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Off-label use of antipsychotic medication in people with intellectual disabilities

Adherence to guidelines, long-term effectiveness, and effects on quality of life
PhD ceremony:Ms L. (Lotte) Ramerman
When:April 15, 2019
Supervisor:prof. dr. P.J. (Pieter) Hoekstra
Co-supervisor:dr. G.M. de Kuijper
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

People with intellectual disabilities often use antipsychotic drugs long-term to reduce challenging behaviours. This thesis discusses the prescription practice, the relationship between long-term use of antipsychotics and quality of life, and the effects of discontinuation of risperidone.

A survey of medical records showed insufficient adherence to guideline recommendations. Only a minority of the surveyed clients receives, in addition to an antipsychotic, a psychological treatment. The annual monitoring of side-effects is infrequent and does not take place for all clients, while only half of the clients attempted to discontinue the medication. Physicians and psychologists suggested that guideline recommendations should be further incorporated into organization-specific treatment policies of organizations to improve adherence.

When people with intellectual disabilities use antipsychotics long-term, their quality of life is often lowered. Also, their mental well-being is often reduced, which is linked with the presence of challenging behaviours. Side-effects, such as parkinsonism and lowered bladder control, can affect physical well-being. Discontinuation of antipsychotics has a positive effect on physical well-being and only resulted in a temporary lowering of mental well-being.

A placebo-controlled discontinuation study showed that withdrawal from risperidone is often possible without a worsening in challenging behaviours, except for a possible increase in stereotypical behaviour. The withdrawal of risperidone has a positive effect on physical health, due to a decrease in weight, waist circumference and an improvement of certain blood levels (prolactin and testosterone).

Reducing antipsychotic drug use by people with intellectual disabilities is an important recommendation for clinical practice.