Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study

Abstract

ObjectivesTo investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses.DesignComparison of cross-sectional data in 2002–2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data.SettingGeneral community.Participants1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data.Main outcome measuresEncashed regular and as-required psychotropic prescriptions.Results50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001).ConclusionsDespite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews.

The prevalence of potential drug–drug interactions in adults with intellectual disability

“…2017; Henderson et al . 2020) and such cumulative effects may therefore negatively impact the health and wellbeing of this population. (2) Our results are similar to both Joos et al .…”

“…2016; Henderson et al . 2020) for all people with ID along with appropriate training for staff to recognise DDIs and mitigate for diagnostic overshadowing (Mason and Scior 2004). (5) Given that our findings highlight that there were 320 instances where people should be provided with further information regarding potential adverse effects, there is also a critical need to ensure that people with ID are provided with an appropriate and understandable level of medication‐related information (O'Dwyer et al .…”

Antidepressant prescribing for adult people with an intellectual disability living in England

“…3 A study from Scotland reported that over the decade from 2004 to 2014, there was an increase in the prescription of antidepressants from 11.2 to 19.1%. 5 The increase was greatest for women and people with mild intellectual disabilities. 5…”

A Study On Prescriptions Contributing To The Risk Of High Anticholinergic Burden In Adults With Intellectual Disabilities: Retrospective Record Linkage Study

“…28 People with intellectual disabilities are particularly vulnerable, with commonplace psychotropic polypharmacy as well as overall anticholinergic polypharmacy. Many people with intellectual disabilities are on antipsychotic medication over years and sometimes decades, 14,29 despite associated health risks, including anticholinergic effects. However, following NHS England's "Stopping over-medication of people with a learning disability, autism or both (STOMP)" initiative, 11 there is some evidence of successful antipsychotic deprescribing, 30 but these prescriptions may be being replaced with other psychotropics, namely antidepressants, 31 which could contribute to anticholinergic burden similarly.…”