Pharmacotherapy for Mental Illness and Behaviours that Challenge in People with Intellectual Disabilities

2020 ◽  
pp. 191-202
Author(s):  
David Branford ◽  
Reena Tharian ◽  
Regi Alexander ◽  
Sabyasachi Bhaumik
Keyword(s):  
Mental Illness ◽  
Intellectual Disability ◽  
Inappropriate Prescribing ◽  
Psychotropic Medications ◽  
Mental Illnesses ◽  
Legitimate Concern ◽  
Prescribing Practice ◽  
People With Intellectual Disabilities ◽  
Practice Framework ◽  
Prescribing Medication

Psychotropic medications are widely prescribed for people with an intellectual disability (ID) both for the management of mental illnesses and behaviours that challenge. It is generally agreed that people with ID are as likely or more likely as the general population to develop mental illnesses and therefore this has to be treated actively. However the appropriateness and extent of prescribing medication to manage behavior that challenges is a matter of debate and legitimate concern. This chapter summarizes the evidence in this field and sets out a practice framework to minimize the risk of inappropriate prescribing practice.

scholarly journals Letter from Australia: mental healthcare in Victoria

2011 ◽  
Vol 17 (1) ◽  
pp. 2-4 ◽  
Author(s):  
David J. Castle
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Intellectual Disability ◽  
Mentally Ill ◽  
Mental Healthcare ◽  
Psychiatric Hospitals ◽  
Mental Illnesses ◽  
Government Agencies ◽  
The Past

SummaryMental health services in the state of Victoria, Australia, have undergone enormous change over the past 15 years, with the closure of all stand-alone psychiatric hospitals and a shift of resources and services into the community. Although successful overall, various areas cause concern, including pressure on acute beds, a paucity of alternative residential options, and suboptimal integration of government and non-government agencies concerned with the care of people with mental illnesses. Certain groups, notably those with complex symptom sets such as substance use and mental illness, intellectual disability and forensic problems, remain poorly catered for by the system. Finally, community stigma and lack of work inclusion for mentally ill individuals are ongoing challenges.

scholarly journals Stigmatised attitudes towards intellectual disability: a randomised crossover trial

2010 ◽  
Vol 34 (8) ◽  
pp. 318-322 ◽  
Author(s):  
Sabu John Varughese ◽  
Jason Luty
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Down Syndrome ◽  
Intellectual Disability ◽  
Crossover Trial ◽  
Response Rate ◽  
Clinical Implications ◽  
Control Groups ◽  
People With Intellectual Disabilities ◽  
The Mean

Aims and methodTackling discrimination, stigma and inequalities in mental health is a major UK government objective yet people with intellectual disabilities continue to suffer serious stigma and discrimination. The project aimed to determine the effect of viewing a picture of a person with intellectual disability on stigmatised attitudes. The 20-point Attitude to Mental Illness Questionnaire (AMIQ) was used and a representative panel of members of the general public were randomised to complete the questionnaire either with (experimental) or without (control) looking at a picture of a man with Down syndrome. Six months later the same experiment was performed with the groups crossed over.ResultsResults were received for 360 participants (response rate 87–93%). The sequence (control or experimental) had no significant effect on the outcome. The mean AMIQ score in the control groups was 1.56 (s.d. = 2.85, s.e. = 0.21,n=186) and in the experiment group (after looking at the pictures) was 2.43 (s.d. = 2.59, s.e. = 0.12,n= 174; median difference 1,P= 0.0016 Mann-WhitneyU-test; effect size 0.23).Clinical implicationsLooking at a picture of a man with Down syndrome significantly reduces reported stigmatised attitudes.

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

BJPsych Open ◽  
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.

scholarly journals Prevalence of Intellectual Disability and Comorbid Mental Illness in an Australian Community Sample

2005 ◽  
Vol 39 (5) ◽  
pp. 395-400 ◽  
Author(s):  
Paul White ◽  
David Chant ◽  
Niki Edwards ◽  
Clare Townsend ◽  
Geoff Waghorn
Keyword(s):  
Mental Illness ◽  
Intellectual Disability ◽  
Depressive Disorder ◽  
Community Sample ◽  
Secondary Analysis ◽  
Mental Illnesses ◽  
Classification Of Diseases ◽  
Australian Community ◽  
International Statistical Classification

