COVID-19 and people with intellectual disability: impacts of a pandemic

The impacts of the COVID-19 pandemic affect all groups in society. People with intellectual disability (ID) are especially vulnerable to the physical, mental and social effects of the pandemic. Cognitive impairments can limit understanding of information to protect them relying on carers to be vigilant on their behalf during quarantine. Restrictions on usual activities are likely to induce mental stress especially among those who are autistic leading to an escalation in challenging behaviours, risk of placement breakdown and increased the use of psychotropic medication. People with ID are vulnerable to exploitation by others where the usual community supports no longer function to protect them. In future pandemics, it is important that lessons are learned from the impacts COVID-19 have on people with ID. Collecting the evidence through a rigorous approach should help to empower people with ID and their carers to face future outbreaks of infectious diseases.

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Chemical restraint of adults with intellectual disability and challenging behaviour in Queensland, Australia: Views of statutory decision makers

Journal of Intellectual Disabilities ◽

10.1177/1744629518782064 ◽

2018 ◽

Vol 24 (2) ◽

pp. 194-211

Author(s):

Nicole Edwards ◽

Julie King ◽

Karen Williams ◽

Sara Hair

Keyword(s):

Mental Illness ◽

Intellectual Disability ◽

Information Seeking ◽

Decision Makers ◽

Negative Consequences ◽

Physical And Mental Health ◽

Chemical Restraint ◽

Positive Behaviour Support ◽

Challenging Behaviours ◽

Community Supports

Background: Psychotropic medication is widely prescribed to treat mental illness. However, it is controversial when used as a chemical restraint (CR) to manage challenging behaviours (CBs) of adults with intellectual disability (ID). CR has potentially negative consequences and affects human rights. Method: Qualitative research conducted between 2014 and 2015 explored the views of ‘guardian’ decision makers appointed under unique Queensland legislation oversighting the use of CR. Results: Findings included (1) negative conceptualization of CR, (2) concerning relationships with prescribers and disability sector staff, (3) challenges to information seeking about people with ID prescribed CR and (4) problematic implementation of positive behaviour support plans. Conclusion: According to guardians, CR may be used in lieu of community supports, and prescribers sometimes diagnose mental illness to avoid CR legislative requirements. Guardians, prescribers and professionals would benefit from training that addresses the intersection between physical and mental health, CB and CR.

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Psychotropic prescribing practices in adults with intellectual disability and autism spectrum disorder in Richmond Neurodevelpmental Services

BJPsych Open ◽

10.1192/bjo.2021.242 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S76-S76

Author(s):

Anushka Dissanayake ◽

Nicholas Davey ◽

Rupal Patel

Keyword(s):

Autism Spectrum Disorder ◽

Intellectual Disability ◽

Psychotropic Medication ◽

Autism Spectrum ◽

Psychotropic Medications ◽

Spectrum Disorder ◽

Psychiatric Diagnoses ◽

Prescribing Practices ◽

Clinical Records ◽

Challenging Behaviours

AimsOur aim was to evaluate psychotropic prescribing practices in adults with intellectual disability (ID) and autism spectrum disorder (ASD) across the Richmond Neurodevelopmental Service (NDS).Stopping over-medication of people with a learning disability, autism or both with psychotropics (STOMP) aims to reduce the potential harm of inappropriate use of psychotropic medications. We aimed to evaluate our prescribing practices in keeping with STOMP and the NICE guidelines.MethodWe collected information from our clinical records on patients that met the inclusion criteria (≥18 years + diagnosis of ID and autism) from October-November 2019. We gathered the following: age, sex, severity of ID, psychiatric diagnoses, psychotropic medication, presence of challenging behaviours, involvement of positive behaviour support (PBS) and documentation of a PBS plan.Result32 patients met our criteria (3:1 Male-Female ratio with an age range of 20-74 (Median 33 years old)). All 32 patients showed evidence of challenging behaviours. In the cohort, mild ID represented 18.8% (n = 6), moderate ID 40.6% (n = 13) and severe ID 40.6% (n = 13).17 patients (53%) had a PBS plan in place. For those without a PBS plan (47%, n = 15), a referral to behavioural analysis had been considered/requested in 67% (n = 10).31 patients were on psychotropic medication and 84% (n = 26) had an indication documented in the notes although every patient had had a medication review in the last 6 months. 67.7% (n = 21) of the prescriptions were for challenging behaviours.The average number of medications prescribed was 2 (median 2, mean 2.41) but this was reduced to 1 (median 1, mean 1.76) when additional psychiatric diagnoses and epilepsy were excluded.ConclusionPrescriptions are regularly reviewed in keeping with STOMP guidance but there is more scope for utilising behaviour analysis input as well as the need to improve documentation of the rationale for psychotropic medications.

