Pharmacotherapy for mood and anxiety disorders in older people with intellectual disability in comparison with the general population

Abstract

Background People with intellectual disability (ID) have high prevalence of psychiatric disorders, but even higher rates of prescription of psychotropic drugs. Methods Using Swedish national registers, we identified a group of older people with ID and diagnosis of mood disorders (ICD-10 codes F32-F39) and/or anxiety (ICD-10 code F4) during 2006–2012 ( n = 587) and a referent group of people from the general population with the same diagnoses during the same time period ( n = 434). For both groups, we collected information on prescription of anxiolytics, hypnotics and sedatives, antidepressants, and GABA-agonists. Results Among those with a diagnosis of anxiety, people with ID were more likely than those in the general population to be prescribed anxiolytics (Relative Risk 1.32 [95% Confidence Interval 1.19–1.46]) and GABA-agonists (1.10 [1.08–1.31]). Moreover, among those with anxiety but without mood disorders, ID was associated with increased prescription of antidepressants (1.20 [1.03–1.39]). Within the ID cohort, behaviour impairment and MSP (i.e. moderate, severe, or profound) ID was associated with increased prescription of anxiolytics, both among those with anxiety (1.15 [1.03–1.30] for behaviour impairment and 1.23 [1.10–1.38] for MSP ID) and among those with mood disorders (1.14 [0.97–1.35] for behaviour impairment and 1.26 [1.04–1.52] for MSP ID). Moreover, MSP ID was associated with increased prescription of GABA-agonists among those with anxiety (1.23 [1.10–1.38]). Conclusions The excess prescription of anxiolytics but not antidepressants may suggest shortages in the psychiatric health care of older people with intellectual disability and mood and anxiety disorders.

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

“…An Irish study which investigated rates of prescribing of psychotropics in older adults with intellectual disabilities reported no increased risk of antidepressant prescribing or any association with problem behaviours. 32 Several studies have reported the increase in rates of antidepressant prescribing in the general population across the UK, which our findings mirror. [33][34][35] In Scotland the number of antidepressant prescriptions rose from 1.16 to 3.53 million per year between 1992 and 2006, 36 and women were prescribed antidepressants more frequently than men.…”

“…An Irish study which investigated rates of prescribing of psychotropics in older adults with intellectual disabilities reported no increased risk of antidepressant prescribing or any association with problem behaviours. 32 …”

Healthcare utilisation patterns among older people with intellectual disability and with affective and anxiety diagnoses in comparison with the general population

“…The staff has to show understanding, patience, and professionalism in providing health care. Furthermore, research shows that people with ID experience significance healthcare disparities, such as high levels of comorbidities and inappropriate medication prescription, compared to people without ID (Axmon et al, 2019;Bond et al, 2019;Carey et al, 2016;Emerson & Baines, 2011). A qualitative study on people with mild ID and with anxiety and depression described "feelings of broken" in terms of emotional overwhelmed and physically damaged, fear and uncertainty, rendering them unable to detect warning signs and isolated because of their mental health problems (Tomlinson & Hewitt, 2018).…”

Community-Based Support and Social Services and Their Association with Frailty Factors in Older People with Intellectual Disability and Affective and Anxiety Disorders: A Swedish National Population-Based Register Study

“…Older people with ID are more likely to have inpatient and unplanned visits in psychiatric and somatic healthcare compared to people of similar ages and sex from the general population with affective and anxiety diagnoses (Ahlström et al 2020 ; El Mrayyan et al, 2020 ). In addition, they receive more prescription of medication with increased severity of ID and with the presence of behavioural impairment and with affective and anxiety diagnoses (Axmon et al, 2019 ; McGillivray & McCabe, 2004 ; Tsiouris, 2010 ). Furthermore, older people with ID and psychiatric disorders are more likely to have a broad range of comorbidities, and thus be at risk for inappropriate prescription of medication, and more extended hospitalisations (Bowring et al, 2017 ; O'Dwyer et al, 2016 ; Scheifes et al, 2016 ).…”