Objective: The aim of this study was to bring to light the high prevalence of Australians affected by intellectual disability and comorbid serious mental illnesses. Results from a broad scale study are used to explore the reasons for this regularly overlooked phenomenon. Methods: This study was based on secondary analysis of data collected in the national ‘Disability, Ageing and Carers Survey, 1998’. The analysed data consisted of an Australian wide sample of 42 664 individuals living at home or in cared accommodation. Classification of intellectual disability and comorbid psychosis, anxiety and depressive disorder was based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Results: The prevalence of intellectual disability in the sampled population was 1.25%. Of these people 1.3% had a psychotic disorder, 8% had a depressive disorder and 14% had an anxiety disorder that had been present for at least 6 months and was of such severity that it too was disabling. Conclusions: Findings indicate that people with intellectual disability are at high risk of developing comorbid serious mental illness. Dual diagnosis is however, often overlooked due to difficulties associated with establishing a diagnosis of a mental disorder in people with an intellectual disability, a problem which is heightened when the individual's capacity to participate in a clinical assessment is limited.

Is it time to include people with intellectual disabilities in Royal Australian and New Zealand College of Psychiatrists’ treatment guidelines?

2019 ◽  
Vol 27 (5) ◽  
pp. 519-521
Author(s):  
Harry Hill
Keyword(s):  
Mental Illness ◽  
Intellectual Disability ◽  
New Zealand ◽  
Treatment Guidelines ◽  
Current Approach ◽  
Specific Population ◽  
People With Intellectual Disabilities ◽  
Zealand College ◽  
Potential Impact ◽  
Missed Opportunity

Objective: The Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) treatment guidelines set the zeitgeist for psychiatric practice in Australasia. This review conceptualises the current approach to treatment of individuals with an intellectual disability and co-occurring mental illness in RANZCP guidelines, and its potential impact. Conclusions: The enduring omission of people with an intellectual disability and co-occurring mental illness from RANZCP clinical guidelines is a missed opportunity in normalising care and optimising outcomes for people with an intellectual disability. There are substantial cultural, political and historical overlays contributing to the ongoing divide between health and disability. In developing psychiatric guidelines, authors should consider including people with co-occurring intellectual disability as a specific population, that requires distinctive consideration.

scholarly journals Utilization of Psychotropic Medications and Polypharmacy Among Adults in Jazan Region, Saudi Arabia

2020 ◽  
pp. 205
Author(s):  
Abdulkarim M. Meraya ◽  
Monira Alwhaibi ◽  
Mamoon H Syed ◽  
Ali Shwihi ◽  
Muath Mashraqi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Regression Models ◽  
Drug Class ◽  
Cross Sectional Study ◽  
Psychotropic Medications ◽  
Mental Illnesses ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Prescribing Practice

Globally, there has been a surge in the prevalence of mental health disorders, not excluding Saudi Arabia. The availability of newer psychotropic medications has led to increased prescribing and polypharmacy. In Saudi Arabia, exploration of the knowledge gap between the outpatient use of psychotropic medications and the extent of polypharmacy has been scarce in the literature. This study evaluated the prescription pattern of psychotropic medications and the prevalence of psychotropic polypharmacy among adult patients with behavioral/mental illnesses. The study was conducted in the psychiatric outpatient clinics of five hospitals in Jazan Region of Saudi Arabia. A retrospective cross-sectional study was conducted with a non-random sample of adults with behavioral/mental illnesses. Psychotropic polypharmacy was the presence of ≥2 psychotropic medication prescriptions. We conducted multivariable logistic regression models to examine the factors associated with psychotropic polypharmacy. A total of 3.052 adults with a behavioral/mental illness were included in the study. Of these, 74.6% had antidepressant prescriptions. The second most prescribed drug class was antipsychotics (51.9%). Furthermore, 65.3% had psychotropic polypharmacy, and 48.2% had interclass psychotropic polypharmacy. Adults with anxiety and other mood disorders were less likely to engage in psychotropic polypharmacy and interclass polypharmacy use than those with depression. However, adults with schizophrenia (adjusted odds ratio [AOR]: 1.91; p<0.001) were more likely to engage in interclass polypharmacy use than those with depression. Adults with behavioral/mental illnesses in Jazan Region of Saudi Arabia have high rates of antidepressants and antipsychotics use. Additionally, psychotropic polypharmacy is a common prescribing practice, and further evaluation of the safety profile of these combinations is warranted.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

