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Safety of antipsychotics in people with intellectual disability

  • Valeria Frighi (a1), Matthew T. Stephenson (a2), Alireza Morovat (a3), Iain E. Jolley (a2), Marialena Trivella (a4), Christina A. Dudley (a5), Ezhil Anand (a6), Sarah J. White (a5), Christina V. Hammond (a7), Rena A. Hockney (a8), Beryl Barrow (a9), Rehana Shakir (a2) and Guy M. Goodwin (a10)...
Abstract
Background

Despite frequent use, little is known about the metabolic and endocrine side-effects of antipsychotics in individuals with intellectual disability.

Aims

To compare indices of obesity, glucose, lipids and prolactin between antipsychotic-treated and antipsychotic-naive individuals with intellectual disability and also between participants with intellectual disability and controls from the general population.

Method

Observational study comparing 138 antipsychotic-treated and 64 antipsychotic-naive participants with intellectual disability in one National Health Service trust with general population controls.

Results

Antipsychotic treatment comprised: risperidone 48%, olanzapine 18%, thioxanthenes 10%, other 24%; monotherapy 95% of participants; mean treatment duration 8 years; median daily chlorpromazine equivalent dose 108mg (range 16–667). Metabolic indices were the same or more favourable in the intellectual disability group than the general population control group but overweight/obesity and type 2 diabetes were more prevalent in the women in the intellectual disability group than the control group. Metabolic indices were similar, statistically or clinically, between the antipsychotic-treated and the antipsychotic-naive groups but there was a non-significant trend towards a higher rate of type 2 diabetes in the antipsychotic group. A total of 100% and 70% of participants on amisulpride/sulpiride and risperidone respectively had hyperprolactinaemia, with secondary hypogonadism in 77% and 4% of affected women and men.

Conclusions

Antipsychotics, on average, did not increase metabolic risk, although the existence of a susceptible subgroup at risk of diabetes cannot be excluded. Some antipsychotics induced hyperprolactinaemic hypogonadism, requiring active management. However, our findings suggest that antipsychotics at the low doses routinely prescribed for people with intellectual disability are generally safe in relation to metabolic adverse effects, even if efficacy remains poorly defined.

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Copyright
Corresponding author
Valeria Frighi, Department of Psychiatry, Neurosciences Building, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, UK. Email: valeria.frighi@psych.ox.ac.uk
Footnotes
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The study was supported by the Baily Thomas Charitable Fund.

Declaration of interest

V.F. has received a donation of drug supplies from Bristol-Myers Squibb (BMS) for a trial sponsored by the National Institute of Health Research. G.M.G. has held grants from Sanofi-Aventis and Servier and has received honoraria for speaking from AstraZeneca, BMS, Eisai, Lundbeck, Sanofi-Aventis and Servier, and for advice from AstraZeneca, Boehringer-Ingelheim, BMS, Cephalon, Eli Lilly, Lundbeck, P1vital, Roche, Sanofi-Aventis, Servier and Wyeth.

Footnotes
References
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Safety of antipsychotics in people with intellectual disability

  • Valeria Frighi (a1), Matthew T. Stephenson (a2), Alireza Morovat (a3), Iain E. Jolley (a2), Marialena Trivella (a4), Christina A. Dudley (a5), Ezhil Anand (a6), Sarah J. White (a5), Christina V. Hammond (a7), Rena A. Hockney (a8), Beryl Barrow (a9), Rehana Shakir (a2) and Guy M. Goodwin (a10)...
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