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Prevalence of Psychotropic Drug Use in Adults with Intellectual Disability: Positive and Negative Findings from a Large Scale Study

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An Erratum to this article was published on 24 August 2012

Abstract

The use of psychotropics by categories and the reason for their prescription was investigated in a large scale study of 4,069 adults with ID, including those with autism spectrum disorder, in New York State. Similar to other studies it was found that 58 % (2,361/4,069) received one or more psychotropics. Six percent received typical, 6 % received typical, while 39 % received atypical antipsychotics. There was greater use of antidepressants (23 %), mood stabilizers (19 %), and antianxiety agents (16 %) relative to other studies. The use of anti-impulsives, stimulants and hypnotics was rare (1–2 %). Half of the psychotropics were prescribed for treatment of major psychiatric disorders, 13 % for control of challenging behaviors, and 38 % for both. Results indicated that the major psychiatric disorders, except anxiety disorder and autism, influenced the use of psychotropics and the number of medication used. These findings imply that although practitioners still rely too heavily on the use of antipsychotics in this population, there is a welcome shift in the prescription patterns relative to other studies. The practitioners appeared to use psychotropics primarily to treat diagnosed psychiatric disorders and not just to control aggressive behavior which suggests that evidence-based practice of psychiatry is playing an increasing role in the ID population.

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Notes

  1. Summary of the 8 MOAS items: attacks others causing mild to severe physical injury; throws or breaks objects, kicks furniture, tears or rips clothes, marks the wall in anger, sets fires; bangs head, hits fist into objects, throws self onto floor or into objects, small cuts or bruises, minor burns, mutilates self, makes deep cuts, bites that bleed, internal injury, fracture, loss of consciousness, loss of teeth.

  2. More precisely, the odds of receiving psychotropic medications for those with bipolar disorder was 5 times the odds of getting the medication for those who did not have bipolar disorder.

  3. Mainly sertraline, paroxetine, fluoxetine, citalopram, escitalopram, trazodone, venlafaxine, buproprion and duloxetine.

References

  • Alexander, G. C., Gallagher, S. A., Mascola, A., Moloney, R. M., & Stafford, R. S. (2011). Increasing off-label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiology and Drug Safety, 20, 177–184.

    Article  PubMed  Google Scholar 

  • Aman, M., Buitelaar, J., Smedt, G. D., Wapenaar, R., & Binder, C. (2005). Pharmacotherapy of disruptive behavior and item changes on a standardized rating scale: Pooled analysis of risperidone effects in children with subaverage IQ. Journal of Child and Adolescent Psychopharmacology, 15, 220–232.

    Article  PubMed  Google Scholar 

  • Aman, M. G., Burrow, W. H., & Wolford, P. L. (1995). The Aberrant Behavior Checklist-Community: Factor validity and effect of subject variables for adults in group homes. American Journal of Mental Retardation, 100, 283–292.

    PubMed  Google Scholar 

  • Aman, M. G., De, S. G., Derivan, A., Lyons, B., & Findling, R. L. (2002). Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. American Journal of Psychiatry, 159, 1337–1346.

    Article  PubMed  Google Scholar 

  • Aman, M. G., Field, C. J., & Bridgman, G. D. (1985). City-wide survey of drug patterns among non-institutionalized mentally retarded persons. Applied Research in Mental Retardation, 6, 159–171.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders-IV. Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders fourth edition text revision. Washington DC: American Psychiatric Association.

    Book  Google Scholar 

  • Branford, D. (1994). A study of the prescribing for people with learning disabilities living in the community and in National Health Service care. Journal of Intellectual Disabilities Research, 38(Pt 6), 577–586.

    Google Scholar 

  • Clarke, D. J., & Gomez, G. A. (1999). Utility of modified DCR-10 criteria in the diagnosis of depression associated with intellectual disability. Journal of Intellectual Disabilities Research, 43(Pt 5), 413–420.

