Monday, November 6, 2017

High Rates of Polypharmacy Found Among Adults With Intellectual Disability Seeking Psychiatric Care

By the time adults with intellectual disability sought specialized psychiatric outpatient services in a Canadian clinic, 70% had already been prescribed one psychotropic medication, and 22% had received three or more psychotropic medications, according to a study in Psychiatric Services in Advance. The findings underscore the importance of educating non-specialist providers about prescribing guidelines for this patient population.

“Understanding the demographic, organizational, and clinical characteristics that place individuals at greater risk of polypharmacy may help in the design of future intervention efforts,” wrote lead author Yona Lunsky, Ph.D., a professor in the Department of Psychiatry at the University of Toronto, and colleagues.

The researchers identified predictors of psychotropic polypharmacy using a retrospective chart audit for patients referred to a specialized psychiatric outpatient clinic for people with intellectual disabilities in Canada between 2005 and 2013. Predictors that psychotropic polypharmacy was likely to occur among these patients included (1) living in a supervised residential setting; (2) having a diagnosis of anxiety, mood, or psychotic disorder; (3) having a diagnosis of psychiatric complexity (two or more diagnostic categories); and (4) being a woman. 

In this study and a prior study, polypharmacy rates were not associated with the severity of intellectual disability or autism spectrum disorder.

The study sample consisted of 517 outpatients (199 females; 318 males) aged 15 to 73 in an urban, tertiary-level mental health care facility in Ontario, Canada. Before receiving specialist care, these individuals with intellectual disability received their medications from either family physicians or general psychiatrists. 

Of the 70% of the study patients prescribed at least one psychotropic medication, 146 (40%) had no psychiatric diagnosis on their intake form. One hundred and twelve (22%) referred to the service received three or more psychotropic medications concurrently, 30 of them without having any psychiatric diagnosis. The most commonly prescribed medication class was antipsychotics (n=275, 53%), followed by antidepressants (n=151, 29%). The most common interclass polypharmacy combination was antipsychotics, mood stabilizers, and antidepressants (n=52). 

“Although there are circumstances in which psychotropic polypharmacy may be warranted, guidelines suggest that intraclass polypharmacy be avoided, that medications for behavior management be offered in combination with psychological or other interventions, and that there be regular monitoring of medication use, with the goal of reducing multiple medications when possible,” the authors wrote. “Both psychiatrists and family physicians can play a role in the judicious use of medications for this vulnerable population.”

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