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Pharmacological management of psychopathology in people with intellectual disabilities and/or autism spectrum disorder

Published online by Cambridge University Press:  03 October 2022

Shoumitro Deb Open the ORCID record for Shoumitro Deb [Opens in a new window] ,
Meera Roy  and
Bharati Limbu
Shoumitro Deb*
Affiliation:
Visiting Professor of Neuropsychiatry at Imperial College London, UK. For many years he was a substantive full-time Clinical Professor of Neuropsychiatry at the University of Birmingham, UK. He has over 300 publications on the neuropsychiatry and psychopharmacology of adult neurodevelopmental disorders and acquired brain injury (citation index: 8407; h-index: 48; i-10 index 124 on 15 Sep 22).
Meera Roy
Affiliation:
Consultant in intellectual disability psychiatry since 1989 and has worked in several NHS trusts in the Midlands. She is now an honorary consultant at Worcestershire Health and Care NHS Trust, Worcester, UK. She has published several papers in the field of autism and intellectual disabilities.
Bharati Limbu
Affiliation:
Research assistant at Imperial College London, UK, and was involved in developing the first free online international psychoeducation programme for carers to help reduce the overmedication of people with intellectual disabilities (SPECTROM). She has published several papers, including systematic reviews and meta-analyses, in the field of intellectual disabilities and autism.
*
Correspondence Professor Shoumitro (Shoumi) Deb. Email: s.deb@imperial.ac.uk
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Summary

On average, 49–63% of people with intellectual disabilities and/or autism spectrum disorder (ASD) are prescribed psychotropic medications to treat psychopathology, including psychiatric illness, behaviours that challenge and the core symptoms and associated behaviours of these developmental disorders. In many cases, psychotropics, particularly antipsychotics, are used off-label without a proper indication, particularly to manage behaviours that challenge. The RCTs show moderate evidence supporting the efficacy of low-dose risperidone and some preliminary evidence for aripiprazole in treating behaviours that challenge among children with ASD and/or intellectual disabilities. The RCT-based evidence for the other psychotropics is equivocal, so no definitive conclusions can be made on their efficacy. Polypharmacy and the use of high doses of antipsychotics are prevalent in this population, leading to the risk of adverse events and drug–drug interactions. Despite various national and international guidelines, and government initiatives encouraging reduced psychotropic use, there is little evidence of this happening; on the contrary, the use of antidepressants, mood stabilisers and benzodiazepines may be increasing. A concerted multi-agency effort is urgently needed to address this significant public health concern of the overmedication of people with intellectual disabilities and/or ASD.

Keywords

Intellectual disabilitiesautism spectrum disorderbehaviours that challengepsychotropic medicationsevidence base
Type
Article
Information
BJPsych Advances , Volume 29 , Special Issue 5: Neurodevelopmental disorders including intellectual disability: a Clinical Toolkit for Mental Health Professionals (Part 2) , September 2023 , pp. 322 - 333
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

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References

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