/2010, 2013/2014, 2016/2017, 2019/2020) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). METHOD Eligible participants were adults (≥40 years) with intellectual disabilities who participated in all four waves of IDS-TILDA and who reported medication use for the entire period. Differences between groups were tested using Cochran's Q test for binary variables and the McNemar-Bowker test for variables with more than two categories. Generalised estimating equation models were used to assess associations between psychotropic use, participants' characteristics and health outcomes. RESULTS Across waves (433 participants) there were no significant differences in prevalence of psychotropic use (61.2-64.2%) and psychotropic polypharmacy (42.7-38.3%). Antipsychotics were the most used subgroup, without significant change in prevalence between waves (47.6-44.6%). A significant decrease was observed for anxiolytics (26.8-17.6%; P < 0.001) and hypnotics/sedatives (14.1-9.0%; P < 0.05). A significant increase was recorded for antidepressants (28.6-35.8%; P < 0.001) and mood-stabilising agents (11.5-14.6%; P < 0.05). Psychotropic polypharmacy (≥2 psychotropics) was significantly associated with moderate to total dependence in performing activities of daily living over the 10-year period (OR = 1.80, 95% CI 1.21-2.69; P < 0.05). CONCLUSIONS The study indicates an increase in usage of some classes of psychotropic, a reduction in others and no change in the relatively high rate of antipsychotic use over 10 years in a cohort of older adults with intellectual disabilities and consequent risk of psychotropic polypharmacy and medication-related harm.
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Affiliation(s)
- Marina Odalović
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland; and Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Ireland
| | - Ashleigh Gorman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland; and Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Ireland
| | - Aviejay Paul
- School of Social Work, College of Public Health, Temple University, Philadelphia, USA
| | - Philip McCallion
- School of Social Work, College of Public Health, Temple University, Philadelphia, USA
| | - Éilish Burke
- School of Nursing and Midwifery, Trinity College Dublin, Ireland; and Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Ireland
| | - Malcolm MacLachlan
- National Clinical Programme for People with Disabilities, Health Service Executive, Dublin, Ireland; Assisting Living & Learning Institute, Maynooth University, Ireland; and Psychology Department, Maynooth University, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, Trinity College Dublin, Ireland; and Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Ireland
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland; and Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Ireland
| | - Maeve Moran
- Faculty of Learning Disability Psychiatry, College of Psychiatrists of Ireland, Dublin, Ireland
| | - Juliette O'Connell
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland; and Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Ireland
| | - Michael Walsh
- National Clinical Programme for People with Disabilities, Health Service Executive, Dublin, Ireland
| | - Rohit Shankar
- Peninsula Medical School, University of Plymouth, UK
| | - Caitriona Ryan
- School of Nursing and Midwifery, Trinity College Dublin, Ireland; and Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland; and Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Ireland
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Rice LJ, Cannon L, Dadlani N, Cheung MMY, Einfeld SL, Efron D, Dossetor DR, Elliott EJ. Efficacy of cannabinoids in neurodevelopmental and neuropsychiatric disorders among children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:505-526. [PMID: 36864363 PMCID: PMC10869397 DOI: 10.1007/s00787-023-02169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
A better understanding of the endocannabinoid system and a relaxation in regulatory control of cannabis globally has increased interest in the medicinal use of cannabinoid-based products (CBP). We provide a systematic review of the rationale and current clinical trial evidence for CBP in the treatment of neuropsychiatric and neurodevelopmental disorders in children and adolescents. A systematic search of MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Trials was performed to identify articles published after 1980 about CBP for medical purposes in individuals aged 18 years or younger with selected neuropsychiatric or neurodevelopmental conditions. Risk of bias and quality of evidence was assessed for each article. Of 4466 articles screened, 18 were eligible for inclusion, addressing eight conditions (anxiety disorders (n = 1); autism spectrum disorder (n = 5); foetal alcohol spectrum disorder (n = 1); fragile X syndrome (n = 2); intellectual disability (n = 1); mood disorders (n = 2); post-traumatic stress disorder (n = 3); and Tourette syndrome (n = 3)). Only one randomised controlled trial (RCT) was identified. The remaining seventeen articles included one open-label trial, three uncontrolled before-and-after trials, two case series and 11 case reports, thus the risk of bias was high. Despite growing community and scientific interest, our systematic review identified limited and generally poor-quality evidence for the efficacy of CBP in neuropsychiatric and neurodevelopmental disorders in children and adolescents. Large rigorous RCTs are required to inform clinical care. In the meantime, clinicians must balance patient expectations with the limited evidence available.
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Affiliation(s)
- Lauren J Rice
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia.
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia.
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia.
| | - Lisa Cannon
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Navin Dadlani
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Melissa Mei Yin Cheung
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Stewart L Einfeld
- The University of Sydney, Faculty of Medicine and Health, Brain and Mind Centre, Sydney, NSW, Australia
| | - Daryl Efron
- Department of General Paediatrics, Health Services, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David R Dossetor
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Sydney, NSW, Australia
- Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
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Yoshida K, Lunsky Y, Müller DJ, Desarkar P. Prevalence of Psychotropic Medication Use and Psychotropic Polypharmacy in Autistic Adults With or Without Intellectual Disability. J Autism Dev Disord 2024:10.1007/s10803-023-06208-y. [PMID: 38219270 DOI: 10.1007/s10803-023-06208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 01/16/2024]
Abstract
The aim of this study was to compare the rates of psychotropic medication use and psychotropic polypharmacy between autistic adults with and without intellectual disability (ID) and to examine factors associated with psychotropic medication use and psychotropic polypharmacy in autistic adults, stratified by the presence of ID. We conducted a retrospective medical chart review of outpatients with an autism diagnosis aged 18 years and older. The rates of psychotropic medication use and psychotropic polypharmacy were compared between autistic adults with and without ID. Subsequently, logistic regression analyses were performed to identify factors associated with psychotropic medication use and psychotropic polypharmacy in autistic adults with ID and those without ID, respectively. The rates of prevalence of psychotropic medication use and polypharmacy were significantly higher in participants with ID than those without ID (78.6% vs. 58.8% and 49.3% vs. 31.2%; p-values < 0.05). Age, gender, race, residence, presence of mood disorders, presence of schizophrenia, absence of anxiety disorder, number of psychiatric comorbidities, and presence of behaviors that challenge were significantly associated with these outcomes, depending on the presence/absence of ID. The need to optimize pharmacotherapy in autistic adults, stratifying by the presence of ID, is highlighted.
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Affiliation(s)
- Kazunari Yoshida
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Pushpal Desarkar
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Taslim S, Shadmani S, Saleem AR, Kumar A, Brahma F, Blank N, Bashir MA, Ansari D, Kumari K, Tanveer M, Varrassi G, Kumar S, Raj A. Neuropsychiatric Disorders: Bridging the Gap Between Neurology and Psychiatry. Cureus 2024; 16:e51655. [PMID: 38313968 PMCID: PMC10838116 DOI: 10.7759/cureus.51655] [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: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Given the ongoing difficulties faced by clinicians and researchers in dealing with neuropsychiatric illnesses, it is becoming more and more evident that there is a need to go beyond traditional disciplinary boundaries. This research consolidates existing material, examining changes in history, the fundamental neurobiological aspects, and the shared clinical manifestations between neurology and psychiatry. This inquiry examines the historical development of neuropsychiatry, focusing on the relationship between early understandings of mental illness and the later division of neurology and psychiatry. The focus is on recent advancements in comprehending the common neurobiological pathways and genetic factors that highlight the merging of these fields. The research highlights the complexities of clinical presentations in neuropsychiatric illnesses by analyzing the overlapping cognitive, affective, and behavioral symptoms. The text critiques the diagnostic issues in traditional frameworks, emphasizing the limitations in differentiating between neurological and psychiatric origins. This has ramifications for achieving correct diagnosis and arranging appropriate treatment. The paper explores developing multidisciplinary care approaches, highlighting successful collaborations between neurologists and psychiatrists. This study examines the difficulties in carrying out a plan and the process of identifying obstacles to combining different elements. It also highlights the urgent need for improved instruction and learning for smooth cooperation. The paper examines the therapeutic implications by investigating pharmacological therapies focusing on shared pathways. It also discusses the difficulties involved in managing neurological and psychiatric diseases that occur together. The study also explores non-pharmacological therapies, such as psychotherapy and rehabilitation methods, as part of a comprehensive treatment approach. Anticipating the future, the report identifies areas where the study could be improved and forecasts the influence of technological improvements on the subject. Suggestions are put out to encourage additional exploration, cooperation, and originality to narrow the divide between neurology and psychiatry, ultimately augmenting our comprehension and treatment of neuropsychiatric illnesses. This real-time synthesis adds to the ongoing discussion, providing valuable insights that align with the ever-changing field of contemporary neuropsychiatric research and therapy.
