1
|
Smith JR, Lim S, Bindra S, Marler S, Rajah B, Williams ZJ, Baldwin I, Hossain N, Wilson JE, Fuchs DC, Luccarelli J. Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism with and without Profound Impairment: An Observational Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.05.24312724. [PMID: 39281739 PMCID: PMC11398597 DOI: 10.1101/2024.09.05.24312724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Introduction Catatonia is a highly morbid psychomotor and affective disorder which can affect autistic individuals with and without profound impairment. Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive therapy, but the longitudinal effectiveness of these treatments has not been described. Methods We conducted a prospective observational cohort study of patients with autism and co-morbid catatonia who received outpatient care in a specialized outpatient clinic from July 1st, 2021 to May 31st, 2024. Data investigating pharmacologic interventions, and clinical measures including the Bush Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), Kanner Catatonia Examination (KCE), and Clinical Global Impression - Improvement (CGI-I) were collected. Results Forty-five patients were identified with 39 (86.7%) meeting criteria for profound autism. All patients received pharmacotherapy. 44 (97.8%) were treated with benzodiazepines with a mean maximal daily dose of 17.4 mg (SD=15.8) lorazepam equivalents. Thirty-five patients (77.8%) required more than one medication class for treatment. Fourteen patients (31.1%) attempted to taper off benzodiazepines during the study period; of these, 5 patients (11.1%) were successfully tapered off, and the remaining 9 (17.8%) discontinued the taper due to a return of catatonic symptoms. Statistically significant improvement was observed across all clinical domains except the KCS. However, the majority remained symptomatic over the study period. Conclusions Despite clinical improvements while receiving the gold standard for psychopharmacologic management of catatonia, chronic symptoms remained for the majority of catatonia patients over the study period, and few were able to taper and discontinue benzodiazepine treatment.
Collapse
Affiliation(s)
- Joshua Ryan Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, Tennessee, 37212
- Vanderbilt Kennedy Center, Vanderbilt University; 110 Magnolia Circle, Nashville, Tennessee, 37203
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center, 1601 23 Ave South, Nashville, Tennessee, 37212
| | - Seri Lim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, Tennessee, 37212
| | - Snehal Bindra
- Vanderbilt University School of Medicine; 1161 21 Ave S, Nashville, Tennessee, 37232
| | - Sarah Marler
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, Tennessee, 37212
| | - Bavani Rajah
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, Tennessee, 37212
| | - Zachary J Williams
- Vanderbilt University School of Medicine; 1161 21 Ave S, Nashville, Tennessee, 37232
| | - Isaac Baldwin
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, Tennessee, 37212
| | - Nausheen Hossain
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, Tennessee, 37212
| | - Jo Ellen Wilson
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center, 1601 23 Ave South, Nashville, Tennessee, 37212
- Critical Illness, Brain Dysfunction and Survivorship Center, Center for Health Services Research, Nashville, TN, 37212
- Geriatric Research, Education, and Clinical Center Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, 37212
| | - D Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, Tennessee, 37212
| | - James Luccarelli
- Department of Psychiatry, Harvard Medical School, 24 Shattuck Street, Boston, Massachusetts, 02115
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114
| |
Collapse
|
2
|
Chue P, Tate M. Crisis care may benefit adults with intellectual disability and/or challenging behaviour. Evid Based Nurs 2024:ebnurs-2024-104065. [PMID: 39025661 DOI: 10.1136/ebnurs-2024-104065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Pierre Chue
- Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Moriah Tate
- Nursing, Athabasca University, Edmonton, Athabasca, Canada
| |
Collapse
|
3
|
Durand M, Nathan R, Holt S, Nall-Evans S, Woodrow C. Who is at risk? Adults with intellectual disability at risk of admission to mental health inpatient care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13210. [PMID: 38382461 DOI: 10.1111/jar.13210] [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: 07/03/2023] [Revised: 11/30/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND NHS England's Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission. METHOD A cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken. RESULTS We compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis. CONCLUSION By furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources.
Collapse
Affiliation(s)
- Marianne Durand
- Learning Disability, Neurodevelopmental Disorders and Aquired Brain Injury, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Rajan Nathan
- Specialist Mental Health, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
- Chester Medical School, University of Chester, Chester, UK
| | - Sophie Holt
- Children, Young People and Families, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Sharleen Nall-Evans
- Information Management and Business Intelligence, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Ceri Woodrow
- Learning Disability, Neurodevelopmental Disorders and Aquired Brain Injury, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
- Centre for Autism, Neurodevelopmental Disorders and Intellectual Disabilities, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| |
Collapse
|
4
|
Liao P, Trollor J, Reppermund S, Cvejic RC, Srasuebkul P, Vajdic CM. Factors associated with acute care service use after epilepsy hospitalisation in people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1317-1335. [PMID: 36330725 PMCID: PMC10952954 DOI: 10.1111/jir.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aimed to identify factors associated with unplanned acute hospital readmission and emergency department (ED) presentation after hospitalisation for epilepsy in people with intellectual disability (ID). METHODS This study is a retrospective cohort study using linked administrative datasets. We identified 3293 people with ID aged 5-64 years with a hospitalisation for epilepsy between 2005 and 2014 in New South Wales, Australia. We examined unplanned readmission and ED presentation within 30 or 365 days and associations with demographic, socio-economic and health status variables. Modified Poisson regression with robust estimation was used to model outcomes within 30 days. Negative binomial regression was used to account for the overdispersion of the data and to model 365-day outcome rates. RESULTS Around half of the cohort had an unplanned readmission and ED presentation within 365 days of the index hospitalisation. In fully adjusted models, being female, being a young adult and having a longer or acute care index admission, mental and physical comorbidities and a history of incarceration were associated with an elevated risk of readmission or ED presentation. The strongest association was observed between history of self-harm and 365-day readmission (incidence rate ratio 2.15, 95% confidence interval 1.41-3.29). CONCLUSIONS Socio-demographic, justice and health factors are associated with unplanned readmission and ED presentation risk after hospitalisation for epilepsy in people with ID. Interventions targeting improving continuity of care should be tailored for individuals and their support workers. The findings also emphasise the importance of person-centred multidisciplinary care across different health sectors.
