Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study

Abstract

ObjeCtivesTo describe the incidence of recorded mental illness and challenging behaviour in people with intellectual disability in UK primary care and to explore the prescription of psychotropic drugs in this group. DesignCohort study.setting 571 general practices contributing data to The Health Improvement Network clinical database.PartiCiPants 33 016 adults (58% male) with intellectual disability who contributed 211 793 person years' data. Main OutCOMe MeasuresExisting and new records of mental illness, challenging behaviour, and psychotropic drug prescription. results 21% (7065) of the cohort had a record of mental illness at study entry, 25% (8300) had a record of challenging behaviour, and 49% (16 242) had a record of prescription of psychotropic drugs. During follow-up, the rate of new cases of mental illness in people without a history at cohort entry was 262 (95% confidence interval 254 to 271) per 10 000 person years and the rate of challenging behaviour was 239 (231 to 247) per 10 000 person years. The rate of new psychotropic drug prescription in those without a previous history of psychotropic drug treatment was 518 (503 to 533) per 10 000 person years. Rates of new recording of severe mental illness declined by 5% (95% confidence interval 3% to 7%) per year (P<0.001), and new prescriptions of antipsychotics declined by 4% (3% to 5%) per year P<0.001) between 1999 and 2013. New prescriptions of mood stabilisers also decreased significantly. The rate of new antipsychotic prescribing was significantly higher in people with challenging behaviour (incidence rate ratio 2.08, 95% confidence interval 1

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

“…110 Additionally, there has been observed a low level of recorded ancillary information in the electronic GP records of patients with ID to justify the level of prescribing observed. 111 In the UK, the scale of the prescribing of psychotropic drugs to patients with ID nationally has been previously described in the CPRD data between 2009 and 2012, 112 and more recently in another primary care database (THIN) from 1999 to 2013. 111 The study based on CPRD data found that, among adults with ID over a 4-year period, 41.3% of follow-up time was exposed to at least one psychotropic drug (including antiepileptic drugs).…”

“…111 In the UK, the scale of the prescribing of psychotropic drugs to patients with ID nationally has been previously described in the CPRD data between 2009 and 2012, 112 and more recently in another primary care database (THIN) from 1999 to 2013. 111 The study based on CPRD data found that, among adults with ID over a 4-year period, 41.3% of follow-up time was exposed to at least one psychotropic drug (including antiepileptic drugs). We provided an alternative summary (and did not count antiepileptic drugs), describing instead the proportion of adults with ID who received a psychotropic drug at any time during single year (2011), and found a similar 4 in 10 proportion.…”

Challenges Ahead: (New) Editor’s Note

“…Key areas feature early intervention, mental and physical health, and inclusion in children with neurodisabilities, but there has not been a similar exercise for adults with neurodisabilities nor is there any mention of pharmacological interventions. Yet psychotropics are prescribed without any evidence for clinical and cost effectiveness in the absence of severe mental illness across the life span (Olfson, King, & Schoenbaum, 2015;Sheehan et al, 2015). The most recent trial of the effectiveness of antipsychotics to have taken place in the UK, with published results in 2008 (Tyrer et al, 2008).…”

Genetic testing in intellectual disability psychiatry: Opinions and practices of UK child and intellectual disability psychiatrists

“…Recent estimates from United Kingdom (UK) primary care records show that approximately 21% of individuals with intellectual disability have a psychiatric disorder, 25% have some record of challenging behaviour, and 49% had been prescribed psychotropic drugs (Sheehan et al., 2015). Given that investigation of the cause of intellectual disability predominately occurs at diagnosis in childhood, there is a large cohort of adults, many with later onset psychiatric disorders, who have not had a diagnostic assessment utilizing the latest genetic technologies (Baker, Raymond, & Bass, 2012).…”