Safety of antipsychotics in people with intellectual disability

Frighi, V; Stephenson, Matthew T; Morovat, Alireza; Jolley, Iain E; Trivella, Marialena; Dudley, Christina A; Anand, Ezhil; White, Sarah J.; Hammond, Crhistina V; Hockney, R.; Barrow, Beryil; Shakir, Rehana; Goodwin, Guy M.

doi:10.1192/bjp.bp.110.085670

Cited by 43 publications

(36 citation statements)

References 35 publications

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“…Likewise, in our study, the most commonly used psychotropic drugs were antipsychotics, followed by MPH and SSRIs. Mostly used antipsychotic was risperidone and it was consistent with the literature which pointed out that risperidone is effective and tolerable agent in children with mental retardation [19]. MPH was another frequently used medication in children with MR having ADHD comorbidity to their situation.…”

Section: Discussionsupporting

confidence: 70%

Psychotropic Medication Use in Children and Adolescents with Mental Retardation (MR)

Temtek¹

2015

AJPN

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Abstract:Background: The aim of this study was to assess the medication use in children and adolescents with mental retardation (MR) retrospectively in a cross-sectional study. Method: Between June and December 2013, records of the children and adolescents admitted by our policlinic were retrospectively evaluated and those who had MR diagnosis were analyzed. Results: Male sex was found as statistically related to the presence of psychiatric comorbidity and the pervasive developmental disorders (PDD). At least one medical diagnosis accompanying with MR was found in 49.7% (n=781) of all patients. 79.6% (n=1252) of all patients did not use any medication, 16.7% (n=262) of all sample were using one medication agent, 3.5% (n=55) of patients were using combined pharmacotherapy. The predictors of psychotropic medication were the following: the presence of comorbid any of psychiatric disorders, having attention deficit hyperactivity disorder (ADHD), having conduct disorders (CD) and having anxiety disorders. Conclusions and Recommendations: This study has a descriptive nature of the children with MR admitted to the child psychiatry department. It was noticed that psychotropic agent use is preferable if there is a comorbid situation in mental retardation. There is a need for further studies with prospectively planned, multi-central with larger sampling in our country to draw up a way of health policies related to the children with MR.

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Section: Discussionsupporting

confidence: 70%

Psychotropic Medication Use in Children and Adolescents with Mental Retardation (MR)

Temtek¹

2015

AJPN

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“…Primarily, the included studies were cross-sectional observational (n = 31 81,82,98,[100][101][102]104,106,[109][110][111]114,116,119,121,124,[126][127][128][129][130][131][132][133][134][135]137,139,142,143,145 ). The remaining studies involved retrospective database or medical records data (n = 22 [83][84][85][86][87][88][89]94,95,99,107,113,115,117,118,120,122,123,136,…”

Section: Study Characteristicsmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

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“…An important side-effect of atypical antipsychotics is the 'metabolic syndrome' comprising obesity, insulin resistance, impaired glucose tolerance, and dyslipidaemia (Newcomer 2007). However, an observational study conducted by Frighi et al found that there were no clinical or statistically significant differences in metabolic indices between people with ID treated with anti-psychotics and those who were anti-psychotic naïve, although there was a trend towards increased rates of type 2 diabetes in the treated group (Frighi et al 2011) Guidelines recommend regular monitoring of blood glucose, lipids and weight for people taking anti-psychotic medication (American Diabetes Association;, although there are indications that people with ID frequently do not receive such investigations (Devapriam et al 2009;Teeluckdharry et al 2013) Extra-pyramidal side-effects (EPSEs) of anti-psychotic medication comprise drug-induced parkinsonism, akathisia, acute dystonic reactions, and tardive dyskinesia. Such side-effects can be persistent, impair quality of life and may be mistaken for core symptoms of the ID.…”

Section: Pharmacological Treatmentmentioning

confidence: 96%