Friday, April 23, 2021

Psychotropic Polypharmacy Common Among Youths With Intellectual and Developmental Disabilities

More than half of youths with intellectual and developmental disabilities who take psychotropic medications take at least three of them, a study published Thursday in Psychiatric Services in Advance has found. Furthermore, a third take anticonvulsants even though they do not have a seizure disorder.

“Future research should assess strategies to further support youths with intellectual and developmental disabilities and to reduce these potentially harmful prescribing practices,” wrote Jennifer L. McLaren, M.D., of the Dartmouth-Hitchcock Medical Center and colleagues.

The researchers analyzed data from 1,333 youth aged 5 through 21 years who had enrolled in the Center for Systematic, Therapeutic, Assessment, Resources, Treatment (START) Services at the University of New Hampshire Institute on Disability between January 2013 and mid-July 2017. START programs provide crisis support, consultation, training, and outreach to individuals, families, and systems of care. All youths in the study had intellectual and developmental disabilities with co-occurring challenging behaviors or psychiatric diagnoses.

Most of the youths in the study “presented with aggression (e.g., physical, verbal, property destruction, and threats), and more than one-third had psychiatric hospitalizations or emergency department visits in the year before START intake,” the authors reported. Many had also been diagnosed with at least one psychiatric disorder, with the most common diagnoses being attention-deficit/hyperactivity disorder, autism spectrum disorder, and depression.

The researchers found the following:

  • 86% of the youths received at least one psychotropic medication.
  • 55% received three or more psychotropic medications.
  • 65% received antipsychotic medications.
  • 32% received anticonvulsants in the absence of a seizure disorder.

The older the youths were, the more likely they were to take more than one psychotropic medication and the more likely they were to receive anticonvulsants without having a seizure disorder. Having a psychiatric hospitalization in the past year was also associated with taking more than one psychotropic medication and receiving anticonvulsants without having a seizure disorder.

“To avoid polypharmacy, providers prescribing psychotropic medications to youths with intellectual and developmental disabilities should consider a slow, step-wise approach when initiating and titrating psychotropic medications and coordinating care with the child’s behaviorist or therapist to provide behavioral data or collateral information,” McLaren and colleagues wrote.

For related information, see the Psychiatric Services article “Psychotropic Polypharmacy Among Youths with Serious Emotional and Behavioral Disorders Receiving Coordinated Care Services.”

(Image: iStock/Chinnapong)

Virtual MindGames This Saturday

MindGames, the popular residents’ competition typically held during the Annual Meeting, will take place virtually
tomorrow, April 24, at 6 p.m. ET. Watch residency teams from Cooper Medical School of Rowan University, SUNY Upstate Medical University, and the University of Texas Health San Antonio have their knowledge tested on patient care, medicine, and psychiatric history while winning team earns bragging rights for their program. Art Walaszek, M.D., will host the event with special judges Michelle Riba, M.D., and Philip Muskin, M.D.


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