Movement Disorders in Adults With Intellectual Disability and Behavioral Problems Associated With Use of Antipsychotics

Scheifes, Arlette; Walraven, Sanne; Stolker, Joost J.; Nijman, Henk; Tenback, Diederik E.; Egberts, Toine C. G.; Heerdink, Eibert R.

doi:10.1097/jcp.0000000000000528

Cited by 13 publications

(13 citation statements)

References 28 publications

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“…In once recent study of hospitalised patients with borderline-mild ID and challenging behaviour, almost half were found to have a movement disorder, and the presence of movement disorder was more likely in those prescribed antipsychotic medication. 21 The most common type was parkinsonism, as in our study. De Kuijper and colleagues in the Netherlands report that just over half of their sample with ID who had been taking antipsychotic drugs for more than a year had evidence of movement side effects.…”

Section: Discussionsupporting

confidence: 75%

Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population-based cohort study

et al. 2017

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ObjectivesTo measure the incidence of movement side effects of antipsychotic drugs in adults with intellectual disability and compare rates with adults without intellectual disability.DesignCohort study using data from The Health Improvement Network.SettingUK primary care.ParticipantsAdults with intellectual disability prescribed antipsychotic drugs matched to a control group of adults without intellectual disability prescribed antipsychotic drugs.Outcome measuresNew records of movement side effect including acute dystonias, akathisia, parkinsonism, tardive dyskinaesia and neuroleptic malignant syndrome.Results9013 adults with intellectual disability and a control cohort of 34 242 adults without intellectual disability together contributed 148 709 person-years data. The overall incidence of recorded movement side effects was 275 per 10 000 person-years (95% CI 256 to 296) in the intellectual disability group and 248 per 10 000 person-years (95% CI 237 to 260) in the control group. The incidence of any recorded movement side effect was significantly greater in people with intellectual disability compared with those without (incidence rate ratio 1.30, 95% CI 1.18 to 1.42, p<0.001, after adjustment for potential confounders), with parkinsonism and akathisia showing the greatest difference between the groups. Neuroleptic malignant syndrome, although occurring infrequently, was three times more common in people with intellectual disability-prescribed antipsychotic drugs (incidence rate ratio 3.03, 95% CI 1.26 to 7.30, p=0.013). Differences in rates of movement side effects between the groups were not due to differences in the proportions prescribed first and second-generation antipsychotic drugs.ConclusionsThis study provides evidence to substantiate the long-held assumption that people with intellectual disability are more susceptible to movement side effects of antipsychotic drugs. Assessment for movement side effects should be integral to antipsychotic drug monitoring in people with intellectual disability. Regular medication review is essential to ensure optimal prescribing in this group.

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Section: Discussionsupporting

confidence: 75%

Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population-based cohort study

et al. 2017

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“…Not surprisingly, hospitalised ADEs in PwNDD were primarily caused by psychotropic medications. This is consistent with findings in previous studies (Ji & Findling 2016;Paton et al 2016;Scheifes et al 2016a). It is also alarming that opioid-related ADEs were prevalent in PwNDD as well as the general population.…”

Section: Discussionsupporting

confidence: 92%

“…; Scheifes et al . ). It is also alarming that opioid‐related ADEs were prevalent in PwNDD as well as the general population.…”

Section: Discussionmentioning

confidence: 97%

Adverse drug event‐related hospitalisation in persons with neurodevelopmental disorders: a state‐wide retrospective cohort study

Zhou

Salvador‐Carulla

et al. 2019

J intellect Disabil Res

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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.

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“…The risks of prescribing antipsychotic drugs to patients with dementia have been well documented [1–4]. Antipsychotic drugs may cause extrapyramidal side effects [5] and studies have shown that the newer second-generation atypical antipsychotic drugs are also associated with an increased risk of stroke [1, 6–9]. Regulatory bodies in several countries have issued warnings, guidance and advice aiming to reduce inappropriate prescribing of antipsychotic drugs to patients diagnosed with dementia [10–21].…”

Section: Introductionmentioning

confidence: 99%

Antipsychotic Prescribing to Patients Diagnosed with Dementia Without a Diagnosis of Psychosis in the Context of National Guidance and Drug Safety Warnings: Longitudinal Study in UK General Practice

et al. 2017

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Introduction Policy interventions to address inappropriate prescribing of antipsychotic drugs to older people diagnosed with dementia are commonplace. In the UK, warnings were issued by the Medicines Healthcare products Regulatory Agency in 2004, 2009 and 2012 and the National Institute for Health and Care Excellence guidance was published in 2006. It is important to evaluate the impact of such interventions. Methods We analysed routinely collected primary-care data from 111,346 patients attending one of 689 general practices contributing to the Clinical Practice Research Datalink to describe the temporal changes in the prescribing of antipsychotic drugs to patients aged 65 years or over diagnosed with dementia without a concomitant psychosis diagnosis from 2001 to 2014 using an interrupted time series and a before-and-after design. Logistic regression methods were used to quantify the impact of patient and practice level variables on prescribing prevalence. Results Prescribing of first-generation antipsychotic drugs reduced from 8.9% in 2001 to 1.4% in 2014 (prevalence ratio 2014/2001 adjusted for age, sex and clustering within practices (0.14, 95% confidence interval 0.12–0.16), whereas there was little change for second-generation antipsychotic drugs (1.01, confidence interval 0.94–1.17). Between 2004 and 2012, several policy interventions coincided with a pattern of ups and downs, whereas the 2006 National Institute for Health and Care Excellence guidance was followed by a gradual longer term reduction. Since 2013, the decreasing trend in second-generation antipsychotic drug prescribing has plateaued largely driven by the increasing prescribing of risperidone. Conclusions Increased surveillance and evaluation of drug safety warnings and guidance are needed to improve the impact of future interventions.

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Movement Disorders in Adults With Intellectual Disability and Behavioral Problems Associated With Use of Antipsychotics

Abstract: The prevalence of movement disorders in people with ID and behavioral problems is high, especially in ID patients using antipsychotics. More attention is needed for these movement disorders and their potential impact.

Cited by 13 publications

References 28 publications

Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population-based cohort study

Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population-based cohort study

Adverse drug event‐related hospitalisation in persons with neurodevelopmental disorders: a state‐wide retrospective cohort study

Antipsychotic Prescribing to Patients Diagnosed with Dementia Without a Diagnosis of Psychosis in the Context of National Guidance and Drug Safety Warnings: Longitudinal Study in UK General Practice

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