COVID-19-related prescribing challenge in intellectual disability

Abstract

Background The COVID-19 pandemic and associated restrictions are expected to affect the mental health of the population, especially people with intellectual disability and/or autism spectrum disorder, because of a variety of biological and psychosocial reasons. Aims This study aimed to estimate if COVID-19 restrictions are associated with a change in number of total consultations carried out by psychiatrists and prescription of psychotropic medication in people with intellectual disability and/or autism spectrum disorder, within a community intellectual disability service. Method A quantitative observational study was conducted, involving retrospective and prospective data collection before and during lockdown. Data was collected on a spreadsheet and emailed to all psychiatrists working within the Coventry and Warwickshire Partnership NHS Trust-wide community intellectual disability service. Variables included total consultations, medication interventions, types of medications used, multidisciplinary team input and clinical reasons for medication interventions. Data was analysed separately for child and adolescent mental health services (CAMHS) and adult intellectual disability teams, and for the whole service. Results During the lockdown period, total consultations in the community intellectual disability service increased by 19 per week and medication interventions increased by two per week. Multidisciplinary team input increased in CAMHS from 0.17 to 0.71 per week and in adult intellectual disability from 5.7 to 6.5 per week. Hypnotics and benzodiazepines were the most commonly prescribed psychotropic medications during the lockdown period. Conclusions COVID-19-related lockdown resulted in an increase in medication interventions, total consultations and involvement of multidisciplinary teams to manage mental health and behavioural issues in people with intellectual disability and/or autism spectrum disorder.

International clinician perspectives on pandemic-associated stress in supporting people with intellectual and developmental disabilities

“…[7][8][9][10] In times of distress and challenging behaviours, this population may experience overprescribing, particularly of psychotropic medications. [11][12][13][14] The priority concerns for people with IDD in the UK during the pandemic have previously been explored through stakeholder engagement. 15 The wide-ranging 28 statements identified as important to this vulnerable population cover mental health, including overmedication, carer strain and diagnostic overshadowing; physical health, including lack of access to services and clinical review; and social circumstances, including isolation, placement breakdown and risk of neglect.…”

“…Other changes do not appear so welcome, particularly the increase in prescribing patterns, which agrees with previously published data in this population. [11][12][13][14] It will be a long and complicated journey to work with patients toward reducing these medications. It is important that psychotherapeutic support is brought back in line with the national policy of all participating countries to stop and reduce continued harm of inappropriate psychotropic prescribing.…”

Psychotropic medication prescribing trends in a developmental–behavioural clinic during the COVID‐19 pandemic

“… 18 Early studies of the impact of COVID‐19 on psychotropic medication prescriptions rates among children and adolescents in the UK reported varying results. 19 , 20 One study described a possible reduction of antipsychotics among children and adolescents accessing mental health services, while another reported an increase in all psychotropic medications, particularly hypnotics and benzodiazepines among children with intellectual disability (ID). 19 , 20 The reduction of psychotropic prescribing in this study is in keeping with initial reports that described Australian parents of children with ADHD withholding medications due to perceived lack of need during COVID‐19 remote learning and school holidays.…”

“… 19 , 20 One study described a possible reduction of antipsychotics among children and adolescents accessing mental health services, while another reported an increase in all psychotropic medications, particularly hypnotics and benzodiazepines among children with intellectual disability (ID). 19 , 20 The reduction of psychotropic prescribing in this study is in keeping with initial reports that described Australian parents of children with ADHD withholding medications due to perceived lack of need during COVID‐19 remote learning and school holidays. 9 Furthermore, the lack of supervision during online teaching and reduced academic and behavioural expectations may contribute to parental perception of reduced symptoms.…”

COVID-19 Isolation and Risk of Death in Cyprus Elderly People

“…Another issue that needs to be considered is that of increased psychological morbidity. Pshychotropic drug use is on the increase during the Covid-19 pandemic (16). It is known that isolated older people are more likely to overuse medication such as antidepressants, anxiolytics, sedatives, or hypnotics (17).…”