Changes over a decade in psychotropic prescribing for people with intellectual disabilities : prospective cohort study
MetadataShow full item record
Objective: To investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses. DESIGN: Comparison of cross-sectional data in 2002-2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data. SETTING: General community. PARTICIPANTS: 1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data. Main Outcome Measures: Encashed regular and as-required psychotropic prescriptions. Results: 50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001). Conclusions: Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews.
Henderson , A , Mcskimming , P , Kinnear , D , McCowan , C , McIntosh , A , Allan , L & Cooper , S A 2020 , ' Changes over a decade in psychotropic prescribing for people with intellectual disabilities : prospective cohort study ' , BMJ Open , vol. 10 , no. 9 , e036862 . https://doi.org/10.1136/bmjopen-2020-036862
Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.
DescriptionFunding: the study was funded by the Greater Glasgow Health Board, the Scottish Government via the Scottish Learning Disabilities Observatory and the UK Medical Research Council (grant number: MC_PC_17217).
Items in the St Andrews Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.