Collapse
Affiliation(s)
- P. Liao
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - J. Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - S. Reppermund
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - R. C. Cvejic
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - P. Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - C. M. Vajdic
- Centre for Big Data Research in Health, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| |
Collapse
|
5
|
Hassiotis A, Kouroupa A, Hamza L, Marston L, Romeo R, Yaziji N, Hall I, Langdon PE, Courtenay K, Taggart L, Morant N, Crossey V, Lloyd-Evans B. Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study. BJPsych Open 2023; 9:e116. [PMID: 37357806 PMCID: PMC10305109 DOI: 10.1192/bjo.2023.74] [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: 08/15/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England. AIMS To investigate the clinical and cost-effectiveness of IST models. METHOD We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2. RESULTS We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI -6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: -0.0088 to 0.0508) and costs (£3409.95; 95% CI -£9957.92 to £4039.89) of the two models were comparable. CONCLUSIONS The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated.
Collapse
Affiliation(s)
| | | | - Leila Hamza
- Assessment and Intervention Team, Barnet, Enfield and Haringey Mental Health NHS Trust, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
| | - Renee Romeo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nahel Yaziji
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ian Hall
- Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, UK
| | - Peter E. Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - Ken Courtenay
- Assessment and Intervention Team, Barnet, Enfield and Haringey Mental Health NHS Trust, UK
| | - Laurence Taggart
- Institute of Nursing and Health Research, Ulster University, Northern Ireland
| | - Nicola Morant
- Division of Psychiatry, University College London, UK
| | - Vicky Crossey
- South West Community Learning Disability Team & Mental Health Intensive Support and Treatment Team, NHS Lothian, UK
| | | |
Collapse
|
6
|
Kompella S, Vittori A, Kroin J, Kaushal S, Khan S, Neuhut S. Impact of Antipsychotic Use on Readmission Rates in Children and Adolescents With Autism Spectrum Disorder and Irritability. Cureus 2022; 14:e22361. [PMID: 35321066 PMCID: PMC8934570 DOI: 10.7759/cureus.22361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Risperidone and aripiprazole have been established as standard pharmacological treatments for irritability and associated aggressive behaviors in individuals with autism spectrum disorder (ASD), and are the only drugs approved by the United States Food and Drug Administration for those purposes. However, the rates of readmission with the use of these drugs in the pediatric population have not been studied, leaving a gap in the knowledge of antipsychotic effects. Readmission rates are a valuable metric of treatment efficacy that also reflect the financial burden, morbidity, and medical complications associated with multiple hospitalizations. Methodology A retrospective study was conducted in 65 Hospital Corporation of America Healthcare hospitals within the United States from 2016 to 2019. Patients aged 6-17 years with a diagnosis of ASD with irritability were included. The primary outcome was 30-, 60-, and 90-day readmission rates. Chi-square tests of independence and post-hoc analyses were used to assess the relatedness between readmission rate and antipsychotic use, as well as the type of antipsychotic medication if used. A binary regression analysis was used to analyze the relationship between demographic characteristics and readmission rate in this population. Patients on antidepressants, anxiolytics, or medications primarily used as mood stabilizers were excluded from the study to reduce confounding effects of such medications. Results A total of 2,375 patients aged 6-17 years were admitted for irritability and a diagnosis of ASD. In total 323 (13.8%) patients were readmitted from this group within 30 days of discharge. After controlling for age, sex, and gender, the use of antipsychotic medication was found to decrease 30- and 90-day readmission rates with an odds ratio of 1.2 to 1.4 times compared to no antipsychotic use (p < 0.04). In patients with autism not on antipsychotics, regression analysis revealed that older age (p = 0.0471) and White race (p = 0.0471) were associated with 30-day readmission (a = 0.05). For these patients, race was also significantly associated with 60-day (p = 0.0494) and 90-day (p = 0.0416) readmission rates. In patients with autism on either risperidone or aripiprazole, age (p = 0.0393) and race (p = 0.0316) were significantly associated with 30-day readmission rate. Conclusions Antipsychotic use reduced readmission rates within 30 days and 90 days in patients with irritability and ASD. Additionally, oral aripiprazole and oral risperidone were found to be equally effective in reducing the 30-day readmission rate, and neither was superior in comparison to the other in 30-, 60-, or 90-day readmission rates. The reduced 30- and 90-day readmission rates seen in our study with the use of antipsychotic medications emphasize the importance of antipsychotic use for individuals with ASD and irritability, even if the antipsychotic is not risperidone or aripiprazole. Groups who can particularly benefit from antipsychotic use include individuals who are refractory to first- and second-line therapies, such as behavioral interventions, or for those who present with persistent and serious risk of harm to themselves or others. Additionally, the use of antipsychotic medications in this scenario may reduce hospitalizations within 30 days of discharge, allowing reduction of the financial and emotional strain associated with these readmissions.
Collapse
|
7
|
Varcin KJ, Herniman SE, Lin A, Chen Y, Perry Y, Pugh C, Chisolm K, Whitehouse AJ, Wood SJ. Occurrence of psychosis and bipolar disorder in adults with autism: a systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 134:104543. [DOI: 10.1016/j.neubiorev.2022.104543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/17/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
|