    Google Scholar 

  • Clarke, D. J., Kelley, S., Thinn, K., & Corbett, J. A. (1990). Psychotropic drugs and mental retardation: 1. Disabilities and the prescription of drugs for behaviour and for epilepsy in three residential settings. Journal of Mental Deficiency Research, 34(Pt 5), 385–395.

    PubMed  Google Scholar 

  • Cohen, I. L., Tsiouris, J. A., Flory, M. J., Kim, S.-Y., Freedland, R., Heaney, G., et al. (2010). A large scale study of the psychometric characteristics of the IBR Modified Overt Aggression Scale: Findings and evidence for increased self-destructive behaviors in adult females with Autism Spectrum Disorder. Journal of Autism and Developmental Disorder, 40, 599–609.

    Article  Google Scholar 

  • Cooper, S. A., Melville, C. A., & Einfeld, S. L. (2003). Psychiatric diagnosis, intellectual disabilities and diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation (DC-LD). Journal of Intellectual Disabilities Research, 47(Suppl 1), 3–15.

    Article  Google Scholar 

  • Cooper, S. A., Smiley, E., Allan, L. M., Jackson, A., Finlayson, J., Mantry, D., et al. (2009). Adults with intellectual disabilities: Prevalence, incidence and remission of self-injurious behaviour, and related factors. Journal of Intellectual Disabilities Research, 53, 200–216.

    Article  Google Scholar 

  • Cooper, S. A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: Prevalence and associated factors. British Journal of Psychiatry, 190, 27–35.

    Article  PubMed  Google Scholar 

  • Crocker, A. G., Mercier, C., Allaire, J. F., & Roy, M. E. (2007). Profiles and correlates of aggressive behaviour among adults with intellectual disabilities. Journal of Intellectual Disabilities Research, 51, 786–801.

    Article  Google Scholar 

  • Crocker, A. G., Mercier, C., Lachapelle, Y., Brunet, A., Morin, D., & Roy, M. E. (2006). Prevalence and types of aggressive behaviour among adults with intellectual disabilities. Journal of Intellectual Disability Research, 50, 652–661.

    Article  PubMed  Google Scholar 

  • de Kuijper, G., Hoekstra, P., Visser, F., Scholte, F. A., Penning, C., & Evenhuis, H. (2010). Use of antipsychotic drugs in individuals with intellectual disability (ID) in the Netherlands: Prevalence and reasons for prescription. Journal of Intellectual Disabilities Research, 54, 659–667.

    Article  Google Scholar 

  • Deb, S., & Fraser, W. (1994). The use of psychotropic medication in people with learning disability: Towards rational prescribing. Human Psychopharmacology, 9, 259–272.

    Article  Google Scholar 

  • Deb, S., Kwok, H., Bertelli, M., Salvador-Carulla, L., Bradley, E., Torr, J., et al. (2009). International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities. World Psychiatry, 8, 181–186.

    PubMed  Google Scholar 

  • Deb, S., Sohanpal, S. K., Soni, R., Lenotre, L., & Unwin, G. (2007). The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilities. Journal of Intellectual Disabilities Research, 51, 766–777.

    Article  Google Scholar 

  • Duggan, L., & Brylewski, J. (1999). Effectiveness of antipsychotic medication in people with intellectual disability and schizophrenia: A systematic review. Journal of Intellectual Disabilities Research, 43(Pt 2), 94–104.

    Article  Google Scholar 

  • Fleming, I., Caine, A., Ahmed, S., & Smith, S. (1996). Aspects of the use of psychoactive medication among people with intellectual disabilities who have been resettled from long-stay hospitals into dispersed housing. Journal of Applied Research in Intellectual Disabilities, 9, 194–205.

    Article  Google Scholar 

  • Fletcher, R., Loschen, E., Stavrakaki, C., & First, M. (2007). Diagnostic Manual-Intellectual Disability (DM-ID): A textbook of diagnosis of mental disorders in persons with intellectual disability. Kingston, NY: NADD Press.