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Appropriateness of psychotropic medication use in a cohort of adolescents with intellectual disability in Queensland, Australia

BJPsych Open ◽

10.1192/bjo.2020.125 ◽

2020 ◽

Vol 6 (6) ◽

Author(s):

Menghuan Song ◽

Robert S. Ware ◽

Tan N. Doan ◽

Lyn McPherson ◽

Julian N. Trollor ◽

...

Keyword(s):

Intellectual Disability ◽

Psychotropic Medication ◽

Clinical Decision Making ◽

Medical Condition ◽

Inappropriate Prescribing ◽

Medication Use ◽

Psychotropic Medications ◽

Off Label ◽

Inappropriate Use ◽

Challenging Behaviours

Background Psychotropic medications are sometimes used off-label and inappropriately. This may cause harm to adolescents with intellectual disability. However, few studies have analysed off-label or inappropriate prescribing to this group. Aims To examine the appropriateness of psychotropic prescribing to adolescents with intellectual disability living in the community in south-east Queensland, Australia. Method Off-label medication use was determined based on whether the recorded medical condition treated was approved by the Australian Therapeutic Goods Administration. Clinical appropriateness of medication use was determined based on published guidelines and clinical opinion of two authors who specialise in developmental disability medicine (J.N.T. and D.H.). Results We followed 429 adolescents for a median of 4.2 years. A total of 107 participants (24.9%) were prescribed psychotropic medications on at least one occasion. Of these, 88 (82.2%) were prescribed their medication off-label or inappropriately at least once. Off-label or inappropriate use were most commonly associated with challenging behaviours. Conclusions Off-label or inappropriate use of psychotropic medications was common, especially for the management of challenging behaviours. Clinical decision-making accounts for individual patient factors and is made based on clinical experience as well as scientific evidence, whereas label indications are developed for regulatory purposes and, although appropriate at a population level, cannot encompass the foregoing considerations. Education for clinicians and other staff caring for people with intellectual disability, and a patient-centred approach to prescribing with involvement of families should encourage appropriate prescribing. The effect of the National Disability Insurance Scheme on the appropriateness of psychotropic medication prescribing should be investigated.

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Receipt of psychotropic medication by people with intellectual disability in residential settings

Journal of Intellectual Disability Research ◽

10.1046/j.1365-2788.2000.00307.x ◽

2000 ◽

Vol 44 (6) ◽

pp. 666-676 ◽

Cited By ~ 69

Author(s):

J. Robertson ◽

E. Emerson ◽

N. Gregory ◽

C. Hatton ◽

S. Kessissoglou ◽

...