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Affiliation(s)
- Sanzida Taslim
- Psychiatry, Ross University School of Medicine, Far Rockaway, USA
| | - Sujeet Shadmani
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | | | - Ajay Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Fnu Brahma
- Psychiatry, Khairpur Medical College, Khairpur, PAK
| | - Narendar Blank
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | | | - Danya Ansari
- Psychiatry, Islamabad Medical and Dental College, Islamabad, PAK
| | - Komal Kumari
- Medicine, New Medical Centre (NMC) Royal Family Medical Centre, Abu Dhabi, ARE
| | | | | | - Satesh Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Arveen Raj
- Psychiatry, Toronto General Hospital, Toronto, CAN
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O'Nions E, Lewer D, Petersen I, Brown J, Buckman JE, Charlton R, Cooper C, El Baou CÉ, Happé F, Manthorpe J, McKechnie DG, Richards M, Saunders R, Zanker C, Mandy W, Stott J. Estimating life expectancy and years of life lost for autistic people in the UK: a matched cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 36:100776. [PMID: 38188276 PMCID: PMC10769892 DOI: 10.1016/j.lanepe.2023.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 01/09/2024]
Abstract
Background Previous research has shown that people who have been diagnosed autistic are more likely to die prematurely than the general population. However, statistics on premature mortality in autistic people have often been misinterpreted. In this study we aimed to estimate the life expectancy and years of life lost experienced by autistic people living in the UK. Methods We studied people in the IQVIA Medical Research Database with an autism diagnosis between January 1, 1989 and January 16, 2019. For each participant diagnosed autistic, we included ten comparison participants without an autism diagnosis, matched by age, sex, and primary care practice. We calculated age- and sex-standardised mortality ratios comparing people diagnosed autistic to the reference group. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy at age 18 and years of life lost. We analysed the data separately by sex, and for people with and without a record of intellectual disability. We discuss the findings in the light of the prevalence of recorded diagnosis of autism in primary care compared to community estimates. Findings From a cohort of nearly 10 million people, we identified 17,130 participants diagnosed autistic without an intellectual disability (matched with 171,300 comparison participants), and 6450 participants diagnosed autistic with an intellectual disability (matched with 64,500 comparison participants). The apparent estimates indicated that people diagnosed with autism but not intellectual disability had 1.71 (95% CI: 1.39-2.11) times the mortality rate of people without these diagnoses. People diagnosed with autism and intellectual disability had 2.83 (95% CI: 2.33-3.43) times the mortality rate of people without these diagnoses. Likewise, the apparent reduction in life expectancy for people diagnosed with autism but not intellectual disability was 6.14 years (95% CI: 2.84-9.07) for men and 6.45 years (95% CI: 1.37-11.58 years) for women. The apparent reduction in life expectancy for people diagnosed with autism and intellectual disability was 7.28 years (95% CI: 3.78-10.27) for men and 14.59 years (95% CI: 9.45-19.02 years) for women. However, these findings are likely to be subject to exposure misclassification biases: very few autistic adults and older-adults have been diagnosed, meaning that we could only study a fraction of the total autistic population. Those who have been diagnosed may well be those with greater support needs and more co-occurring health conditions than autistic people on average. Interpretation The findings indicate that there is a group of autistic people who experience premature mortality, which is of significant concern. There is an urgent need for investigation into the reasons behind this. However, our estimates suggest that the widely reported statistic that autistic people live 16-years less on average is likely incorrect. Nine out of 10 autistic people may have been undiagnosed across the time-period studied. Hence, the results of our study do not generalise to all autistic people. Diagnosed autistic adults, and particularly older adults, are likely those with greater-than-average support needs. Therefore, we may have over-estimated the reduction in life expectancy experienced by autistic people on average. The larger reduction in life expectancy for women diagnosed with autism and intellectual disability vs. men may in part reflect disproportionate underdiagnosis of autism and/or intellectual disability in women. Funding Dunhill Medical Trust, Medical Research Council, National Institute for Health and Care Research, and the Royal College of Psychiatrists.
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Affiliation(s)
- Elizabeth O'Nions
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Dan Lewer
- Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Irene Petersen
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Jude Brown
- National Autistic Society, 393 City Rd, London, EC1V 1NG, UK
| | - Joshua E.J. Buckman
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, New Cross, London, SE14 6NW, UK
| | - Claudia Cooper
- Queen Mary University of London, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, London, E1 2AD, UK
| | - CÉline El Baou
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK
| | - Jill Manthorpe
- NIHR Health & Social Care Workforce Research Unit, King's College London, Strand, London, WC2R 2LS, UK
| | - Douglas G.J. McKechnie
- UCL Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Rob Saunders
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | | | - Will Mandy
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
| | - Joshua Stott
- UCL Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, 1 – 19 Torrington Place, London, WC1E 7HB, UK
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Nurminen F, Rättö H, Arvio M, Teittinen A, Vesala HT, Saastamoinen L. Medicine use in people with intellectual disabilities: a Finnish nationwide register study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1291-1305. [PMID: 36372946 DOI: 10.1111/jir.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/09/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND People with intellectual disability (ID) are a vulnerable group in our society; many of them depend on other people for assistance in their everyday lives. Compared with the general population, people with ID have poorer general health and, therefore, need more healthcare services and use more medicines. The aim of this study is to define the population of all Finnish people with ID using administrative data and to compare their medicine use and expenditure on medicines to those of the age-matched and sex-matched controls. METHODS People with ID and their age-matched and sex-matched controls (1:1) were extracted from nationwide healthcare and social allowance registers. Administrative register data on all prescription medicine purchases in 2019 were used to determine the prevalence of medicine use in both groups on a general level and by medicine categories. The differences in the prevalence of medicine use between the two groups were analysed using the logistic regression model. In addition, we studied the total expenditure on reimbursable medicine purchases covered by the National Health Insurance between people with ID and control group. RESULTS The subpopulation of people with ID consisted 37 196 individuals, of whom 82.7% purchased prescription medicines in 2019. The corresponding share of individuals purchasing prescription medicines in the control group was 70.3%. The differences in the prevalence of medicine use between the two populations were highest in the younger age groups (0-6, 7-12 and 13-17). In the study population, 28.1% (OR = 12.28; 95% CI: 11.54-13.07) of the people used antipsychotics, making it the most used medicine category in people with ID. In the control group, 3.3% of people used antipsychotics. Compared with the control group, the use of antiepileptics, drugs for constipation, mineral supplements and anxiolytics was four to seven times higher among people with ID. Furthermore, the median expenditure on medicine use among people with ID was four times higher than in the control group. CONCLUSIONS Compared with the control group, people with ID used more medicines, especially psychotropics, and their expenditure on medicine use was higher.
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Affiliation(s)
- F Nurminen
- Research Unit, The Social Insurance Institution, Helsinki, Finland
| | - H Rättö
- Research Unit, The Social Insurance Institution, Helsinki, Finland
| | - M Arvio
- Päijät-Häme Joint Municipal Authority, Neurology, Lahti, Finland
- PEDEGO, Oulu University Hospital, Oulu, Finland
- Department of General Practice, Turku University, Turku, Finland
- Turku University Central Hospital, Turku, Finland
| | - A Teittinen
- Research Unit, The Social Insurance Institution, Helsinki, Finland
| | - H T Vesala
- Finnish Association on Intellectual and Developmental Disabilities (FAIDD), Espoo, Finland
| | - L Saastamoinen
- Research Unit, The Social Insurance Institution, Helsinki, Finland
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Takano T. Cardiometabolic Effects of Antipsychotics in Challenging Behavior and Neuropsychiatric Symptoms in Patients With Intellectual Disability. Cureus 2023; 15:e48088. [PMID: 38046756 PMCID: PMC10691170 DOI: 10.7759/cureus.48088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Despite the well-established association between antipsychotics and metabolic adverse effects in psychiatric disorders, the variable influence of long-term and off-label antipsychotic medication on behavioral disorders has not been investigated in detail. Objective To clarify the impact of antipsychotic use on challenging behavior (CB) and neuropsychiatric symptoms (NPS), we evaluated the clinical findings and cardiometabolic effects in individuals with intellectual disability (ID) hospitalized in our residential facility for profoundly disabled patients. Patients and methods A total of 130 individuals hospitalized in our residential facility were retrospectively investigated and divided into two groups - individuals with and without CB and NPS. Antipsychotics (first- and second-generation antipsychotics) are prescribed to all individuals in the CB and NPS-positive ID group. Conversely, antipsychotics were not prescribed to any individuals in the CB- and NPS-negative ID groups. To investigate the cardiometabolic effects of antipsychotics, the following metabolic parameters were measured: body weight (BW), total calorie intake per day, body mass index (BMI), blood pressure, serum lipid levels (total cholesterol, high-density lipoprotein cholesterol, and triglyceride), and corrected QT interval (QTc) of electrocardiogram (ECG). The etiology of disabilities, level of ID, severity of motor disability, and presence or absence of epilepsy were also examined. Results Two main results were derived: (1) Autism spectrum disorder was the most predominant etiology in individuals with CB and NPS who were prescribed antipsychotics, and (2) the mean values of metabolic parameters were all normal in both medicated and nonmedicated individuals, but the total calorie intake was significantly higher in individuals who were prescribed antipsychotics. Conclusions Our investigation demonstrated that in individuals with an adequate energy intake, most metabolic parameters can be maintained within normal limits. We suggest that body weight control is the primary step in avoiding the cardiometabolic adverse effects of antipsychotics in intellectually disabled individuals with CB and NPS.
