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Changes over a decade in psychotropic prescribing for people with intellectual disabilities : prospective cohort study

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Date
10/09/2020
Author
Henderson, Angela
Mcskimming, Paula
Kinnear, Deborah
McCowan, Colin
McIntosh, Alasdair
Allan, Linda
Cooper, Sally Ann
Funder
Medical Research Council
Grant ID
MC_PC_17217
Keywords
Adult psychiatry
Clinical pharmacology
Depression & mood disorders
Mental health
Psychiatry
Schizophrenia & psychotic disorders
BF Psychology
R Medicine
Medicine(all)
3rd-NDAS
SDG 3 - Good Health and Well-being
Metadata
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Abstract
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.
Citation
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
Publication
BMJ Open
Status
Peer reviewed
DOI
https://doi.org/10.1136/bmjopen-2020-036862
ISSN
2044-6055
Type
Journal article
Rights
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.
Description
Funding: 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).
Collections
  • University of St Andrews Research
URI
http://hdl.handle.net/10023/20681

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