    Google Scholar 

  • Frighi, V., Stephenson, M. T., Morovat, A., Jolley, I. E., Trivella, M., Dudley, C. A., et al. (2011). Safety of antipsychotics in people with intellectual disability. British Journal of Psychiatry, 199, 289–295.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., & Kalachnik, J. (1981). Prevalence and pattern of drug treatment for behavior and seizure disorders of TMR students. American Journal of Mental Deficiency, 85, 588–595.

    PubMed  Google Scholar 

  • Greendyke, R. M., & Kanter, D. R. (1986). Therapeutic effects of pindolol on behavioral disturbances associated with organic brain disease: A double-blind study. Journal of Clinical Psychiatry, 47, 423–426.

    PubMed  Google Scholar 

  • Greendyke, R. M., Kanter, D. R., Schuster, D. B., Verstreate, S., & Wootton, J. (1986). Propranolol treatment of assaultive patients with organic brain disease. A double-blind crossover, placebo-controlled study. Journal of Nervous and Mental Deficiencies, 174, 290–294.

    Article  Google Scholar 

  • Harper, D. C., & Wadsworth, J. S. (1993). Behavioral problems and medication utilization. Mental Retardation, 31, 97–103.

    PubMed  Google Scholar 

  • Hill, B. K., Balow, E. A., & Bruininks, R. H. (1985). A national study of prescribed drugs in institutions and community residential facilities for mentally retarded people. Psychopharmacology Bulletin, 21, 279–284.

    PubMed  Google Scholar 

  • Holden, B., & Gitlesen, J. P. (2004). Psychotropic medication in adults with mental retardation: Prevalence, and prescription practices. Research in Developmental Disabilities, 25, 509–521.

    Article  PubMed  Google Scholar 

  • Hurley, A. D. (2008). Depression in adults with intellectual disability: Symptoms and challenging behaviour. Journal of Intellectual Disabilities Research, 52, 905–916.

    Article  Google Scholar 

  • Intagliata, J., & Rinck, C. (1985). Psychoactive drug use in public and community residential facilities for mentally retarded persons. Psychopharmacology Bulletin, 21, 268–278.

    PubMed  Google Scholar 

  • Jones, S., Cooper, S. A., Smiley, E., Allan, L., Williamson, A., & Morrison, J. (2008). Prevalence of, and factors associated with, problem behaviors in adults with intellectual disabilities. Journal of Nervous and Mental Deficiencies, 196, 678–686.

    Article  Google Scholar 

  • Kiernan, C., Reeves, D., & Alborz, A. (1995). The use of anti-psychotic drugs with adults with learning disabilities and challenging behaviour. Journal of Intellectual Disability Research, 39, 263–274.

    Google Scholar 

  • La Malfa, G., Bertelli, M., & Conte, M. (2001). Fluvoxamine and aggression in mental retardation. Psychiatric Services, 52, 1105.

    Article  PubMed  Google Scholar 

  • Long, J. S., & Freese, J. (2006). Regression models for categorical dependent variables using stata (2nd ed.). College Station, TX: Stata Press.

    Google Scholar 

  • Mahan, S., Holloway, J., Bamburg, J. W., Hess, J. A., Fodstad, J. C., & Matson, J. L. (2010). An Examination of psychotropic medication side effects: Does taking a greater number of psychotropic medications from different classes affect presentation of side effects in adults with ID? Research in Developmental Disabilities, 31, 1561–1569.

    Article  PubMed  Google Scholar 

  • Martin, J. E., & Agran, M. (1985). Psychotropic and anticonvulsant drug use by mentally retarded adults across community residential and vocational placements. Applied Research in Mental Retardation, 6, 33–49.

    Article  PubMed  Google Scholar 

  • Matson, J. L., & Mahan, S. (2010). Antipsychotic drug side effects for persons with intellectual disability. Research in Developmental Disabilities, 31, 1570–1576.