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Affiliation(s)
- Tomoyuki Takano
- Department of Pediatrics, Biwako-Gakuen Medical and Welfare Center of Yasu, Yasu, JPN
- Department of Pediatrics, Shiga University of Medical Science, Otsu, JPN
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Iffland M, Livingstone N, Jorgensen M, Hazell P, Gillies D. Pharmacological intervention for irritability, aggression, and self-injury in autism spectrum disorder (ASD). Cochrane Database Syst Rev 2023; 10:CD011769. [PMID: 37811711 PMCID: PMC10561353 DOI: 10.1002/14651858.cd011769.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Pharmacological interventions are frequently used for people with autism spectrum disorder (ASD) to manage behaviours of concern, including irritability, aggression, and self-injury. Some pharmacological interventions might help treat some behaviours of concern, but can also have adverse effects (AEs). OBJECTIVES To assess the effectiveness and AEs of pharmacological interventions for managing the behaviours of irritability, aggression, and self-injury in ASD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 11 other databases and two trials registers up to June 2022. We also searched reference lists of relevant studies, and contacted study authors, experts and pharmaceutical companies. SELECTION CRITERIA We included randomised controlled trials of participants of any age with a clinical diagnosis of ASD, that compared any pharmacological intervention to an alternative drug, standard care, placebo, or wait-list control. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes were behaviours of concern in ASD, (irritability, aggression and self-injury); and AEs. Secondary outcomes were quality of life, and tolerability and acceptability. Two review authors independently assessed each study for risk of bias, and used GRADE to judge the certainty of the evidence for each outcome. MAIN RESULTS We included 131 studies involving 7014 participants in this review. We identified 26 studies as awaiting classification and 25 as ongoing. Most studies involved children (53 studies involved only children under 13 years), children and adolescents (37 studies), adolescents only (2 studies) children and adults (16 studies), or adults only (23 studies). All included studies compared a pharmacological intervention to a placebo or to another pharmacological intervention. Atypical antipsychotics versus placebo At short-term follow-up (up to 6 months), atypical antipsychotics probably reduce irritability compared to placebo (standardised mean difference (SMD) -0.90, 95% confidence interval (CI) -1.25 to -0.55, 12 studies, 973 participants; moderate-certainty evidence), which may indicate a large effect. However, there was no clear evidence of a difference in aggression between groups (SMD -0.44, 95% CI -0.89 to 0.01; 1 study, 77 participants; very low-certainty evidence). Atypical antipsychotics may also reduce self-injury (SMD -1.43, 95% CI -2.24 to -0.61; 1 study, 30 participants; low-certainty evidence), possibly indicating a large effect. There may be higher rates of neurological AEs (dizziness, fatigue, sedation, somnolence, and tremor) in the intervention group (low-certainty evidence), but there was no clear evidence of an effect on other neurological AEs. Increased appetite may be higher in the intervention group (low-certainty evidence), but we found no clear evidence of an effect on other metabolic AEs. There was no clear evidence of differences between groups in musculoskeletal or psychological AEs. Neurohormones versus placebo At short-term follow-up, neurohormones may have minimal to no clear effect on irritability when compared to placebo (SMD -0.18, 95% CI -0.37 to -0.00; 8 studies; 466 participants; very low-certainty evidence), although the evidence is very uncertain. No data were reported for aggression or self -injury. Neurohormones may reduce the risk of headaches slightly in the intervention group, although the evidence is very uncertain. There was no clear evidence of an effect of neurohormones on any other neurological AEs, nor on any psychological, metabolic, or musculoskeletal AEs (low- and very low-certainty evidence). Attention-deficit hyperactivity disorder (ADHD)-related medications versus placebo At short-term follow-up, ADHD-related medications may reduce irritability slightly (SMD -0.20, 95% CI -0.40 to -0.01; 10 studies, 400 participants; low-certainty evidence), which may indicate a small effect. However, there was no clear evidence that ADHD-related medications have an effect on self-injury (SMD -0.62, 95% CI -1.63 to 0.39; 1 study, 16 participants; very low-certainty evidence). No data were reported for aggression. Rates of neurological AEs (drowsiness, emotional AEs, fatigue, headache, insomnia, and irritability), metabolic AEs (decreased appetite) and psychological AEs (depression) may be higher in the intervention group, although the evidence is very uncertain (very low-certainty evidence). There was no evidence of a difference between groups for any other metabolic, neurological, or psychological AEs (very low-certainty evidence). No data were reported for musculoskeletal AEs. Antidepressants versus placebo At short-term follow-up, there was no clear evidence that antidepressants have an effect on irritability (SMD -0.06, 95% CI -0.30 to 0.18; 3 studies, 267 participants; low-certainty evidence). No data for aggression or self-injury were reported or could be included in the analysis. Rates of metabolic AEs (decreased energy) may be higher in participants receiving antidepressants (very low-certainty evidence), although no other metabolic AEs showed clear evidence of a difference. Rates of neurological AEs (decreased attention) and psychological AEs (impulsive behaviour and stereotypy) may also be higher in the intervention group (very low-certainty evidence) although the evidence is very uncertain. There was no clear evidence of any difference in the other metabolic, neurological, or psychological AEs (very low-certainty evidence), nor between groups in musculoskeletal AEs (very low-certainty evidence). Risk of bias We rated most of the studies across the four comparisons at unclear overall risk of bias due to having multiple domains rated as unclear, very few rated as low across all domains, and most having at least one domain rated as high risk of bias. AUTHORS' CONCLUSIONS Evidence suggests that atypical antipsychotics probably reduce irritability, ADHD-related medications may reduce irritability slightly, and neurohormones may have little to no effect on irritability in the short term in people with ASD. There was some evidence that atypical antipsychotics may reduce self-injury in the short term, although the evidence is uncertain. There was no clear evidence that antidepressants had an effect on irritability. There was also little to no difference in aggression between atypical antipsychotics and placebo, or self-injury between ADHD-related medications and placebo. However, there was some evidence that atypical antipsychotics may result in a large reduction in self-injury, although the evidence is uncertain. No data were reported (or could be used) for self-injury or aggression for neurohormones versus placebo. Studies reported a wide range of potential AEs. Atypical antipsychotics and ADHD-related medications in particular were associated with an increased risk of metabolic and neurological AEs, although the evidence is uncertain for atypical antipsychotics and very uncertain for ADHD-related medications. The other drug classes had minimal or no associated AEs.
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Affiliation(s)
- Michelle Iffland
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
| | - Nuala Livingstone
- Cochrane Evidence Production and Methods Directorate , Cochrane, London, UK
| | - Mikaela Jorgensen
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Donna Gillies
- Senior Practitioner Branch, NDIS Quality and Safeguards Commission, Penrith, Australia
- Sydney, Australia
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Aulanko I, Rahikkala E, Moilanen J. Psychiatric symptoms in Salla disease. Eur Child Adolesc Psychiatry 2023; 32:2043-2047. [PMID: 35796883 PMCID: PMC10533638 DOI: 10.1007/s00787-022-02031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
Salla disease (SD) is a rare lysosomal storage disorder characterised by intellectual disability ataxia, athetosis, nystagmus, and central nervous system demyelination. Although the neurological spectrum of SD's clinical phenotype is well defined, psychotic symptoms in SD remain unreported. We reviewed the presence of psychiatric symptoms in patients diagnosed with SD. Medical records of all SD patients at Oulu University Hospital during the years 1982-2015 were systematically reviewed to evaluate the presence of psychiatric symptoms. Psychiatric symptoms were frequently associated with SD (10/24, 42%), and two patients were described as developing psychosis as adolescents. We reported their clinical characteristics in detail and assessed the prevalence of psychiatric symptoms in a cohort of 24 patients. Other psychiatric factors associated with SD were sleeping disorders (8/24, 32%), aggressive behaviour disorders or restlessness (6/24, 25%), and off-label antipsychotic medication (4/24, 17%). This report expands the knowledge of the phenotypic spectrum of SD and demonstrates the importance of recognising the possibility of psychiatric symptoms, including psychosis, in persons with SD.
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Affiliation(s)
- Ida Aulanko
- PEDEGO Research Unit, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland.
- Department of Clinical Genetics, Oulu University Hospital, OYS, P.O. Box 23, 90029, Oulu, Finland.
| | - Elisa Rahikkala
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Clinical Genetics, Oulu University Hospital, OYS, P.O. Box 23, 90029, Oulu, Finland
| | - Jukka Moilanen
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Clinical Genetics, Oulu University Hospital, OYS, P.O. Box 23, 90029, Oulu, Finland
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21
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Heuvelman H, Davies NM, Ben-Shlomo Y, Emond A, Evans J, Gunnell D, Liebling R, Morris R, Payne R, Storey C, Viner M, Rai D. Antidepressants in pregnancy: applying causal epidemiological methods to understand service-use outcomes in women and long-term neurodevelopmental outcomes in exposed children. Health Technol Assess 2023; 27:1-83. [PMID: 37842916 DOI: 10.3310/aqtf4490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background Antidepressants are commonly prescribed during pregnancy, despite a lack of evidence from randomised trials on the benefits or risks. Some studies have reported associations of antidepressants during pregnancy with adverse offspring neurodevelopment, but whether or not such associations are causal is unclear. Objectives To study the associations of antidepressants for depression in pregnancy with outcomes using multiple methods to strengthen causal inference. Design This was an observational cohort design using multiple methods to strengthen causal inference, including multivariable regression, propensity score matching, instrumental variable analysis, negative control exposures, comparison across indications and exposure discordant pregnancies analysis. Setting This took place in UK general practice. Participants Participants were pregnant women with depression. Interventions The interventions were initiation of antidepressants in pregnancy compared with no initiation, and continuation of antidepressants in pregnancy compared with discontinuation. Main outcome measures The maternal outcome measures were the use of primary care and secondary mental health services during pregnancy, and during four 6-month follow-up periods up to 24 months after pregnancy, and antidepressant prescription status 24 months following pregnancy. The child outcome measures were diagnosis of autism, diagnosis of attention deficit hyperactivity disorder and intellectual disability. Data sources UK Clinical Practice Research Datalink. Results Data on 80,103 pregnancies were used to study maternal primary care outcomes and were linked to 34,274 children with at least 4-year follow-up for neurodevelopmental outcomes. Women who initiated or continued antidepressants during pregnancy were more likely to have contact with primary and secondary health-care services during and after pregnancy and more likely to be prescribed an antidepressant 2 years following the end of pregnancy than women who did not initiate or continue antidepressants during pregnancy (odds ratioinitiation 2.16, 95% confidence interval 1.95 to 2.39; odds ratiocontinuation 2.40, 95% confidence interval 2.27 to 2.53). There was little evidence for any substantial association with autism (odds ratiomultivariableregression 1.10, 95% confidence interval 0.90 to 1.35; odds ratiopropensityscore 1.06, 95% confidence interval 0.84 to 1.32), attention deficit hyperactivity disorder (odds ratiomultivariableregression 1.02, 95% confidence interval 0.80 to 1.29; odds ratiopropensityscore 0.97, 95% confidence interval 0.75 to 1.25) or intellectual disability (odds ratiomultivariableregression 0.81, 95% confidence interval 0.55 to 1.19; odds ratiopropensityscore 0.89, 95% confidence interval 0.61 to 1.31) in children of women who continued antidepressants compared with those who discontinued antidepressants. There was inconsistent evidence of an association between initiation of antidepressants in pregnancy and diagnosis of autism in offspring (odds ratiomultivariableregression 1.23, 95% confidence interval 0.85 to 1.78; odds ratiopropensityscore 1.64, 95% confidence interval 1.01 to 2.66) but not attention deficit hyperactivity disorder or intellectual disability; however, but results were imprecise owing to smaller numbers. Limitations Several causal-inference analyses lacked precision owing to limited numbers. In addition, adherence to the prescribed treatment was not measured. Conclusions Women prescribed antidepressants during pregnancy had greater service use during and after pregnancy than those not prescribed antidepressants. The evidence against any substantial association with autism, attention deficit hyperactivity disorder or intellectual disability in the children of women who continued compared with those who discontinued antidepressants in pregnancy is reassuring. Potential association of initiation of antidepressants during pregnancy with offspring autism needs further investigation. Future work Further research on larger samples could increase the robustness and precision of these findings. These methods applied could be a template for future pharmaco-epidemiological investigation of other pregnancy-related prescribing safety concerns. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (15/80/19) and will be published in full in Health Technology Assessment; Vol. 27, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hein Heuvelman
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Neil M Davies
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Alan Emond
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Jonathan Evans
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - David Gunnell
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Rachel Liebling
- Fetal Medicine Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Richard Morris
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Rupert Payne
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Dheeraj Rai
- Department of Population Health Sciences, University of Bristol, Bristol, UK
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Di Sarro R, Varrucciu N, Di Santantonio A, Natali F, Kaleci S, Bianco A, Cappai M, Lucchi F, Bertelli MO. Appropriateness of psychopharmacological therapies to psychiatric diagnoses in persons with autism spectrum disorder with or without intellectual disabilities: a cross-sectional analytic study. Expert Opin Drug Saf 2023; 22:1271-1281. [PMID: 36681385 DOI: 10.1080/14740338.2023.2172396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Observational studies highlighted high rates of psychotropic medication in persons with autistic spectrum disorder (ASD) with or without intellectual disability, which seems to be associated with the management of problem behaviors more than co-occurrent psychiatric disorders. The purpose of the study is to investigate psychopharmacology use and diagnoses of co-occurrent psychiatric disorder (PD) in persons with ASD attending a public mental health service in Emilia Romagna, Italy. METHODS The present study is a multicenter, cross-sectional study. RESULTS 275 persons out of 486 (56.5%) resulted to receive at least one psychotropic drug, compared to 74 persons (15.2%) that were diagnosed with a PD. 63.6% were on poly-pharmacotherapy (2-10 compounds), with 37.8% receiving 3 or more medications. Antipsychotics were the most frequently prescribed class of psychotropic drugs (89%), followed by antiepileptics/mood stabilizers/lithium (42.1%) and anxiolytics (BDZ) (38.5%). Most common psychiatric disorders were psychotic disorders (29.7%), followed by anxiety disorders (17.5%), bipolar disorders (12.2%), and depressive disorders (9.4%). CONCLUSIONS Our findings support earlier research showing that many individuals with ASD receive pharmacotherapy without being diagnosed with a co-occurring psychiatric disorder, indicating that the main reasons for prescription and the type of compound frequently have little to no link with specific psychopathology.
