Overuse of Antipsychotic Medications for Developmental Disorders

A new study finds that antipsychotic medication is often prescribed to individuals with intellectual and developmental disabilities (IDD), often in the absence of an accompanying psychiatric diagnosis. Common IDD include Down syndrome, fetal alcohol syndrome, and autism.

Canadian researchers believe the findings suggest that antipsychotic medications are being used to manage behavioral issues, a practice that is only recommended if other options have failed.

The study was conducted by the Centre for Addiction and Mental Health (CAMH) and Institute for Clinical Evaluative Sciences (ICES) and appears in The Canadian Journal of Psychiatry.

Investigators believe the six-year population-based study brings a new perspective about prescribing practices of antipsychotic medication to adults with IDD.

Researchers examined the health care data of 51,881 adults with IDD who were less than 65 years of age. The study is the first population-based study to investigate the use of antipsychotic medication in adults with IDD in Canada.

“The results of our study make us question how often antipsychotics are being used as tool to manage behavioral issues. We need to understand more about why these medications are prescribed to those without psychiatric disorders, what else has been tried prior to medication, and how well these medications are being monitored,” says lead author Yona Lunsky.

Antipsychotics can be prescribed to adults with IDD as a method of managing behavioral challenges, however, the practice is often performed with a comprehensive assessment of the underlying contributors to such behaviors.

According to guidelines, antipsychotics should not be used as a first line treatment for behavior challenges.

“This study shows that antipsychotic use in adults with IDD is common. We need to pay more attention to how antipsychotics are prescribed and monitored to ensure appropriate prescribing for this vulnerable population,” says Tara Gomes, co-author on the study, a scientist at ICES and a principal investigator of Ontario Drug Policy Research Network (ODPRN).

The researchers add that antipsychotic prescribing is particularly problematic for this population due to the potential for adverse effects such as the increased risk for metabolic complications.

In this study, one in six adults had diabetes and one in five had hypertension. Furthermore, adults with IDD may have difficulties in providing informed medical consent and reporting unfavorable side effects should they arise.

The six-year study found:

• 39 percent of Ontario adults with IDD were dispensed antipsychotic medication (20,316 individuals)
• 29 percent of the antipsychotic users did not have a documented psychiatric diagnosis

This study also analyzed a sub-cohort of adults with IDD living in Ontario group homes and found:

• 56 percent (4,073) of individuals residing in group homes were prescribed an antipsychotic
• Of the antipsychotic users in a group home setting, 43 percent did not have a documented psychiatric diagnosis

Source: Centre for Addiction and Mental Health/EurekAlert

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