Keyword(s):

Intellectual Disability ◽

Psychotropic Medication ◽

Residential Settings

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Psychotropic Medication for Challenging Behaviour in People With Intellectual Disability: Results of an Online Survey of Family Carers

10.26226/morressier.5a7070e6d462b80290b57a11 ◽

2018 ◽

Author(s):

Rory Sheehan

Keyword(s):

Intellectual Disability ◽

Psychotropic Medication ◽

Online Survey ◽

Challenging Behaviour ◽

Family Carers

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Transfer and transition referrals of patients with intellectual disability from children's services to adult community learning disability teams

BJPsych Open ◽

10.1192/bjo.2021.307 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S103-S103

Author(s):

Jalil-Ahmad Sharif

Keyword(s):

Intellectual Disability ◽

Learning Disability ◽

Psychotropic Medication ◽

Limited Information ◽

Children's Services ◽

Term Care ◽

Community Learning ◽

Children’S Services ◽

Support Plan ◽

Transition Support

AimsThe audit aimed to assess if patients under the care of children's services in Wessex were transferred at the appropriate age and whether transition referrals to Community Learning Disability teams (CTLD) occurred timely. It also aimed to look at how many patients underwent transitions in a three month period, and if their transition support plan (TSP) was completed. A transition support plan should include chronological information on psychopharmacology, psychotherapy, and social support measures. Patients should be referred between the ages of 17–19 but require a justification after 18 years of age.MethodThe BI team was contacted to provide all IDs for patients referred within a three month period between the ages of 17–19. The BI team provided 42 patients with their ID. Patients discharged from services within a short time span were excluded for the following reason: inappropriate referral (9pts), discharged after 1st assessment (6pts), internal discussion (6pts), only referred to Autism team (4pts), moved out of area (1pts). From the initial 42 patients, 16 patients were analysed using the collection tool.Result4/16 had a TSP, and only two had a complete TSP and transitioned in another trust and were inter-team referrals.CAMHS services referred 1/16 patients.Psychotropic medication was prescribed to 12/16 prior to or on time of referral, but only two patients had a complete psychotropic medication history.8/16 patients' referral was commenced prior to their 18th birthday, and no information was provided for delay in transfer.Health records did mention psychotherapy, but apart from 2/16 TSP records, no additional information was available on the modality.ConclusionPatients with Intellectual Disability face challenges when transferring from children to adult services. Insufficient referral information may have a detrimental impact on patients wellbeing and long-term care.Access to a patient's chronological journey through the different children's services allows Adult CTLD health professionals to provide effective care. Historical psycho-social and pharmacological interventions provide a reference point for future interventions.Concerns included: limited information on most TSP regarding psycho-social and psychotropic treatments, lack of access to CAMHS/CHYPS paperwork and ineffective inter-trust communication for transition patients.This project highlighted the average number of transition cases in 3 months. It led to changes to the transition pathway, as awareness was raised in trust and CCG meetings to improve patient outcome. CTLD created the new role of transition facilitators to support children's services. They sit in meetings before patients transition referrals.

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Types of Mental Disorders in People with Intellectual Disability

Oxford Textbook of the Psychiatry of Intellectual Disability ◽

10.1093/med/9780198794585.003.0006 ◽

2020 ◽

pp. 55-60

Author(s):

Sally-Ann Cooper

Keyword(s):

Intellectual Disability ◽

General Population ◽

Mental Disorders ◽

Mental Disorder ◽

Bipolar Affective Disorder ◽

Hyperactivity Disorder ◽

Dsm 5 ◽

Icd 10 ◽

Physical Disorders ◽

Challenging Behaviours

Mental disorders are common in people with intellectual disability, with a reported point prevalence of 36% in children and young people (including challenging behaviours), and 40.9% in adults (or 28.3% excluding challenging behaviours). People with intellectual disability experience all types of mental disorders, some more commonly than the general population, e.g. autism, attention-deficit hyperactivity disorder, schizophrenia, bipolar affective disorder, and dementia. Challenging behaviours are also common, and have no clear general population equivalent. Multi-morbidity of mental and physical disorders is typical. Mental disorder assessments are complex due to multi-morbidity and polypharmacy, in addition to impairments in communication, understanding, vision, and hearing, and the need to work with family and paid carers as well as the person with intellectual disability. Mental disorder classificatory systems have been developed for people with intellectual disability, in view of under-reporting when using general population manuals: DC-LD was designed to complement ICD-10, and DM-ID 2 to interpret DSM-5.

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