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Affiliation(s)
- Rita Di Sarro
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Niccolò Varrucciu
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Anna Di Santantonio
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Francesca Natali
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annamaria Bianco
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy
| | - Michela Cappai
- Emilia-Romagna Region, Mental Health and Pathological Addictions, Italy
| | - F Lucchi
- Department of Mental Health and Pathological Addictions, Public Local Health Bologna, Italy
| | - Marco O Bertelli
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy
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Wilson NJ, Barratt M, Jorgensen M, Limbu B, Donley M, Buchholtz M, Smith V, Deb S. Training support workers about the overmedication of people with intellectual disabilities: an Australian pre-post pilot study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:519-530. [PMID: 36880447 DOI: 10.1111/jir.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is evidence that psychotropic medications are overprescribed and overused to manage behaviours of concern for people with intellectual disabilities. Disability support workers and support staff lack education and training on the administration and safety of psychotropic medication use. This study aimed to test the applicability and preliminary efficacy of SPECTROM, an education programme developed in the UK, in an Australian context. METHODS The training comprises two parts: Module 1 encompasses psychotropic medications, their use and side effects. Module 2 focuses on non-pharmacological interventions for supporting people with behaviours of concern. Thirty-three participants attended the training course and completed pre-training and post-training surveys on the Psychotropic Knowledge Questionnaire and Management of Aggression and Violence Attitude Scale-Revised at four time points: pre-training, 2 weeks, 3 months and 5 months post-training. RESULTS Psychotropic Knowledge Questionnaire scores showed statistically significant post-training improvement at all post-training time points (P < 0.05). Management of Aggression and Violence Attitude Scale-Revised scores were high at pre-training and did not change significantly at any of the post-training survey time points. A 2-week post-training feedback questionnaire reported 80% agreement that the training programme was appropriate, useful and valid. Only 36% of participants completed questionnaires at all time points. CONCLUSIONS SPECTROM training increased staff knowledge of psychotropic medications, yet loss of participants was high. Further refinement of the applicability of the training for the Australian context and evaluation of the feasibility of implementation, clinical and cost-effectiveness of the programme are required.
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Affiliation(s)
- N J Wilson
- School of Nursing and Midwifery, Western Sydney University, Hawkesbury Campus, Richmond, NSW, Australia
| | - M Barratt
- School of Nursing and Midwifery, Western Sydney University, Hawkesbury Campus, Richmond, NSW, Australia
| | - M Jorgensen
- Practice Quality Division, NDIS Quality and Safeguards Commission, Parramatta, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - B Limbu
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - M Donley
- Behaviour Intervention and Support, Life Without Barriers, Newcastle, NSW, Australia
| | - M Buchholtz
- Behaviour Intervention and Support, Life Without Barriers, Newcastle, NSW, Australia
| | - V Smith
- Behaviour Intervention and Support, Life Without Barriers, Newcastle, NSW, Australia
| | - S Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
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24
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MacHale R, Ffrench C, McGuire B. The experiences and views of adults with intellectual disabilities accessing digital mental health interventions: A qualitative systematic review and thematic synthesis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:448-457. [PMID: 36781378 DOI: 10.1111/jar.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Technology is ubiquitous in all aspects of daily life and research interest in the topic of digital mental health interventions (DMHI) for people with intellectual disabilities is growing. In addition, the COVID-19 pandemic has accelerated technology use in delivering mental health supports. METHOD This review used a qualitative systematic literature review methodology with the aim of collating the views and experiences of adults with intellectual disabilities accessing DMHI. The electronic databases MEDLINE, PsycINFO, CINAHL and SCOPUS were searched in March 2022. RESULTS Five studies were selected in this review, and three major narrative themes were generated, each with sub-themes: (1) User experience with DMHI (personal experience, digital experience); (2) Relationships fostered through technology (interpersonal support, relating to virtual characters, computer as skilled helper); (3) Psychological benefits (new skills development, personal autonomy development). CONCLUSION This review highlights that, although there is a diversity of views and experiences of people with intellectual disabilities, the evidence suggests that DMHI has potential to support this population given the right opportunities. Findings also point to the benefit of technology as a complement to therapy, but not necessarily as a replacement to in-person therapeutic encounters.
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Affiliation(s)
| | - Cathal Ffrench
- School of Psychology, University of Galway, Galway, Ireland
| | - Brian McGuire
- School of Psychology, University of Galway, Galway, Ireland
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25
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Sugiyama Y, Mutai R, Matsushima M. Association between patient complexity and healthcare costs in primary care on a Japanese island: a cross-sectional study. BMJ Open 2023; 13:e068497. [PMID: 36963794 PMCID: PMC10040045 DOI: 10.1136/bmjopen-2022-068497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVES This study aimed to elucidate the relationship between patient complexity and healthcare costs in a primary care setting on a Japanese island. DESIGN Cross-sectional study. SETTING Tarama Clinic, Okinawa Miyako Hospital, on Tarama Island, Okinawa Prefecture, Japan. PARTICIPANTS Patients who visited Tarama Clinic from 1 April 2018 to 30 June 2018, were aged 20 years or above, were resident in Tarama Village and had decision-making capacity. OUTCOME MEASURES Patient complexity scored using Patient Centred Assessment Method (PCAM), healthcare costs per person per year/visit and participant characteristics. RESULTS We included 355 study participants. The means (SD) of the total PCAM scores and healthcare costs per person per year/visit were 21.4 (5.7) and 1056.4 (952.7)/125.7 (86.7) in US dollars, respectively. Spearman's rank correlation coefficients between the total PCAM scores and healthcare costs per person per year/visit were 0.33 and 0.28 (p values <0.0001 and <0.0001), respectively. The healthcare costs per person tended to be relatively low in the patient groups with the highest complexity. In the groups, the proportion of those with psychological conditions tended to be higher and those with cardiovascular diseases tended to be lower than in the other groups. Multiple regression analysis showed that total PCAM scores were associated with healthcare costs per person per year/visit, which were log-transformed: the regression coefficients were 3.87×10-2 and 2.34×10-2, respectively; the p values were <0.001 and <0.001, respectively. CONCLUSIONS This study clarified the association between patient complexity and healthcare costs in a primary care setting on a Japanese island. We found that such costs tended to be relatively low in patient groups with the highest complexity. In primary care, healthcare costs probably do not accurately reflect the value of services provided by medical institutions; it may be essential to introduce a system that provides incentives for problem-solving approaches to social issues.
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Affiliation(s)
- Yoshifumi Sugiyama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Tarama Clinic, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
- Division of Community Health and Primary Care, Center for Medical Education, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Rieko Mutai
- Department of Adult Nursing, The Jikei University School of Nursing, Chofu, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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26
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Pouls KPM, Cuypers M, Mastebroek M, Wieland J, Koks-Leensen MCJ, Leusink GL, Assendelft WJJ. Mental healthcare for adults with mild intellectual disabilities: population-based database study in Dutch mental health services. BJPsych Open 2023; 9:e48. [PMID: 36866924 PMCID: PMC10044331 DOI: 10.1192/bjo.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Adults with mild intellectual disability (MID) experience more mental health disorders than the general population. However, mental healthcare may be insufficiently tailored to match their needs. Detailed information is lacking regarding care provided to people with MID in mental health services. AIMS To compare mental health disorders and care provided to patients with and without MID in Dutch mental health services, including patients with missing MID status in the service files. METHOD In this population-based database study, we used a Statistics Netherlands mental health service database, containing health insurance claims of patients who utilised advanced mental health services in 2015-2017. Patients with MID were identified by linking this database with Statistic Netherlands' social services and long-term care databases. RESULTS We identified 7596 patients with MID, of whom 60.6% had no intellectual disability registration in the service files. Compared with patients without intellectual disability (n = 329 864), they had different profiles of mental health disorders. They received fewer diagnostic (odds ratio 0.71, 95% CI 0.67-0.75) and treatment activities (odds ratio 0.56, 95% CI 0.53-0.59), and required more interprofessional consultations outside of the service (odds ratio 2.06, 95% CI 1.97-2.16), crisis interventions (odds ratio 2.00, 95% CI 1.90-2.10) and mental health-related hospital admissions (odds ratio 1.72, 95% CI 1.63-1.82). CONCLUSIONS Patients with MID in mental health services have different profiles of mental health disorders and care than patients without intellectual disability. In particular, fewer diagnostics and treatments are provided, especially in those with MID with no intellectual disability registration, putting patients with MID at risk of undertreatment and poorer mental health outcomes.
