Prevalence of psychotropic medication and factors associated with antipsychotic treatment in adults with intellectual disabilities: a cross‐sectional, epidemiological study in Germany

Abstract

BackgroundMental health services in people with intellectual disabilities (ID) are frequently limited to psychotropic medication (PM), especially antipsychotics. The objectives of this study were to assess the prevalence rates of PM treatment in adults with ID in Germany and to identify factors associated with antipsychotic treatment.MethodsThis study is an epidemiological, cross‐sectional study. Sampling was realised by a random selection of service‐providing institutions, followed by a random selection of adults with ID within these participating institutions. Interviews were conducted with formal and informal carers of n = 197 adults with ID. Data were analysed using descriptive statistics and risk ratios.ResultsThe 4‐week prevalence rate of PM was 53.8%. Antipsychotics were the most frequent PM (43.7%). Polypharmacy and off‐label use were common. Antipsychotic treatment is associated with living in a residential home [relative risk (RR) = 2.99], not working in a sheltered workshop (RR = 1.46), autism spectrum disorder (RR = 1.89), a documented psychiatric diagnosis (RR = 1.61), psychiatric symptomatology (RR = 1.44) and (mild) challenging behaviours (RR = 4.58).ConclusionsFurther efforts are needed to provide adequate mental health care, specifically to improve PM treatment regarding amount, indication and the consideration of non‐psychopharmacological treatment options.

A survey on service users' perspectives about information and shared decision‐making in psychotropic drug prescriptions in people with intellectual disabilities

“…The prevalence of psychotropic drug use among people with intellectual disabilities varies from 38% to 90%, depending on the setting and the study population. The prevalence of psychotropic use increases with age (García‐Domínguez et al, 2022; Koch et al, 2012; Perry et al, 2018); roughly one in five younger people with intellectual disabilities are prescribed one or more psychotropic drugs (Sullivan & Sadeh, 2015), with the figure rising to 6 in 10 older adults (O'Dwyer et al, 2017). In general, the prevalence is higher in residential facilities than in community populations.…”

What outcome measures are most useful in measuring the effectiveness of anti-dementia medication in people with intellectual disabilities and dementia?

“…However, once people with ID are diagnosed with dementia, they are more likely to be prescribed antipsychotic medication and benzodiazepine derivatives. The use of antipsychotic medication as a means of managing behavioural disturbances is of increasing concern (Koch et al , 2021). National initiatives, such as stopping the over-medication of people with an intellectual disability, autism or both, have been implemented to prevent inappropriate prescription of multiple psychotropic medications (Branford et al , 2019).…”

Withdrawing Antipsychotics for Challenging Behaviours in Adults with Intellectual Disabilities: Experiences and Views of Prescribers

“…Although it is recommended that long-term off-label psychotropic drug prescription should be discontinued especially antipsychotics, they are still frequently prescribed for the treatment of challenging behaviours [ 34 , 35 , 36 ]. This may, at least partially be, because of failures of successful discontinuation of antipsychotics due to worsening of behaviour upon drug withdrawal [ 37 ].…”