Appropriateness of psychotropic medication use in a cohort of adolescents with intellectual disability in Queensland, Australia

Abstract

Background Psychotropic medications are sometimes used off-label and inappropriately. This may cause harm to adolescents with intellectual disability. However, few studies have analysed off-label or inappropriate prescribing to this group. Aims To examine the appropriateness of psychotropic prescribing to adolescents with intellectual disability living in the community in south-east Queensland, Australia. Method Off-label medication use was determined based on whether the recorded medical condition treated was approved by the Australian Therapeutic Goods Administration. Clinical appropriateness of medication use was determined based on published guidelines and clinical opinion of two authors who specialise in developmental disability medicine (J.N.T. and D.H.). Results We followed 429 adolescents for a median of 4.2 years. A total of 107 participants (24.9%) were prescribed psychotropic medications on at least one occasion. Of these, 88 (82.2%) were prescribed their medication off-label or inappropriately at least once. Off-label or inappropriate use were most commonly associated with challenging behaviours. Conclusions Off-label or inappropriate use of psychotropic medications was common, especially for the management of challenging behaviours. Clinical decision-making accounts for individual patient factors and is made based on clinical experience as well as scientific evidence, whereas label indications are developed for regulatory purposes and, although appropriate at a population level, cannot encompass the foregoing considerations. Education for clinicians and other staff caring for people with intellectual disability, and a patient-centred approach to prescribing with involvement of families should encourage appropriate prescribing. The effect of the National Disability Insurance Scheme on the appropriateness of psychotropic medication prescribing should be investigated.

Characteristics associated with frequent health system use by Australian adults with intellectual disability: A cohort study

“…However, nearly one third of participants were prescribed psychotropic drugs but only about one tenth had been diagnosed with mental disorders at baseline. We have previously demonstrated frequent inappropriate prescribing of psychotropic medications in people with intellectual disability in communities of Queensland (Song, Ware, Doan, McPherson, et al, 2020). We would argue that inappropriate use of psychotropic medications may contribute to the observed association.…”

“…using the Anatomical Therapeutic Chemical classification system (WHO Collaborating Centre for Drug Statistics Methodology, 2021). Psychotropic medications included antipsychotics, antidepressants, anxiolytics, psychostimulants, hypnotics/sedatives, and anti-Parkinson medications (Song, Ware, Doan, McPherson, et al, 2020).…”

“…Adequate management of ACSCs in primary care could avoid or reduce further ED presentations or hospital admissions (Falik et al, 2001). The administration of psychotropic medications to manage challenging behaviours is common and not always appropriate (Song, Ware, Doan, McPherson, et al, 2020), and may precipitate inappropriate psychiatric service presentations.…”

An Exploratory Study among Intellectual Disability Physicians on the Care and Coercion Act and the Use of Psychotropic Drugs for Challenging Behaviour

“…Challenging behaviour is often the primary reason for the prescription of psychotropic drugs for people with an intellectual disability [6], even though little evidence exists that these medications are effective in these situations [7,8]. Furthermore, they are often used off-label, which means that they are not prescribed in accordance with the registered indication [6,9,10]. The prevalence of antipsychotic drug use in a Dutch population living in sheltered care facilities was 32.2%; furthermore, in 58% of these cases, challenging behaviour was the primary reason for the prescription of antipsychotic drugs [6].…”

Health Profile of Australian Adolescents with Intellectual Disability

“…These behaviours include self-injury (36%), aggressive-destructive behaviour (30%), and stereotyped behaviour (26%) [12]. Adolescents with intellectual disability are often prescribed psychotropic medication, often off-label or inappropriately, for behaviour problems [13,14].…”