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Affiliation(s)
- Katrien P M Pouls
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
| | - Maarten Cuypers
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
| | - Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
| | - Jannelien Wieland
- Curium LUMC, Leiden University Medical Center, The Netherlands; and Poli+, Leiden, The Netherlands
| | | | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
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Shoumi Deb S, Limbu B, Nancarrow T, Gerrard D, Shankar R. The UK psychiatrists' experience of rationalising antipsychotics in adults with intellectual disabilities: A qualitative data analysis of free-text questionnaire responses. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:594-603. [PMID: 36808782 DOI: 10.1111/jar.13083] [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: 08/16/2022] [Revised: 12/13/2022] [Accepted: 01/19/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Overprescribing of off-licence psychotropic medications, particularly antipsychotics, for challenging behaviours in people with intellectual disabilities without a psychiatric disorder is a significant public health concern. In the United Kingdom, the National Health Service England launched an initiative in 2016, 'STopping Over-Medication of People with learning disabilities, autism or both (STOMP)', to address this concern. STOMP is supposed to encourage psychiatrists in the United Kingdom and elsewhere to rationalise psychotropic medication use in people with intellectual disabilities. The current study aims to gather UK psychiatrists' views and experience of implementing the STOMP initiative. METHODS An online questionnaire was sent to all UK psychiatrists working in the field of intellectual disabilities (estimated 225). Two open-ended questions allowed participants to write comments in response to these questions in the free text boxes. One question asked about the challenges psychiatrists faced locally to implement STOMP, and the other asked for examples of successes and positive experiences from the process. The free text data were analysed using a qualitative method with the help of the NVivo 12 plus software. RESULTS Eighty-eight (estimated 39%) psychiatrists returned the completed questionnaire. The qualitative analysis of free-text data has shown variation within services in the experience and views of the psychiatrists. In areas with good support for STOMP implementation provided through adequate resources, psychiatrists reported satisfaction in the process with successful antipsychotic rationalisation, better local multi-disciplinary and multi-agency working, and increased awareness of STOMP issues among the stakeholders such as people with intellectual disabilities and their caregivers and multidisciplinary teams, and improved quality of life caused by reduced medication-related adverse events in people with intellectual disabilities. However, where resource utilisation is not optimum, psychiatrists seemed dissatisfied with the process with little success in medication rationalisation. CONCLUSIONS Whereas some psychiatrists are successful and enthusiastic about rationalising antipsychotics, others still face barriers and challenges. Much work is needed to achieve a uniformly positive outcome throughout the United Kingdom.
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Affiliation(s)
- Shoumitro Shoumi Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, Truro, Cornwall, UK
| | - Bharati Limbu
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, Truro, Cornwall, UK
| | - Tom Nancarrow
- University of Exeter Medical School, Truro, Cornwall, UK
| | | | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, Cornwall, UK
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Campos-Jara R, Martínez-Salazar C, Campos-Jara C, Fernández JM, Martínez-García D, Contreras-Osorio F. Pharmacological treatment for challenging behavior in adults with intellectual disability: Systematic review and meta-analysis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2023:S1888-9891(23)00004-6. [PMID: 37839961 DOI: 10.1016/j.rpsm.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Few evidence on the use of antipsychotics in people with intellectual disabilities and challenging behaviors, generates the need to develop studies that contribute to collect, compare and synthesize the available information. The present systematic review and meta-analysis aims to determine the clinical efficacy of antipsychotic medication in reducing critical episodes in this population. METHODS We searched Web of Science, Scopus, EBSCO, Embase, and PubMed for randomized controlled trials of antipsychotic medication versus placebo. Preliminarily yielded 1354 abstracts and citations; six studies with 274 subjects met the inclusion criteria of studies with experimental design, longitudinal type, with pre- and post-intervention measurements. RESULTS There is evidence for the use of psychotropic drugs in the acute management of challenging behaviors in patients with intellectual disability (SMD=-0.85; 95% CI=-1.69 to -0.01; p=0.05). CONCLUSIONS Our results coincide with the recommendations on the efficacy of the use of antipsychotics. Although our study provides evidence, the limited number of studies included in this research does not allow us to obtain totally conclusive results, although it can be considered as a guide for future studies.
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Affiliation(s)
| | - Cristian Martínez-Salazar
- Department of Physical Education, Sports, and Recreation, Pedagogy in Physical Education, School of Education and Social Sciences and Humanities, Universidad de La Frontera, Temuco 4780000, Chile
| | - Christian Campos-Jara
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | | | - Darío Martínez-García
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
| | - Falonn Contreras-Osorio
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile.
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29
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Barratt M, Jorgensen M, Deb SS, Limbu B, Donley M, Buchholtz M, Smith V, Wilson N. Staff perceptions following a training programme about reducing psychotropic medication use in adults with intellectual disability: The need for a realistic professional practice framework. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:486-496. [PMID: 36655535 DOI: 10.1111/jar.13070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adults with intellectual disability are at higher risk of being administered psychotropic medications. The UK-developed SPECTROM (Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities) training programme educates disability support workers on psychotropic medications and alternatives to these medications. METHOD Interviews were conducted with 10 participants who took part in the pilot SPECTROM training programme to elicit their views on the programme and its appropriateness in an Australian context. RESULTS The key theme was 'Need for a psychotropic medication practice framework'. Four sub-themes were Broad satisfaction with the SPECTROM training programme; Disability support workers acknowledging the limitations of their scope of practice; Empowering training through prescriptive and reflective methods and; Need for future mentoring from Multi-Disciplinary Team members in the application of new knowledge. CONCLUSIONS Participants felt that whilst they could improve their knowledge and attitudes surrounding psychotropic medication administration for behaviours of concern through SPECTROM training, a national practice framework is needed to execute its goals at scale.
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Affiliation(s)
- Macey Barratt
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
| | - Mikaela Jorgensen
- Practive Quality Division, NDIS Quality and Safeguards Commission, Parramatta, Australia.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Shoumitro Shoumi Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Bharati Limbu
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Mandy Donley
- National Behaviour Intervention Support Team, Life Without Barriers, Newcastle, Australia
| | - Moira Buchholtz
- National Behaviour Intervention Support Team, Life Without Barriers, Newcastle, Australia
| | - Victoria Smith
- National Behaviour Intervention Support Team, Life Without Barriers, Newcastle, Australia
| | - Nathan Wilson
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia
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Madley-Dowd P, Thomas R, Boyd A, Zammit S, Heron J, Rai D. Intellectual disability in the children of the Avon Longitudinal Study of Parents and Children (ALSPAC). Wellcome Open Res 2023; 7:172. [PMID: 37333842 PMCID: PMC10276197 DOI: 10.12688/wellcomeopenres.17803.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 08/03/2023] Open
Abstract
Background: Intellectual disability (ID) describes a neurodevelopmental condition involving impaired cognitive and functional ability. Here, we describe a multisource variable of ID using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: The multisource indicator variable for ID was derived from i) IQ scores less than 70 measured at age 8 and at age 15, ii) free text fields from parent reported questionnaires, iii) school reported provision of educational services for individuals with a statement of special educational needs for cognitive impairments, iv) from relevant READ codes contained in GP records, iv) international classification of disease diagnoses contained in electronic hospital records and hospital episode statistics and v) recorded interactions with mental health services for ID contained within the mental health services data set. A case of ID was identified if two or more sources indicated ID. A second indicator, labelled as "probable ID", was created by relaxing the cut off in IQ scores to be less than 85. An indicator variable for known causes of ID was also created to aid in aetiological studies where ID with a known cause may need to be excluded. Results: 158 of 14,370 participants (1.10%) were indicated as having ID by two or more sources and 449 (3.12%) were indicated as having probable ID when the criteria for IQ scores was relaxed to less than 85. There were 476 participants (3.31%) with 1 or fewer sources of available information on ID; these participants had their multisource variable set to missing. The number of cases of ID with known cause was 31 (0.22% of the cohort, 19.6% of those with ID). Conclusions: The multisource variable of ID can be used in future analyses on ID in ALSPAC children.
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Affiliation(s)
- Paul Madley-Dowd
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Richard Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Stanley Zammit
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, BS8 2BN, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Jon Heron
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Dheeraj Rai
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, BS8 2BN, UK
- Avon and Wiltshire Partnership NHS Mental Health Trust, University of Bristol, Bristol, BA1 3QE, UK
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Laermans P, Morisse F, Lombardi M, Gérard S, Vandevelde S, de Kuijper G, Audenaert K, Claes C. Aligning quality of life and guidelines for off-label psychotropic drugs in adults with intellectual disabilities and challenging behaviour. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:398-413. [PMID: 37213586 PMCID: PMC10197992 DOI: 10.1080/20473869.2023.2195721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/23/2023]
Abstract
Introduction Adults with intellectual disabilities have an increased vulnerability to mental health problems and challenging behaviour. In addition to psychotherapeutic or psychoeducational methods, off-label pharmacotherapy, is a commonly used treatment modality. Objective The aim of this study was to establish evidence-based guideline recommendations for the responsible prescription of off-label psychotropic drugs, in relation to Quality of Life (QoL). Method A list of guidelines was selected, and principles were established based on international literature, guideline review and expert evaluation. The Delphi method was used to achieve consensus about guideline recommendations among a 58-member international multidisciplinary expert Delphi panel. Thirty-three statements were rated on a 5-point Likert-scale, ranging from totally disagree to totally agree, in consecutive Delphi rounds. When at least 70% of the participants agreed (score equal or higher than 4), a statement was accepted . Statements without a consensus were adjusted between consecutive Delphi rounds based on feedback from the Delphi panel. Results Consensus was reached on 4 general:the importance of non-pharmaceutical treatments, comprehensive diagnostics and multidisciplinary treatment. Consensus was reached in 4 rounds on 29 statements. No consensus was reached on 4 statements concerning: freedom-restricting measures, the treatment plan, the evaluation of the treatment plan, and the informed consent. Conclusion The study led to recommendations and principles for the responsible prescription - aligned with the QoL perspective - of off-label psychotropic drugs for adults with intellectual disabilities and challenging behaviour. Extensive discussion is needed regarding the issues on which there was no consensus to furthering the ongoing development of this guideline.
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Affiliation(s)
- P. Laermans
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
- Correspondence to: Pauline Laermans, EQUALITY//ResearchCollective, University College Ghent.