    Article  PubMed  Google Scholar 

  • Matson, J. L., & Wilkins, J. (2008). Antipsychotic drugs for aggression in intellectual disability. Lancet, 371, 9–10.

    Article  PubMed  Google Scholar 

  • Molyneux, P., Emerson, E., & Caine, A. (1999). Prescription of psychotropic medication to people with intellectual disabilities in primary health-care settings. Journal of Applied Research in Intellectual Disabilities, 12, 46–57.

    Article  Google Scholar 

  • Moss, S. C., Prosser, H., Costello, H., Simpson, N., & Patel, P. (1996). PAS-ADD checklist. Manchester: Hester Adrian Research Centre, University of Manchester.

    Google Scholar 

  • Myrbakk, E., & von Tetzchner, T. S. (2008). Psychiatric disorders and behavior problems in people with intellectual disability. Research in Developmental Disabilities, 29, 316–332.

    Article  PubMed  Google Scholar 

  • Neece, C. L., Baker, B. L., Blacher, J., & Crnic, K. A. (2011). Attention-deficit/hyperactivity disorder among children with and without intellectual disability: An examination across time. Journal of Intellectual Disabilities Research, 55, 623–635.

    Article  Google Scholar 

  • Oliver-Africano, P., Murphy, D., & Tyrer, P. (2009). Aggressive behaviour in adults with intellectual disability: Defining the role of drug treatment. CNS Drugs, 23, 903–913.

    Article  PubMed  Google Scholar 

  • Paton, C., Flynn, A., Shingleton-Smith, A., McIntyre, S., Bhaumik, S., Rasmussen, J., et al. (2011). Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. Journal of Intellectual Disabilities Research, 55, 665–674.

    Article  Google Scholar 

  • R Development Core Team. (2011). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://www.R-project.org/.

  • Robertson, J., Emerson, E., Gregory, N., Hatton, C., Kessissoglou, S., & Hallam, A. (2000). Receipt of psychotropic medication by people with intellectual disability in residential settings. Journal of Intellectual Disability Research, 44, 666–676.

    Article  PubMed  Google Scholar 

  • Romeo, R., Knapp, M., Tyrer, P., Crawford, M., & Oliver-Africano, P. (2009). The treatment of challenging behaviour in intellectual disabilities: cost-effectiveness analysis. Journal of Intellectual Disabilities Research, 53, 633–643.

    Article  Google Scholar 

  • Rosenberg, R. E., Mandell, D. S., Farmer, J. E., Law, J. K., Marvin, A. R., & Law, P. A. (2010). Psychotropic medication use among children with autism spectrum disorders enrolled in a national registry, 2007–2008. Journal of Autism and Developmental Disorder, 40, 342–351.

    Article  Google Scholar 

  • Ruedrich, S. L., Grush, L., & Wilson, J. (1990). Beta adrenergic blocking medications for aggressive or self-injurious mentally retarded persons. American Journal of Mental Retardation, 95, 110–119.

    PubMed  Google Scholar 

  • Scheifes, A., Stolker, J. J., Egberts, A. C., Nijman, H. L., & Heerdink, E. R. (2011). Representation of people with intellectual disabilities in randomised controlled trials on antipsychotic treatment for behavioural problems. Journal of Intellectual Disabilities Research, 55, 650–664.

    Article  Google Scholar 

  • Shedlack, K. J., Hennen, J., Magee, C., & Cheron, D. M. (2005). Assessing the utility of atypical antipsychotic medication in adults with mild mental retardation and comorbid psychiatric disorders. Journal of Clinical Psychiatry, 66, 52–62.

    Article  PubMed  Google Scholar 

  • Silva, D. A. (1979). The use of medication in a residential institution for mentally retarded persons. Mental Retardation, 17, 285–288.

