1
|
Gomes T, Khuu W, Tadrous M, Vigod S, Cobigo V, Lunsky Y. Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study. BMJ Open 2019; 9:e028125. [PMID: 31366646 PMCID: PMC6677990 DOI: 10.1136/bmjopen-2018-028125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To describe factors associated with initiating antipsychotics and patterns of persistence to antipsychotic therapy in a large cohort of adults with intellectual and developmental disabilities. DESIGN Population-based cohort study. SETTING Ontario, Canada. PARTICIPANTS Adults with intellectual and developmental disabilities (IDD) in Ontario. OUTCOME MEASURES We used multivariable logistic regression to investigate patient characteristics associated with antipsychotic initiation. Patient characteristics studied included sociodemographic characteristics, measures of clinical comorbidity and health service use. RESULTS Among 39 244 individuals eligible for this study, 6924 (17.6%) initiated an antipsychotic over the accrual window, of whom 1863 (26.9%) had no psychiatric diagnosis in the prior 2 years. A number of factors were significantly associated with antipsychotic initiation, including male gender, residence in a group home, prior use of benzodiazepines, antidepressants or cognitive enhancers, a recent emergency department visit or mental health hospitalisation and a visit to a psychiatrist or family physician in the prior 90 days. In a secondary analysis, the association between antipsychotic initiation and age, prior diagnosis of diabetes or myocardial infarction and polypharmacy differed slightly on the basis of whether an individual had a previously diagnosed psychiatric disorder. CONCLUSIONS Factors associated with the initiation of an antipsychotic differ according to the presence of a psychiatric diagnosis. Given the long duration of antipsychotic use in this population, future research is needed to understand the appropriateness of antipsychotic initiation among adults with IDD and the safety implications of long-term use of these products.
Collapse
Affiliation(s)
- Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | - Mina Tadrous
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada
| | - Virginie Cobigo
- ICES, Toronto, Ontario, Canada
- Department of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Yona Lunsky
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Zhou M, Du W, Salvador-Carulla L, Glasgow N. Adverse drug event-related hospitalisation in persons with neurodevelopmental disorders: a state-wide retrospective cohort study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:429-440. [PMID: 30609156 DOI: 10.1111/jir.12586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/06/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD). OBJECTIVE The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs. METHODS The all-inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE-related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests. RESULTS A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE-related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14-year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE-related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socio-economic disadvantage and less private insurance coverage, suffered with less severe but different co-morbid clinical conditions and incurred more challenges in the acute hospital care setting. CONCLUSION Although the pattern of ADE-related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group.
Collapse
Affiliation(s)
- M Zhou
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
- Pharmacy department, People's Hospital of Xinjiang, Urumqi, China
| | - W Du
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, Australia
| | - L Salvador-Carulla
- Centre of Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia
| | - N Glasgow
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, Australia
| |
Collapse
|
3
|
Lunsky Y, Khuu W, Tadrous M, Vigod S, Cobigo V, Gomes T. Antipsychotic Use With and Without Comorbid Psychiatric Diagnosis Among Adults with Intellectual and Developmental Disabilities. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:361-369. [PMID: 28830241 PMCID: PMC5971404 DOI: 10.1177/0706743717727240] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Antipsychotic use is controversial in the management of adults with intellectual and developmental disabilities (IDD) because of inconclusive evidence for efficacy in the absence of a comorbid psychiatric condition, and substantial concerns about adverse effects. We aimed to characterize antipsychotic use among Ontario adults with IDD and compare profiles of those with and without a documented psychiatric diagnosis. METHOD This population-based study included 51,881 adults with IDD under 65 y as of April 2010 receiving provincial drug benefits in Ontario who were followed until March 2016 to identify those dispensed at least one antipsychotic medication. Profiles of those with and without a psychiatric diagnosis were compared. RESULTS Overall, 39.2% of adults ( n = 20,316) were dispensed an antipsychotic medication, which increased to 56.4% in a subcohort residing in group homes. Almost one-third (28.91%) of people prescribed an antipsychotic medication did not have a documented psychiatric diagnosis. Those without a psychiatric diagnosis differed considerably from those with a diagnosis. In particular, those without a psychiatric diagnosis were older, less likely to have used antidepressants or benzodiazepines in the year before, and less likely to have used ambulatory and acute care. CONCLUSIONS Antipsychotic use in IDD is common, and occurs frequently without a psychiatric diagnosis. Attention toward how antipsychotics are prescribed and monitored for people with IDD in Canada is warranted to ensure appropriate prescribing.
Collapse
Affiliation(s)
- Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry at the University of Toronto, Toronto, Ontario, Canada
| | - Wayne Khuu
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mina Tadrous
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry at the University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation at the University of Toronto, Toronto, Ontario, Canada
| | - Virginie Cobigo
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Tara Gomes
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation at the University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Tint A, Weiss JA, Lunsky Y. Identifying the clinical needs and patterns of health service use of adolescent girls and women with autism spectrum disorder. Autism Res 2017; 10:1558-1566. [PMID: 28474493 DOI: 10.1002/aur.1806] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/01/2017] [Accepted: 04/12/2017] [Indexed: 12/14/2022]
Abstract
Girls and women in the general population present with a distinct profile of clinical needs and use more associated health services compared to boys and men; however, research focused on health service use patterns among girls and women with Autism Spectrum Disorder (ASD) is limited. In the current study, caregivers of 61 adolescent girls and women with ASD and 223 boys and men with ASD completed an online survey. Descriptive analyses were conducted to better understand the clinical needs and associated service use patterns of girls and women with ASD. Sex/gender comparisons were made of individuals' clinical needs and service use. Adolescent girls and women with ASD had prevalent co-occurring mental and physical conditions and parents reported elevated levels of caregiver strain. Multiple service use was common across age groups, particularly among adolescent girls and women with intellectual disability. Overall, few sex/gender differences emerged, although a significantly greater proportion of girls and women accessed psychiatry and emergency department services as compared to boys and men. Though the current study is limited by its use of parent report and small sample size, it suggests that girls and women with ASD may share many of the same high clinical needs and patterns of services use as boys and men with ASD. Areas for future research are discussed to help ensure appropriate support is provided to this understudied population. Autism Res 2017, 10: 1558-1566. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ami Tint
- Department of Psychology, York University, Toronto, Ontario, Canada, M3J 1P3.,Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, M5V 2B4
| | - Jonathan A Weiss
- Department of Psychology, York University, Toronto, Ontario, Canada, M3J 1P3
| | - Yona Lunsky
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, M5V 2B4.,Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8
| |
Collapse
|