| | - F. Morisse
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - M. Lombardi
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
| | - S. Gérard
- Superior Health Council, Brussels, Belgium
| | - S. Vandevelde
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - G. de Kuijper
- Centre for Intellectual Disabilities & Mental Health, Mental Healthcare Drenthe, the Netherlands
| | - K. Audenaert
- Department of Psychiatry, Ghent University, Ghent, Belgium
| | - C. Claes
- EQUALITY//ResearchCollective, University College Ghent, Ghent, Belgium
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Zylbersztejn A, Stilwell PA, Zhu H, Ainsworth V, Allister J, Horridge K, Stephenson T, Wijlaars L, Gilbert R, Heys M, Hardelid P. Trends in hospital admissions during transition from paediatric to adult services for young people with learning disabilities or autism: Population-based cohort study. Lancet Reg Health Eur 2023; 24:100531. [PMID: 36394000 PMCID: PMC9649375 DOI: 10.1016/j.lanepe.2022.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background Transition from paediatric to adult health care may disrupt continuity of care, and result in unmet health needs. We describe changes in planned and unplanned hospital admission rates before, during and after transition for young people with learning disability (LD), or autism spectrum disorders (ASD) indicated in hospital records, who are likely to have more complex health needs. Methods We developed two mutually exclusive cohorts of young people with LD, and with ASD without LD, born between 1990 and 2001 in England using national hospital admission data. We determined the annual rate of change in planned and unplanned hospital admission rates before (age 10–15 years), during (16–18 years) and after (19–24 years) transition to adult care using multilevel negative binomial regression models, accounting for area-level deprivation, sex, birth year and presence of comorbidities. Findings The cohorts included 51,291 young people with LD, and 46,270 autistic young people. Admission rates at ages 10–24 years old were higher for young people with LD (54 planned and 25 unplanned admissions per 100 person-years) than for autistic young people (17/100 and 16/100, respectively). For young people with LD, planned admission rates were highest and constant before transition (rate ratio [RR]: 0.99, 95% confidence interval [CI] 0.98–0.99), declined by 14% per year of age during (RR: 0.86, 95% CI: 0.85–0.88), and remained constant after transition (RR: 0.99, 95% CI: 0.99–1.00), mainly due to fewer admissions for non-surgical care, including respite care. Unplanned admission rates increased by 3% per year of age before (RR: 1.03, 95% CI: 1.02–1.03), remained constant during (RR: 1.01, 95% CI: 1.00–1.03) and increased by 3% per year after transition (RR: 1.03, 95% CI: 1.02–1.04). For autistic young people, planned admission rates increased before (RR: 1.06, 95% CI: 1.05–1.06), decreased during (RR: 0.95, 95% CI: 0.93–0.97), and increased after transition (RR: 1.05, 95%: 1.04–1.07). Unplanned admission rates increased most rapidly before (RR: 1.16, 95% CI: 1.15–1.17), remained constant during (RR: 1.01, 95% CI: 0.99–1.03), and increased moderately after transition (RR: 1.03, 95% CI: 1.02–1.04). Interpretation Decreases in planned admission rates during transition were paralleled by small but consistent increases in unplanned admission rates with age for young people with LD and autistic young people. Decreases in non-surgical planned care during transition could reflect disruptions to continuity of planned/respite care or a shift towards provision of healthcare in primary care and community settings and non-hospital arrangements for respite care. Funding National Institute for Health Research Policy Research Programme.
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Pouls KPM, Koks-Leensen MCJ, Assendelft WJJ, Mastebroek M, Leusink GL. Primary mental healthcare for adults with mild intellectual disabilities: a Dutch database study. Eur J Gen Pract 2022; 28:234-241. [DOI: 10.1080/13814788.2022.2142936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Katrien P. M. Pouls
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Willem J. J. Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geraline L. Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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Uso de psicofármacos en personas con discapacidad intelectual en Extremadura, España. ACTA COLOMBIANA DE PSICOLOGIA 2022. [DOI: 10.14718/acp.2023.26.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
El uso de psicofármacos es frecuente en adultos con discapacidad intelectual, a menudo por conductas desafiantes en ausencia de diagnóstico de trastorno mental. Investigaciones previas cuestionan la eficacia de estos tratamientos a falta de una enfermedad psiquiátrica, y destacan sus efectos secundarios. El objetivo de esta investigación es analizar el uso de psicofármacos en función del diagnóstico de enfermedad mental y conducta desafiante, así como la distribución de la población según el uso de psicofármacos en 569 adultos con discapacidad intelectual que presentan enfermedad mental o conductas desafiantes. Los datos acerca de la elevada prescripción de psicofármacos y, especialmente, de antipsicóticos alertan sobre la necesidad de una profunda revisión de la práctica clínica que permita reducir el uso de esta medicación en el tratamiento de la conducta y los trastornos mentales en esta población, para garantizar una atención de calidad y el respeto de los derechos de estas personas.
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de Kuijper G, de Haan J, Deb S, Shankar R. Withdrawing Antipsychotics for Challenging Behaviours in Adults with Intellectual Disabilities: Experiences and Views of Prescribers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17095. [PMID: 36554973 PMCID: PMC9779134 DOI: 10.3390/ijerph192417095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
International current best practice recommends the discontinuation of antipsychotics for challenging behaviours in people with intellectual disabilities (ID), due to lack of evidence of efficacy and risks of harmful side-effects. In clinical practice, discontinuation may be difficult. The aim of this study was to gain insight into prescribers' practice by investigating their experiences with the discontinuation of long-term antipsychotics for challenging behaviour. From professionals' associations thirty-four registered ID physicians, psychiatrists and specialist mental healthcare nurses were recruited who completed an online questionnaire in this survey-study. Almost all participants had attempted to deprescribe antipsychotics for their patients with ID. Sixty-five percent of participants achieved complete discontinuation in 0-25% of their patients, but none in over 50%. Barriers were a lack of non-pharmaceutical treatments for challenging behaviours and caregivers' and/or family concern. Seventy percent of participants indicated that their institutions had encouraged implementing their discontinuation policies in line with the new Dutch Act on Involuntary care and a new Dutch multidisciplinary guideline on problem behaviour in adults with ID. Support and facilitation of clinicians from institutions' managers and political and professional bodies may be helpful in further implementation of best practice in the treatment of challenging behaviour in people with ID.
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Affiliation(s)
- Gerda de Kuijper
- GGZ-Drenthe/Centre for ID and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
- Academic Collaboration ID and Mental Health, Department Psychiatry and Department Family Practice, University Medical Centre Groningen, 9713 GZ Hanzeplein, The Netherlands
| | - Joke de Haan
- GGZ-Drenthe/Centre for ID and Mental Health, Middenweg 19, 9404 LL Assen, The Netherlands
| | - Shoumitro Deb
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Rohit Shankar
- Peninsula School of Medicine, University of Plymouth and Cornwall Partnership NHS Foundation Trust, Plymouth PL4 8AA, UK
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Turner J, Barry A, Doyle J, Hogg J, Hynes A, Mahon E, Moloney C, Shortt E, O’Dwyer M. The adverse effects of long-term exposure to antipsychotics among older people with intellectual disabilities: a scoping review. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13644.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Antipsychotics are among the medications most prescribed to older adults with intellectual disabilities despite limited evidence to support their safety and efficacy in this population. Antipsychotics are associated with a significant burden of long-term adverse effects including movement disorders, metabolic and cardiovascular adverse effects, sedation and anticholinergic effects. This scoping review aims to evaluate the current extent of the literature relating to adverse effects of long-term antipsychotic use in older adults with intellectual disabilities and identify any existing gaps. Methods The review was conducted in line with the framework for scoping reviews proposed by Arksey and O’Malley. A systematic literature search was carried out, including searches of PubMed, Cochrane Library, ScienceDirect, Embase, PsycINFO and grey literature databases. Reference lists of studies were also reviewed as part of the search. Studies were included in the review if they related to adults over 40 years of age with an intellectual disability who had been taking antipsychotic medication for at least 3 months. Results A total of 13 studies were identified for inclusion in the review. These included retrospective reviews,observational studies, case reports, cohort studies and cross-sectional studies. Adverse effects reported include extrapyramidal symptoms, cardiovascular and metabolic effects, and case reports of rhinorrhoea, hypothermia and ischaemic colitis. Increasing age was associated with a greater burden of adverse effects in some studies. Conclusion The available evidence on the adverse effects of long-term antipsychotic use in older adults with intellectual disabilities is weak and conflicting. The studies included were generally of poor quality with numerous limitations including small sample sizes and lack of control groups. More research is needed to inform understanding of adverse effects associated with long-term antipsychotic use in this population.
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Paton C, Roy A, Purandare K, Rendora O, Barnes TRE. Prescribing antipsychotic medication for adults with intellectual disability: shared responsibilities between mental health services and primary care. BJPsych Bull 2022; 46:311-315. [PMID: 34308827 PMCID: PMC9813760 DOI: 10.1192/bjb.2021.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIMS AND METHOD We conducted a secondary analysis of data from a Prescribing Observatory for Mental Health audit to assess the quality of requests from intellectual disability services to primary care for repeat prescriptions of antipsychotic medication. RESULTS Forty-six National Health Service Trusts submitted treatment data on 977 adults with intellectual disability, receiving antipsychotic medication for more than a year, for whom prescribing responsibility had been transferred to primary care. Therapeutic effects had been monitored in the past 6 months in 80% of cases with a documented communication indicating which service was responsible for this and 72% of those with no such communication. The respective proportions were 69% and 42% for side-effect monitoring, and 79% and 30% for considering reducing/stopping antipsychotic medication. CLINICAL IMPLICATIONS Where continuing antipsychotic medication is prescribed in primary care for people with intellectual disability, lack of guidance from secondary care regarding responsibilities for monitoring its effectiveness may be associated with inadequate review.
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Affiliation(s)
- Carol Paton
- Imperial College London, UK.,Royal College of Psychiatrists, UK
| | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, UK
| | - Kiran Purandare
- Imperial College London, UK.,Central and North West London NHS Foundation Trust, UK
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Costello A, Hudson E, Morrissey S, Sharma D, Kelly D, Doody O. Management of psychotropic medications in adults with intellectual disability: a scoping review. Ann Med 2022; 54:2486-2499. [PMID: 36120887 PMCID: PMC9518601 DOI: 10.1080/07853890.2022.2121853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND/OBJECTIVE(S) Psychotropic medications are commonly prescribed among adults with intellectual disability, often in the absence of a psychiatric diagnosis. The aim of this scoping review is to provide an overview of the extent, range, and nature of the available research on medication use and practices and medication management in people with intellectual disability taking psychotropic medications for behaviours that challenge. MATERIALS AND METHODS A scoping review of research studies (qualitative, quantitative, and mixed design) and Grey Literature (English) was carried out. Databases included: Ovid MEDLINE, Embase, CINAHL, JBI Evidence Synthesis, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Scopus. A three-step search strategy was followed, with results screened by two independent reviewers. Data was extracted independently by two reviewers using a data extraction tool with results mapped and presented using a narrative form supported by tables and diagrams to the research questions. RESULTS Following the removal of duplicates, records were screened, full texts assessed, and 49 studies were included. Medication outcomes included reduced repetitive, stereotypic, and/or aggressive behaviours. High dosing/prescribing in the setting of an absent/unclear clinical indication was associated with worsening of symptoms for which psychotropics were prescribed. While psychotropics had a role in managing behaviours that challenge, reducing or discontinuing psychotropics is sometimes warranted. Study designs were frequently pragmatic resulting in small sample sizes and heterogeneous cohorts receiving different doses and combinations of medications. Access to multidisciplinary teams, guidelines, medication reviews, staff training, and enhanced roles for carers in decision-making were warranted to optimize psychotropic use. CONCLUSIONS These findings can inform prescribing interventions and highlight the need for timely and comprehensive patient outcome data, especially on long-term use of high doses of psychotropics and what happens when reduce or stop prescribing these doses.KEY MESSAGESPsychotropic medications are frequently prescribed for people with intellectual disabilities, often at high doses and these medications are associated with both positive and negative patient outcomes.Work to rationalize psychotropic use has been reported with interventions aiming to reduce polypharmacy or deprescribe a single psychotropic medicine. These interventions had mixed success and risk of relapse was documented in some studies.Limitations in sample size and heterogenous patient cohorts make it challenging to understand the risks and benefits associated with reducing or stopping psychotropic medicines.Patient, carer, and clinician partnerships are critical to advance medication management.