    PubMed  Google Scholar 

  • Singh, A. N., Matson, J. L., Cooper, C. L., Dixon, D., & Sturmey, P. (2005). The use of risperidone among individuals with mental retardation: Clinically supported or not? Research in Developmental Disabilities, 26, 203–218.

    Article  PubMed  Google Scholar 

  • Szalavitz, M. (2011, May 26). Drugging the vulnerable: Atypical antipsychotics in children and the elderly. Time:Heathland. Retrieved July 18, 2012 from http://healthland.time.com..

  • Tsiouris, J. A. (2010). Pharmacotherapy for aggressive behaviours in persons with intellectual disabilities: Treatment or mistreatment? Journal of Intellectual Disabilities Research, 54, 1–16.

    Article  Google Scholar 

  • Tsiouris, J., Cohen, I. L., Patti, P. J., & Korosh, W. M. (2003). Treatment of previously undiagnosed psychiatric disorders in persons with developmental disabilities decreased or eliminated self-injurious behavior. Journal of Clinical Psychiatry, 62, 1081–1090.

    Article  Google Scholar 

  • Tsiouris, J. A., Kim, S. Y., Brown, W. T., & Cohen, I. L. (2011). Association of aggressive behaviours with psychiatric disorders, age, sex and degree of intellectual disability: A large-scale survey. Journal of Intellectual Disabilities Research, 55, 636–649.

    Article  Google Scholar 

  • Tyrer, P., Oliver-Africano, P., Ahmed, Z., Bouras, N., Cooray, S., Deb, S., et al. (2008). Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: A randomised controlledtrial. Lancet, 371, 63.

    Google Scholar 

  • Wilson, D. (2009). Poor children likelier to get antipsychotics. New York: New York Times.

    Google Scholar 

  • World Health Organization. (1978). Mental disorders: Glossary and guide to their classification in accordance with the ninth revision of the international classification of diseases. Geneva: World Health Organization.

    Google Scholar 

  • Wright, D. B., Strubler, K. A., & Vallano, J. P. (2011). Statistical techniques for juror and jury research. Legal and Criminological Psychology, 16, 90–125.

    Article  Google Scholar 

  • Yudofsky, S. C., Silver, J. M., Jackson, W., Endicott, J., & Williams, D. (1986). The Overt Aggression Scale for the objective rating of verbal and physical aggression. American Journal of Psychiatry, 143, 35–39.

    PubMed  Google Scholar 

  • Zeiles, A. (2008). Regression models for count data in R. Journal of Statistical Software, 27, 8.

    Google Scholar 

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Acknowledgments

This research was supported by funds from the New York State Office for People with Developmental Disabilities (OPWDD). The authors are grateful to the following Chief Psychologists without whom this project could not have been done: James Baker, Stephen Daurio, Mary Kennedy, Herbert Medetsky, Jerome Meyer, Ron Michelini, Don Morris, Donald Noble, Ed Sorel, Joseph Szempruch, Ann Troy, Susan Verzulli, and Richard Zelhof, and to Christine Muller, OPWDD Research and Analysis Unit, Division of Policy and Enterprise Solutions, for providing the demographics of the population.

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  1. George A. Jervis Clinic, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Rd., Staten Island, NY, 10314, USA

    John A. Tsiouris

  2. OPWDD Statewide Services, Albany, NY, USA

    Jill Pettinger

  3. Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Rd., Staten Island, NY, 10314, USA

    W. Ted Brown

  4. Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Rd., Staten Island, NY, 10314, USA

    Soh-Yule Kim & Ira L. Cohen

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Correspondence to Ira L. Cohen.

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Tsiouris, J.A., Kim, SY., Brown, W.T. et al. Prevalence of Psychotropic Drug Use in Adults with Intellectual Disability: Positive and Negative Findings from a Large Scale Study. J Autism Dev Disord 43, 719–731 (2013). https://doi.org/10.1007/s10803-012-1617-6

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