Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study
Objectives 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 rec...
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| Format: | Article |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e036862.full |
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| author | Paula McSkimming Angela Henderson Sally-Ann Cooper Deborah Kinnear Colin McCowan Linda Allan Alasdair McIntosh |
| author_facet | Paula McSkimming Angela Henderson Sally-Ann Cooper Deborah Kinnear Colin McCowan Linda Allan Alasdair McIntosh |
| author_sort | Paula McSkimming |
| collection | DOAJ |
| description | Objectives 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. |
| format | Article |
| id | doaj-art-4138ce932aa54264b8a726a9f64c466c |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-4138ce932aa54264b8a726a9f64c466c2025-01-08T10:05:08ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-036862Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort studyPaula McSkimming0Angela Henderson1Sally-Ann Cooper2Deborah Kinnear3Colin McCowan4Linda Allan5Alasdair McIntosh62 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK2 Mental Health and Wellbeing, University of Glasgow School of Health and Wellbeing, Glasgow, UK1University of Glasgow1 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UKSchool of Medicine, University of St Andrews, St Andrews, Fife, UK1 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UKRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UKObjectives 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.https://bmjopen.bmj.com/content/10/9/e036862.full |
| spellingShingle | Paula McSkimming Angela Henderson Sally-Ann Cooper Deborah Kinnear Colin McCowan Linda Allan Alasdair McIntosh Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study BMJ Open |
| title | Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study |
| title_full | Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study |
| title_fullStr | Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study |
| title_full_unstemmed | Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study |
| title_short | Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study |
| title_sort | changes over a decade in psychotropic prescribing for people with intellectual disabilities prospective cohort study |
| url | https://bmjopen.bmj.com/content/10/9/e036862.full |
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