Psychopharmacology

Deb, Shoumitro; Bertelli, Marco O.; Rossi, M.

doi:10.1007/978-3-319-95720-3_11

Cited by 16 publications

(15 citation statements)

References 151 publications

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“…To help a person with BtC, it is crucial to understand the reason behind the BtC rather than to inappropriately use medication [ 2 , 6 ]. BtC can be considered a form of communication whereby a person with ID conveys their distress [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Causes of and Alternatives to Medication for Behaviours That Challenge in People with Intellectual Disabilities: Direct Care Providers’ Perspectives

Limbu

Unwin

Weaver

2022

IJERPH

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Behaviours that challenge (BtC), such as aggression and self-injury, are manifested by many people with intellectual disabilities (ID). National and international guidelines recommend non-pharmacological psychosocial intervention before considering medication to address BtC. Support staff play a pivotal role in the prescription process. Using coproduction, we developed a training programme for support staff, called SPECTROM, to give them knowledge and empower them to question inappropriate prescriptions and ask for the discontinuation of medication if appropriate and instead look for ways to help people with ID when they are distressed without relying on medication. We have presented data from two focus groups that we conducted during the development of SPECTROM: one that included support staff, and another that had service managers and trainers. In these focus groups, we explored participants’ views on the use of medication to address BtC with a particular emphasis on the causes of and alternatives to medication for BtC. Along with the participants’ views, we have also presented how we have addressed these issues in the SPECTROM resources.

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Section: Introductionmentioning

confidence: 99%

“…Despite the poor evidence for the effectiveness of medications in managing BtC [ 6 ], psychotropic medications are used widely among people with ID (49–63%) and often off-license [ 16 ], which is a major public health concern [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Causes of and Alternatives to Medication for Behaviours That Challenge in People with Intellectual Disabilities: Direct Care Providers’ Perspectives

Limbu

Unwin

Weaver

2022

IJERPH

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“…Other PBS-based non-pharmacological interventions have also been shown to reduce BtC ( 13 ) and help with psychotropic medication withdrawal ( 14 ). In contrast, the evidence for medication effectiveness in addressing BtC is equivocal ( 15 ). Nevertheless, psychotropic medications are prescribed for a large number of people with ID/ASD (49–63%) ( 16 , 17 ) often to treat BtC outside their licensed indication, such as in the absence of psychiatric disorders (>70%) ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Support staff liaising effectively with family caregivers: Findings from a co-design event and recommendation for a staff training resource

Deb

Limbu

2022

Front. Psychiatry

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A high proportion of people with intellectual disabilities (ID) and autism spectrum disorder (ASD) are prescribed psychotropic medications such as antipsychotics, antidepressants etc., outside their licensed indications, primarily for the management of behaviors that challenge (BtC) in the absence of a psychiatric disorder. Examples of BtC are aggression to people and property or self-injury. BtC could be challenging to manage and may cause the person with ID/ASD and their caregivers distress, breakdown of community placement leading to hospitalization, and restrictive practices such as restraint or inappropriate medication use. Caregivers play a pivotal role in the prescribing process. However, many family caregivers feel that they have not been fully involved in the shared decision-making process about the care planning of their relatives with ID/ASD. To address the public health concern regarding the overuse of off-license prescribing in people with ID/ASD, we have recently developed a training programme called SPECTROM (https://spectrom.wixsite.com/project) (Short-term Psycho-Education for Carers To Reduce OverMedication of people with intellectual disabilities) for direct care staff who support people with ID/ASD within community settings. We used co-production and a modified Experience-Based Co-Design (EBCD) method to develop SPECTROM, which involved a literature review, four focus groups and a co-design event day involving 26 stakeholders. Recommendations from the co-design event day were analyzed by a Programme Development Group (PDG) consisting of 21 stakeholders who made the final recommendations to the project team regarding the contents and the format of SPECTROM, which was finalized after receiving feedback from further 59 stakeholders. SPECTROM has web-based resources introduced through two core modules in face-to-face workshops/training. A small field test found SPECTROM was effective in improving staff's knowledge of psychotropic medications and attitude toward BtC and people with ID (p < 0.05). One of the 14 STOMP modules is “Effective liaison with family carers and advocates”. In this paper, we have presented data from the co-design event day recommendations for this particular module. The group recommended ways to improve collaborative working and effective shared decision-making with family caregivers and people with ID/ASD.

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“…Rates of over 40% for polypharmacy use in adults with ID who exhibit aggressive behaviour are reported [ 4 ]. The risks and benefits of combining different psychotropic medication in those with ID and challenging behaviour are unknown [ 5 ]. In addressing this, we also need to be mindful that the use of more than one psychotropic medication may also bring benefits when used in the appropriate clinical context.…”

Section: Introductionmentioning

confidence: 99%

Adults with Intellectual Disability and Autism Spectrum Disorder: What Is the Evidence around the Use of Polypharmacy

McCarthy

Chaplin

2022

IJERPH

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A review on the mental health needs of adults with intellectual disability (ID) and autism spectrum disorder (ASD) published just over 10 years ago found a limited evidence base for pharmacological intervention in this group. The aim of this paper was therefore to review the evidence in the subsequent 10 years, with a focus on polypharmacy use in adults who have both ID and ASD. A critical literature review of key papers published from 2009 to 2021 was undertaken on adults with both ID and ASD and related to psychopharmacology, polypharmacy, antipsychotics, antidepressants, mood stabilisers and anxiolytics interventions in improving symptoms. After excluding articles for lack of relevance, a review with a focus on the use of polypharmacy was carried out on the retrieved results. Four papers were identified as relevant to adults with both ID and ASD. Three main themes were identified in the review, including the application of pharmacogenetics, the influence of national policy on prescribing practices and safety concerns in a population with multiple health comorbidities. The past decade has produced a small increase in the evidence base on psychopharmacology use in adults with ID and ASD. However, more evidence on the effectiveness and impact of long-term polypharmacy use is required.

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Psychopharmacology

Cited by 16 publications

References 151 publications

Causes of and Alternatives to Medication for Behaviours That Challenge in People with Intellectual Disabilities: Direct Care Providers’ Perspectives

Causes of and Alternatives to Medication for Behaviours That Challenge in People with Intellectual Disabilities: Direct Care Providers’ Perspectives

Support staff liaising effectively with family caregivers: Findings from a co-design event and recommendation for a staff training resource

Adults with Intellectual Disability and Autism Spectrum Disorder: What Is the Evidence around the Use of Polypharmacy

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