Prescriptive Power: Biologism, Biopsychiatry and Drug-centred Psychopharmacology

Somatechnics ◽  
2019 ◽  
Vol 9 (2-3) ◽  
pp. 291-309
Author(s):  
Francis Russell
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Justice ◽  
Cultural Theory ◽  
Human Experience ◽  
Mental Illnesses ◽  
False Consciousness ◽  
The Subject ◽  
Biological Ontology ◽  
Health Discourse

This paper looks to make a contribution to the critical project of psychiatrist Joanna Moncrieff, by elucidating her account of ‘drug-centred’ psychiatry, and its relation to critical and cultural theory. Moncrieff's ‘drug-centred’ approach to psychiatry challenges the dominant view of mental illness, and psychopharmacology, as necessitating a strictly biological ontology. Against the mainstream view that mental illnesses have biological causes, and that medications like ‘anti-depressants’ target specific biological abnormalities, Moncrieff looks to connect pharmacotherapy for mental illness to human experience, and to issues of social justice and emancipation. However, Moncrieff's project is complicated by her framing of psychopharmacological politics in classical Marxist notions of ideology and false consciousness. Accordingly, she articulates a political project that would open up psychiatry to the subjugated knowledge of mental health sufferers, whilst also characterising those sufferers as beholden to ideology, and as being effectively without knowledge. Accordingly, in order to contribute to Moncrieff's project, and to help introduce her work to a broader humanities readership, this paper elucidates her account of ‘drug-centred psychiatry’, whilst also connecting her critique of biopsychiatry to notions of biologism, biopolitics, and bio-citizenship. This is done in order to re-describe the subject of mental health discourse, so as to better reveal their capacities and agency. As a result, this paper contends that, once reframed, Moncrieff's work helps us to see value in attending to human experience when considering pharmacotherapy for mental illness.

Effective e-health design for those with, and without, mental health disorders: shallow navigation, concentrated contents, modest number of links, one screen area for links. (Preprint)

2018 ◽  
Author(s):  
Armando Rotondi ◽  
Jonathan Grady ◽  
Barbara H. Hanusa ◽  
Michael R. Spring ◽  
Kaleab Z. Abebe ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Success Rate ◽  
Fractional Factorial ◽  
Mental Illnesses ◽  
Schizophrenia Spectrum Disorders ◽  
Design Elements ◽  
Website Usability ◽  
Schizophrenia Spectrum ◽  
Health Applications

BACKGROUND E-health applications are an avenue to improve service responsiveness, convenience, and appeal, and tailor treatments to improve relevance, engagement, and use. It is critical to user engagement that the designs of e-health applications are intuitive to navigate. Limited research exists on designs that work for those with a severe mental illness, many of whom infrequently seek treatment, and tend to discontinuation medications and psychosocial treatments. OBJECTIVE The purpose of this study was to evaluate the influence of 12 design elements (e.g., website depth, reading level, use of navigational lists) on the usability of e-health application websites for those with, and without, mental health disorders (including severe mental illness). METHODS A 212-4 fractional factorial experimental design was used to specify the designs of 256 e-health websites, which systematically varied the 12 design elements. The final destination contents of all websites were identical, only the navigational pages varied. Three subgroups of participants comprising 226 individuals, were used to test these websites (those with schizophrenia-spectrum disorders, other mental illnesses, and no mental illness). Unique to this study was that the 12 design elements were manipulated systematically to allow assessment of combinations of design elements rather than only one element at a time. RESULTS The best and worst designs were identified for each of the three subgroups, and the sample overall. The depth of a website’s navigation, that is, the number of screens/pages users needed to navigate to find desired content, had the strongest influence on usability (ability to find information). The worst performing design for those with schizophrenia-spectrum disorders had an 8.6% success rate (ability to find information), the best had a 53.2% success rate. The navigational design made a 45% difference in usability. For the subgroup with other mental illnesses the design made a 52% difference, and for those with no mental illness a 50% difference in success rate. The websites with the highest usability all had several key similarities, as did the websites with the poorest usability. A unique finding is that the influences on usability of some design elements are variable. For these design elements, whether they had a positive or negative effect, and the size of its effect, could be influenced by the rest of the design environment, that is, the other elements in the design. This was not the case for navigational depth, a shallower hierarchy is better than a deeper hierarchy. CONCLUSIONS It is possible to identify evidence-based strategies for designing e-health applications that result in a high level of usability. Even for those with schizophrenia, or other severe mental illnesses, there are designs that are highly effective. The best designs have key similarities, but can also vary in some respects. Key words: schizophrenia, severe mental illness, e-health, design, website, usability, website design, website usability, fractional factorial design.

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