Stopping, rationalising or optimising antipsychotic drug treatment in people with intellectual disability and/or autism

Shankar, Rohit; Wilcock, Michael; Oak, Katy; McGowan, Paula; Sheehan, Rory

doi:10.1136/dtb.2018.000009

Cited by 22 publications

(12 citation statements)

References 15 publications

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“…“Act” was to find solutions to overcome the challenges and to plan the next cycle. Four cycles of PDSA were carried out with the final one leading to using the principals suggested by theoretical evidence established (Shankar, Wilcock, Oak, McGowan, & Sheehan, ). It was recognized during the QI cycles that new approaches and tools need to be developed to overcome the challenges as available methods could not lend itself directly on occasions to the QI improvement cycles.…”

Section: Introductionmentioning

confidence: 99%

A structured programme to withdraw antipsychotics among adults with intellectual disabilities: The Cornwall experience

Shankar

Wilcock

Goodey

et al. 2019

Research Intellect Disabil

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Background Antipsychotic medications are used among 19%–58% of adults with intellectual disabilities to manage challenging behaviour against the NICE guideline recommendations. Studies show that it is possible to completely withdraw antipsychotics in about one third of adults with intellectual disabilities and a dose reduction of 50% or more in another third. Method In Cornwall, over three years the present authors developed a structured pathway to withdraw antipsychotics among adults with intellectual disabilities which involved people with intellectual disabilities and their carers, GPs, community learning disability team members and pharmacists. Results The present authors managed to withdraw antipsychotics totally among 46.5% (33/71) and reduced over 50% of dosage in another 11.3% (8/71) of adults with intellectual disabilities. At three months follow‐up no one required hospital admission or change in placement. Conclusion It is possible to withdraw/reduce antipsychotics in a high proportion of adults with intellectual disabilities if a concerted effort is made involving all stakeholders from the outset.

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Section: Introductionmentioning

confidence: 99%

A structured programme to withdraw antipsychotics among adults with intellectual disabilities: The Cornwall experience

Shankar

Wilcock

Goodey

et al. 2019

Research Intellect Disabil

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…A multidisciplinary group of health professionals should be involved in assessment. 29 Medical conditions, the social environment and other environmental factors should be assessed, taken into account and modified when feasible and appropriate. 30 Better coordination is needed among different support areas (for example, health, disability, education and family support) to aid appropriate use of psychotropic medications for challenging behaviours, and follow-up of treatment.…”

Section: Recommendations For Improving the Use Of Psychotropic Medicamentioning

confidence: 99%

Appropriateness of psychotropic medication use in a cohort of adolescents with intellectual disability in Queensland, Australia

et al. 2020

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Background Psychotropic medications are sometimes used off-label and inappropriately. This may cause harm to adolescents with intellectual disability. However, few studies have analysed off-label or inappropriate prescribing to this group. Aims To examine the appropriateness of psychotropic prescribing to adolescents with intellectual disability living in the community in south-east Queensland, Australia. Method Off-label medication use was determined based on whether the recorded medical condition treated was approved by the Australian Therapeutic Goods Administration. Clinical appropriateness of medication use was determined based on published guidelines and clinical opinion of two authors who specialise in developmental disability medicine (J.N.T. and D.H.). Results We followed 429 adolescents for a median of 4.2 years. A total of 107 participants (24.9%) were prescribed psychotropic medications on at least one occasion. Of these, 88 (82.2%) were prescribed their medication off-label or inappropriately at least once. Off-label or inappropriate use were most commonly associated with challenging behaviours. Conclusions Off-label or inappropriate use of psychotropic medications was common, especially for the management of challenging behaviours. Clinical decision-making accounts for individual patient factors and is made based on clinical experience as well as scientific evidence, whereas label indications are developed for regulatory purposes and, although appropriate at a population level, cannot encompass the foregoing considerations. Education for clinicians and other staff caring for people with intellectual disability, and a patient-centred approach to prescribing with involvement of families should encourage appropriate prescribing. The effect of the National Disability Insurance Scheme on the appropriateness of psychotropic medication prescribing should be investigated.

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“…There is a need to improve the quality of psychotropic medication use in people with ID, yet despite consensus guidelines of good practice17 18 there has been relatively little work to investigate practical methods to achieve medication optimisation in this group. The current study introduced a structured medication review tool in community psychiatric services for adults with ID and demonstrates that it would be feasible to test outcomes in a definitive trial.…”

Section: Discussionmentioning

confidence: 99%

A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study

Sheehan

Strydom²,

Marston

et al. 2019

BMJ Open

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ObjectivesTo investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID).DesignSingle-arm feasibility study conducted over a 6-month period.SettingSpecialist community ID teams in England.ParticipantsPsychiatrists working with adults with ID and adults with ID who had been prescribed psychotropic medication.InterventionA structured web-based psychotropic medication review tool (the HealthTracker-based structured medication review) comprising measures of therapeutic benefit and adverse side-effects was made available for use by psychiatrists in routine clinic appointments. A summary measure of medication effectiveness was graphically presented to aid discussion and decision-making.Main outcome measuresFeasibility metrics including number of people with ID referred, eligible and recruited, and uptake of the medication review tool in naturalistic clinical settings. Psychiatrist and patient feedback was collected to assess acceptability of the intervention and suggestions for development.ResultsFifteen psychiatrists from five clinical teams took part. In total 94 potentially eligible people with ID were referred, of whom 79 (84%) were recruited and together underwent 97 medication reviews over the 6-month study period. Feedback from participants with ID was favourable. Psychiatrists indicated that the HealthTracker-based structured medication review was broadly acceptable and suggested adaptations to improve integration with existing information technology systems and to enhance patient involvement in the review.ConclusionsStructured psychotropic medication review can be used in community services for adults with ID as part of a programme of medication optimisation. It would be feasible to test clinical and patient outcomes of the HealthTracker-based medication review in a randomised clinical trial.

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Stopping, rationalising or optimising antipsychotic drug treatment in people with intellectual disability and/or autism

Cited by 22 publications

References 15 publications

A structured programme to withdraw antipsychotics among adults with intellectual disabilities: The Cornwall experience

A structured programme to withdraw antipsychotics among adults with intellectual disabilities: The Cornwall experience

Appropriateness of psychotropic medication use in a cohort of adolescents with intellectual disability in Queensland, Australia

A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study

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