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Affiliation(s)
- Ashley Costello
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Eithne Hudson
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Susan Morrissey
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Drona Sharma
- Intellectual Disabilities, Nua Healthcare Services, Naas, Ireland
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Owen Doody
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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McCarthy JM, Chaplin E. Adults with Intellectual Disability and Autism Spectrum Disorder: What Is the Evidence around the Use of Polypharmacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15974. [PMID: 36498043 PMCID: PMC9738258 DOI: 10.3390/ijerph192315974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
A review on the mental health needs of adults with intellectual disability (ID) and autism spectrum disorder (ASD) published just over 10 years ago found a limited evidence base for pharmacological intervention in this group. The aim of this paper was therefore to review the evidence in the subsequent 10 years, with a focus on polypharmacy use in adults who have both ID and ASD. A critical literature review of key papers published from 2009 to 2021 was undertaken on adults with both ID and ASD and related to psychopharmacology, polypharmacy, antipsychotics, antidepressants, mood stabilisers and anxiolytics interventions in improving symptoms. After excluding articles for lack of relevance, a review with a focus on the use of polypharmacy was carried out on the retrieved results. Four papers were identified as relevant to adults with both ID and ASD. Three main themes were identified in the review, including the application of pharmacogenetics, the influence of national policy on prescribing practices and safety concerns in a population with multiple health comorbidities. The past decade has produced a small increase in the evidence base on psychopharmacology use in adults with ID and ASD. However, more evidence on the effectiveness and impact of long-term polypharmacy use is required.
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Affiliation(s)
- Jane M. McCarthy
- Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Eddie Chaplin
- Foundation for People with Learning Disabilities, Institute of Health and Social Care, London South Bank University, London SE1 0AA, UK
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de Kuijper G, de Haan J, Deb S, Shankar R. Withdrawing Antipsychotics for Challenging Behaviours in Adults with Intellectual Disabilities: Experiences and Views of Experts by Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15637. [PMID: 36497711 PMCID: PMC9736624 DOI: 10.3390/ijerph192315637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
People with intellectual disabilities (PwID) are frequently prescribed long-term antipsychotics for behaviours that challenge (BtC) despite the lack of proven effectiveness and the increased risks for side effects of these medications in this population. National and international good clinical practice guidelines recommend deprescribing antipsychotics for BtC, which is often not successful due to environmental and other factors. The involvement of all stakeholders, including PwID, is crucial for deprescribing. However, studies showed that PwID and/or their families are often not involved in decision-making regarding the (de)prescribing of antipsychotics despite their desire to get involved. Moreover, studies on the views of PwID regarding their experiences of withdrawing from antipsychotics are lacking. The aim of this study was to gain insight into the views of PwID by investigating their experiences of discontinuation of long-term prescribed antipsychotics for BtC. A qualitative study was set up. Seven experts by experience with mild intellectual disabilities were interviewed. After six interviews, data saturation was achieved. Interviews were transcribed verbatim. Using phenomenological analysis, themes on lived experiences were extracted. Each consecutive interview was analysed. The four main themes extracted from the interviews were the quality of treatment, knowledge and information about psychotropics and the process of withdrawal, support from the participants' environment and the coping style of the interviewees themselves.
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Affiliation(s)
- Gerda de Kuijper
- GGZ-Drenthe/Centre for ID and Mental Health, 9404 LL Assen, The Netherlands
- Academic Collaboration ID and Mental Health, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
| | - Joke de Haan
- GGZ-Drenthe/Centre for ID and Mental Health, 9404 LL Assen, The Netherlands
| | - Shoumitro Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London SW7 2BX, UK
| | - Rohit Shankar
- Peninsula School of Medicine, University of Plymouth, Plymouth PL4 8AA, UK
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Lokman S, van Oorsouw WMWJ, Didden R, Embregts PJCM. Setting up a new team of support staff for people with mild intellectual disability or borderline intellectual functioning and severe challenging behaviour: A concept mapping study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1348-1359. [PMID: 35789034 PMCID: PMC9795899 DOI: 10.1111/jar.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies about teams of staff supporting people with intellectual disability have focused on team performance of existing teams. This study aimed to examine important factors in the process of setting up a new team of support staff. Specifically, we considered the process for a team that supports service users with mild intellectual disability or borderline intellectual functioning who display severe challenging behaviour from the orthopedagogical perspective (i.e., with a focus on contextual factors). METHOD Three participant groups (service users, support staff, and professionals supporting a team) participated in a concept mapping procedure, including generating statements in interviews and focus groups, sorting, and rating. An expert group interpreted the results. RESULTS Important factors to one or more groups were: service users and support staff getting acquainted early, team safety, social support, a shared vision, and a positive reputation of the new home. CONCLUSIONS Four core outcomes were addressed that may help service organisations to provide an environment matching the needs of service users who show severe challenging behaviour from the start.
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Affiliation(s)
- Suzanne Lokman
- Tranzo, Tilburg School of Social and Behavorial SciencesTilburg UniversityTilburgThe Netherlands
| | | | - Robert Didden
- Radboud UniversityBehavioural Science InstituteNijmegenThe Netherlands,TrajectumZwolleThe Netherlands
| | - Petri J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavorial SciencesTilburg UniversityTilburgThe Netherlands
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Laura Ward M, Cooper SA, Henderson A, Stanley B, Greenlaw N, Pacitti C, Cairns D. A study on prescriptions contributing to the risk of high anticholinergic burden in adults with intellectual disabilities: retrospective record linkage study. Ann Gen Psychiatry 2022; 21:41. [PMID: 36309752 PMCID: PMC9617313 DOI: 10.1186/s12991-022-00418-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with intellectual disabilities may face a disproportionate risk of experiencing high anticholinergic burden, and its negative sequalae, from a range of medications, and at younger ages than the general population, but there has been little previous study. Our aim was to determine the source of anticholinergic burden from prescribed medication. METHODS Retrospective matched observational study using record linkage. Adults with (n = 4,305), and without (n = 12,915), intellectual disabilities matched by age-, sex- and neighbourhood deprivation. The main outcome measure was the prescription of long-term (approximately 12 months use) anticholinergic medications overall (classified according to the Anticholinergic Risk Scale [ARS]), by drug class, individual drugs, and polypharmacy. RESULTS Adults with n = 1,654 (38.4%), and without n = 3,047 (23.6%), intellectual disabilities were prescribed medications long-term with anticholinergic effects. Of those on such drugs, adults with intellectual disabilities were most likely to be on central nervous system (62.6%), gastrointestinal (46.7%), and cardiovascular (28.4%) medications. They were prescribed more central nervous system, gynaecological/urinary tract, musculoskeletal, and respiratory medications, and less cardiovascular, infection, and endocrine medications than their matched comparators. Regardless of age, sex, or neighbourhood deprivation, adults with intellectual disabilities had greater odds of being prescribed antipsychotics (OR = 5.37 [4.40-6.57], p < 0.001), antiepileptics (OR = 2.57 [2.22-2.99], p < 0.001), and anxiolytics/hypnotics (OR = 1.28 [1.06-1.56], p = 0.012). Compared to the general population, adults with intellectual disabilities were more likely to be exposed to overall anticholinergic polypharmacy (OR = 1.48 [1.33-1.66], p < 0.001), and to psychotropic polypharmacy (OR = 2.79 [2.41-3.23], p < 0.001). CONCLUSIONS Adults with intellectual disabilities are exposed to a greater risk of having very high anticholinergic burden through polypharmacy from several classes of medications, which may be prescribed by several different prescribers. There is a need for evidence-based recommendations specifically about people with intellectual disabilities with multiple physical and mental ill-health conditions to optimise medication use, reduce inappropriate prescribing and adverse anticholinergic effects.
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Affiliation(s)
- McKernan Laura Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 0XH, Scotland
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 0XH, Scotland
| | - Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 0XH, Scotland
| | - Bethany Stanley
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, G12 8QW, Scotland
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, G12 8QW, Scotland
| | - Christine Pacitti
- Greater Glasgow & Clyde NHS, Leverndale Hospital, Glasgow, G53 7TU, Scotland
| | - Deborah Cairns
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 0XH, Scotland.
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Sappok T, Hassiotis A, Bertelli M, Dziobek I, Sterkenburg P. Developmental Delays in Socio-Emotional Brain Functions in Persons with an Intellectual Disability: Impact on Treatment and Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013109. [PMID: 36293690 PMCID: PMC9603789 DOI: 10.3390/ijerph192013109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 05/06/2023]
Abstract
Intellectual disability is a neurodevelopmental disorder with a related co-occurrence of mental health issues and challenging behaviors. In addition to purely cognitive functions, socio-emotional competencies may also be affected. In this paper, the lens of developmental social neuroscience is used to better understand the origins of mental disorders and challenging behaviors in people with an intellectual disability. The current concept of intelligence is broadened by socio-emotional brain functions. The emergence of these socio-emotional brain functions is linked to the formation of the respective neuronal networks located within the different parts of the limbic system. Thus, high order networks build on circuits that process more basic information. The socio-emotional skills can be assessed and complement the results of a standardized IQ-test. Disturbances of the brain cytoarchitecture and function that occur at a certain developmental period may increase the susceptibility to certain mental disorders. Insights into the current mental and socio-emotional functioning of a person may support clinicians in the calibration of treatment and support. Acknowledging the trajectories of the socio-emotional brain development may result in a more comprehensive understanding of behaviors and mental health in people with developmental delays and thus underpin supports for promotion of good mental health in this highly vulnerable population.
