Advertisement

Journal of Autism and Developmental Disorders

, Volume 43, Issue 3, pp 719–731 | Cite as

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

  • John A. Tsiouris
  • Soh-Yule Kim
  • W. Ted Brown
  • Jill Pettinger
  • Ira L. CohenEmail author
Article

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.

Keywords

Psychotropics Intellectual disability Survey Diagnosis Challenging behavior Aggression 

Notes

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.

References

  1. 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.PubMedCrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders-IV. Washington, DC: American Psychiatric Association.Google Scholar
  7. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders fourth edition text revision. Washington DC: American Psychiatric Association.CrossRefGoogle Scholar
  8. 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
  9. 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
  10. 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.PubMedGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. Deb, S., & Fraser, W. (1994). The use of psychotropic medication in people with learning disability: Towards rational prescribing. Human Psychopharmacology, 9, 259–272.CrossRefGoogle Scholar
  19. 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.PubMedGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. Harper, D. C., & Wadsworth, J. S. (1993). Behavioral problems and medication utilization. Mental Retardation, 31, 97–103.PubMedGoogle Scholar
  29. 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.PubMedGoogle Scholar
  30. Holden, B., & Gitlesen, J. P. (2004). Psychotropic medication in adults with mental retardation: Prevalence, and prescription practices. Research in Developmental Disabilities, 25, 509–521.PubMedCrossRefGoogle Scholar
  31. Hurley, A. D. (2008). Depression in adults with intellectual disability: Symptoms and challenging behaviour. Journal of Intellectual Disabilities Research, 52, 905–916.CrossRefGoogle Scholar
  32. Intagliata, J., & Rinck, C. (1985). Psychoactive drug use in public and community residential facilities for mentally retarded persons. Psychopharmacology Bulletin, 21, 268–278.PubMedGoogle Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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
  35. La Malfa, G., Bertelli, M., & Conte, M. (2001). Fluvoxamine and aggression in mental retardation. Psychiatric Services, 52, 1105.PubMedCrossRefGoogle Scholar
  36. Long, J. S., & Freese, J. (2006). Regression models for categorical dependent variables using stata (2nd ed.). College Station, TX: Stata Press.Google Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. Matson, J. L., & Mahan, S. (2010). Antipsychotic drug side effects for persons with intellectual disability. Research in Developmental Disabilities, 31, 1570–1576.PubMedCrossRefGoogle Scholar
  40. Matson, J. L., & Wilkins, J. (2008). Antipsychotic drugs for aggression in intellectual disability. Lancet, 371, 9–10.PubMedCrossRefGoogle Scholar
  41. 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.CrossRefGoogle Scholar
  42. 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
  43. Myrbakk, E., & von Tetzchner, T. S. (2008). Psychiatric disorders and behavior problems in people with intellectual disability. Research in Developmental Disabilities, 29, 316–332.PubMedCrossRefGoogle Scholar
  44. 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.CrossRefGoogle Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. 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.CrossRefGoogle Scholar
  47. 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/.
  48. 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.PubMedCrossRefGoogle Scholar
  49. 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.CrossRefGoogle Scholar
  50. 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.CrossRefGoogle Scholar
  51. 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.PubMedGoogle Scholar
  52. 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.CrossRefGoogle Scholar
  53. 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.PubMedCrossRefGoogle Scholar
  54. Silva, D. A. (1979). The use of medication in a residential institution for mentally retarded persons. Mental Retardation, 17, 285–288.PubMedGoogle Scholar
  55. 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.PubMedCrossRefGoogle Scholar
  56. 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..
  57. Tsiouris, J. A. (2010). Pharmacotherapy for aggressive behaviours in persons with intellectual disabilities: Treatment or mistreatment? Journal of Intellectual Disabilities Research, 54, 1–16.CrossRefGoogle Scholar
  58. 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.CrossRefGoogle Scholar
  59. 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.CrossRefGoogle Scholar
  60. 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
  61. Wilson, D. (2009). Poor children likelier to get antipsychotics. New York: New York Times.Google Scholar
  62. 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
  63. Wright, D. B., Strubler, K. A., & Vallano, J. P. (2011). Statistical techniques for juror and jury research. Legal and Criminological Psychology, 16, 90–125.CrossRefGoogle Scholar
  64. 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.PubMedGoogle Scholar
  65. Zeiles, A. (2008). Regression models for count data in R. Journal of Statistical Software, 27, 8.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • John A. Tsiouris
    • 1
  • Soh-Yule Kim
    • 4
  • W. Ted Brown
    • 3
  • Jill Pettinger
    • 2
  • Ira L. Cohen
    • 4
    Email author
  1. 1.George A. Jervis ClinicNew York State Institute for Basic Research in Developmental DisabilitiesStaten IslandUSA
  2. 2.OPWDD Statewide ServicesAlbanyUSA
  3. 3.Department of Human GeneticsNew York State Institute for Basic Research in Developmental DisabilitiesStaten IslandUSA
  4. 4.Department of PsychologyNew York State Institute for Basic Research in Developmental DisabilitiesStaten IslandUSA

Personalised recommendations