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Affiliation(s)
- Tanja Sappok
- Berlin Center for Mental Health in Developmental Disabilities, Ev. Krankenhaus Königin Elisabeth Herzberge, 10365 Berlin, Germany
- Correspondence:
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Marco Bertelli
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, 50142 Florence, Italy
| | - Isabel Dziobek
- Clinical Psychology of Social Interaction, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Paula Sterkenburg
- Bartiméus, 3941 XM Doorn, The Netherlands
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
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44
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Deb S, Roy M, Limbu B. Pharmacological management of psychopathology in people with intellectual disabilities and/or autism spectrum disorder. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY
On average, 49–63% of people with intellectual disabilities and/or autism spectrum disorder (ASD) are prescribed psychotropic medications to treat psychopathology, including psychiatric illness, behaviours that challenge and the core symptoms and associated behaviours of these developmental disorders. In many cases, psychotropics, particularly antipsychotics, are used off-label without a proper indication, particularly to manage behaviours that challenge. The RCTs show moderate evidence supporting the efficacy of low-dose risperidone and some preliminary evidence for aripiprazole in treating behaviours that challenge among children with ASD and/or intellectual disabilities. The RCT-based evidence for the other psychotropics is equivocal, so no definitive conclusions can be made on their efficacy. Polypharmacy and the use of high doses of antipsychotics are prevalent in this population, leading to the risk of adverse events and drug–drug interactions. Despite various national and international guidelines, and government initiatives encouraging reduced psychotropic use, there is little evidence of this happening; on the contrary, the use of antidepressants, mood stabilisers and benzodiazepines may be increasing. A concerted multi-agency effort is urgently needed to address this significant public health concern of the overmedication of people with intellectual disabilities and/or ASD.
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Limbu B, Deb SS. Support staff liaising effectively with professionals for the rational use of psychotropics for behaviours that challenge in adults with intellectual disabilities: Findings from a co-design event. Front Psychiatry 2022; 13:954522. [PMID: 36245886 PMCID: PMC9559865 DOI: 10.3389/fpsyt.2022.954522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Experience Based Co-Design (EBCD) and co-production are interdisciplinary collaborative approaches to improve health care services by involving all stakeholders. These approaches capture the experiences of all stakeholders who come in contact with services and use experiences as evidence to promote and implement service changes. The use of psychotropic medications for behaviours that challenge (BtC) in people with intellectual disabilities (ID) is a complex issue because of its off-licence use and use in combination with other medications for physical and psychiatric co-morbidities, which leads to overmedication of people with ID. As support staff plays a pivotal role in the prescribing for people with ID, we have developed a staff training programme, SPECTROM, to help reduce overmedication. A project team developed SPECTROM under the guidance of a Programme Development Group (PDG) consisting of 21 stakeholders. The PDG analysed data from a literature review, four focus groups and a co-design event day involving 26 stakeholders. In this paper, we have presented data based on the findings from the co-design event day, primarily on the issue of support staff effectively liaising with professionals such as doctors, nurses, and other community learning disability team members. In-depth information and recommendations were proposed at the co-design event, which helped develop the draft SPECTROM. The draft was finalised after receiving feedback from 56 stakeholders. Co-production and a modified EBCD can be successfully used to create training interventions and improve health care services. More research should utilise co-production and EBCD and use service users' experiences to develop interventions and improve health care services.
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Affiliation(s)
- Bharati Limbu
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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46
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Smith E, Stogios N, Au E, Maksyutynska K, De R, Ji A, Erlang Sørensen M, St John L, Lin HY, Desarkar P, Lunsky Y, Remington G, Hahn M, Agarwal SM. The metabolic adverse effects of antipsychotic use in individuals with intellectual and/or developmental disability: A systematic review and meta-analysis. Acta Psychiatr Scand 2022; 146:201-214. [PMID: 35894550 DOI: 10.1111/acps.13484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with intellectual and/or developmental disability (IDD) are often prescribed antipsychotics (APs). However, despite their known propensity to cause metabolic adverse effects, including weight gain, diabetes, and increased risk of cardiovascular events, there is currently a limited body of literature describing the metabolic consequences of AP use in this population. METHODS We searched MEDLINE, EMBASE, PsychINFO, CENTRAL, and CINAHL databases to identify all randomized trials that reported on the metabolic effects of APs in individuals with IDD. Random effects meta-analyses were used to examine weight gain as both a continuous and dichotomous outcome. RESULTS Eighteen randomized trials met our inclusion criteria with a total of 1376 patients across a variety of IDDs. AP use was associated with significantly greater weight gain compared with placebo (Continuous: mean difference = 1.10 kg, [0.79, 1.40], p < 0.00001, I2 = 54%; Dichotomous: odds ratio = 3.94, [2.15, 7.23], p < 0.00001, I2 = 0). Sub-group analysis revealed no significant effect of AP type. Data regarding the effects of APs on other metabolic outcomes were limited. CONCLUSION This review (PROSPERO # CRD42021255558) demonstrates that AP use is associated with significant weight gain among patients with IDD. Concerningly, most reported studies were in children and adolescents, which sets up an already vulnerable population for adverse medical sequalae at an early age. There was also a lack of long-term studies in adults with IDD. Further studies are required to better understand how AP use affects metabolic parameters in this group of individuals.
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Affiliation(s)
- Emily Smith
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Emily Au
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Kateryna Maksyutynska
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Riddhita De
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Andrew Ji
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Mikkel Erlang Sørensen
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - Laura St John
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Hsiang-Yuan Lin
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Pushpal Desarkar
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Pharmacology, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada
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47
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Kelly N, Kilmartin A, Lannon K, Lee C, McLoughlin R, Mulvanny L, Mohamed O, Treacy M, Rossi K, O'Connell J. Rating scales to measure adverse effects of medications in people with intellectual disability: a scoping review. Eur J Clin Pharmacol 2022; 78:1711-1725. [PMID: 36042024 PMCID: PMC9546988 DOI: 10.1007/s00228-022-03375-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
Purpose Intellectual disability (ID) is a chronic neurodevelopmental condition characterised by limitations in intelligence and adaptive skills with an onset prior to the age of 18 years. People with ID have complex healthcare needs and are more likely than the general population to experience multiple comorbidities and polypharmacy, with subsequent increased risk of adverse medication effects. The aim of this scoping review is to characterise rating scales used to measure adverse effects of medication in people with ID. Methods Four online databases (PsycINFO, Medline, Web of Science and OpenGrey) were searched in April 2020. Studies were assessed for inclusion against pre-specified eligibility criteria. Reference lists of included studies were hand searched. Data extraction was carried out by two independent reviewers and key findings were tabulated for consideration. Studies were assessed for quality using the Mixed Methods Appraisal Tool. Results The search resulted in 512 unique records, of which fifteen met the inclusion criteria. Fourteen scales were identified. All scales assessed adverse effects of psychotropics only. Of the scales, only one, the Matson Evaluation of Drug Side Effects, which focuses on psychotropic medications, was originally developed for use in a population with ID. Conclusion The Matson Evaluation of Drug Side Effects scale appears to be the most reliable and well-researched scale in people with ID. However, a scale which measures adverse effects across multiple medication classes would be valuable for use in this population. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03375-2.
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Affiliation(s)
- Neasa Kelly
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Andrew Kilmartin
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Kevin Lannon
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Caren Lee
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Rory McLoughlin
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Lara Mulvanny
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Omnyiah Mohamed
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Mairead Treacy
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Karen Rossi
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Juliette O'Connell
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin, Ireland.
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48
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Deb S(S, Limbu B, Unwin GL, Weaver T. Causes of and Alternatives to Medication for Behaviours That Challenge in People with Intellectual Disabilities: Direct Care Providers' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9988. [PMID: 36011623 PMCID: PMC9408416 DOI: 10.3390/ijerph19169988] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 05/10/2023]
Abstract
Behaviours that challenge (BtC), such as aggression and self-injury, are manifested by many people with intellectual disabilities (ID). National and international guidelines recommend non-pharmacological psychosocial intervention before considering medication to address BtC. Support staff play a pivotal role in the prescription process. Using coproduction, we developed a training programme for support staff, called SPECTROM, to give them knowledge and empower them to question inappropriate prescriptions and ask for the discontinuation of medication if appropriate and instead look for ways to help people with ID when they are distressed without relying on medication. We have presented data from two focus groups that we conducted during the development of SPECTROM: one that included support staff, and another that had service managers and trainers. In these focus groups, we explored participants' views on the use of medication to address BtC with a particular emphasis on the causes of and alternatives to medication for BtC. Along with the participants' views, we have also presented how we have addressed these issues in the SPECTROM resources.
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Affiliation(s)
- Shoumitro (Shoumi) Deb
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, 2nd Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | - Bharati Limbu
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, 2nd Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | - Gemma L. Unwin
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Room 314, Edgbaston, Birmingham B15 2TT, UK
| | - Tim Weaver
- Department of Health & Social Care, School of Health Social Care and Education, Middlesex University, London NW4 4BT, UK
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49
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Branford D, Shankar R. Antidepressant prescribing for adult people with an intellectual disability living in England. Br J Psychiatry 2022; 221:488-493. [PMID: 35249557 DOI: 10.1192/bjp.2022.34] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The prescribing of psychotropic medications for people with an intellectual disability has changed. In many locations across England, antidepressants have become the most widely prescribed psychotropic. In the context of the current NHS England STOMP programme to reduce inappropriate psychotropic prescribing for people with intellectual disability, there is an urgent need to understand whether this change reflects evidence-based use of the medications involved. There has been little analysis into the benefits or problems associated with the change and whether it is of concern. This paper offers a variety of possible explanations and opportunities to improve clinical practice and policy.
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Affiliation(s)
- David Branford
- Cornwall Intellectual Disability Equitable Research, University of Plymouth Peninsula Medical School, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research, University of Plymouth Peninsula Medical School, UK; and Services for People with Adult Learning Disabilities, Cornwall Partnership NHS Foundation Trust, UK
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50
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Analysing trends of psychiatric disorders, treatment and service use across time in adults with borderline intellectual impairment: A cross-sectional study of private households. J Psychiatr Res 2022; 151:339-346. [PMID: 35533517 DOI: 10.1016/j.jpsychires.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
While there is evidence that mental health problems are more prevalent in people with borderline intellectual functioning (BIF) compared to the general population, it is not known to what extent this has varied or changed over time and whether there have been changes in access to services. This paper compares the prevalence rates of psychiatric disorders and monitors trends in treatment and services in this population compared to the general population. We conducted secondary analysis on the Adult Psychiatric Morbidity Surveys carried out in England in 2000, 2007 and 2014. The total sample analysed included 21,796 participants, with 12.8% of individuals identified with BIF (n = 2786). Regression models were used to examine trends in psychiatric disorders, treatment and service use across the three datasets. People with BIF had significantly higher odds of developing mood and anxiety disorders, psychosis, drug dependence and suicidal behaviour than the general population, increasing at each subsequent timepoint. They received significantly more pharmacological treatments than the general population but have had increasingly more access to general practitioners, community care and daycare services over time. This study shows increasing prevalence rates of several mental disorders in people with BIF. Access to day-care, community care and healthcare services has increased over time for this group but not formal psychiatric care. These changes over time underline some of the problems this population faces, emphasizing a need to recognize that this is a population often overlooked in research and clinical practice.
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