A survey of off-label prescribing for inpatients with mild intellectual disability and mental illness

2005 ◽  
Vol 49 (11) ◽  
pp. 858-864 ◽  
Author(s):  
C. Haw ◽  
J. Stubbs
BJGP Open ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. bjgpopen18X101541 ◽  
Author(s):  
Carmela Salomon ◽  
Helena Britt ◽  
Allan Pollack ◽  
Julian Trollor

BackgroundPeople with intellectual disability (ID) experience a range of health disparities. Little is known about differential primary care prescribing patterns for people with and without ID.AimTo compare medications recommended by GPs at encounters where ID is recorded versus other encounters.Design & settingAnalysis of national Australian GP medication data from the Bettering the Evaluation and Care of Health (BEACH) programme, January 2003–December 2012 inclusive.MethodMedication recommendations made at encounters where an ID-defining problem was recorded as a reason for encounter (RFE) and/or as a problem managed, were allocated to the ‘ID group’ (n = 563). These encounters were compared with all other encounters (the ‘non-ID group’, n = 1 004 095) during the study period. Following age–sex standardisation of ID group encounters, significant differences were determined by non-overlapping 95% confidence intervals (CIs).ResultsAntipsychotics and anticonvulsants were recommended more frequently at ID group encounters than at non-ID group encounters. Antidepressant and anxiolytic recommendation rates did not differ between groups. Narcotic analgesic and antihypertensive recommendations were significantly lower at ID group encounters.ConclusionHigher rates of epilepsy and mental illness, and off-label use of some antipsychotics and anticonvulsants for behaviour management in people with ID, may have contributed to medication recommendations observed in this analysis. Lower narcotic analgesic recommendations at ID group encounters may relate to complex presentations and the nature of problems managed, while lower antihypertensive recommendations may indicate some potential omission of routine blood pressure measurement.


2014 ◽  
Vol 8 (2) ◽  
pp. 79-90 ◽  
Author(s):  
Sue Mesa ◽  
Elias Tsakanikos

Purpose – The purpose of this paper is to investigate whether acute inpatient psychiatric staffs’ attitudes and self-efficacy towards adults with mild intellectual disability, were different than towards the general mental health population. And whether their understanding of the policy for those with mental illness and intellectual disability differed. Design/methodology/approach – The study is a between-subject design, using a self-administered postal questionnaire. The sample was all qualified staff from the acute inpatient psychiatric provision of an inner London borough. Potential participants were randomly assigned to two research groups, half being given a questionnaire regarding people with intellectual disability and the other half an identical one regarding people with mental illness. Comparisons were made between the two. Findings – The majority of staff were unaware of the current policy direction for adults with intellectual disability although were on the whole in agreement to the idea that they should access mainstream services. Staff overall did not have more negative attitudes to those with intellectual disability although were less likely to empower or encourage self-advocacy. Staff were significantly less confident that they had sufficient training and experience, and in their perceived ability to be able to communicate, assess and treat adults with mild intellectual disability when compared to those with mental illness. Research limitations/implications – The response rate and small sample size is a limitation. Further research could usefully look at whether self-efficacy and attitudes differ in different models of mainstream psychiatric care. Originality/value – Government policy in the UK regarding services for people with intellectual disability advocates for inclusion and equality (Chaplin and Taggart, 2012). Those requiring psychiatric care should access this from mainstream services (Department of Health, 2001, 2009, 2011; Foundation for People with Learning Disabilities et al., 2004; Bradley, 2009.) There are, however, no UK-based studies investigating the views of mainstream acute inpatient psychiatric staff towards their role. Intellectual disability staff have concerns about their attitudes and self-efficacy and it is know that acute care is the setting where most adults with intellectual disability will come across mainstream psychiatric staff. Findings have relevance to managers and staff in both intellectual disability and psychiatric services and could be considered in the context of trying to work together as is the direction of policy.


Author(s):  
Meena Balasubramanian ◽  
Alexander J. M. Dingemans ◽  
Shadi Albaba ◽  
Ruth Richardson ◽  
Thabo M. Yates ◽  
...  

AbstractWitteveen-Kolk syndrome (OMIM 613406) is a recently defined neurodevelopmental syndrome caused by heterozygous loss-of-function variants in SIN3A. We define the clinical and neurodevelopmental phenotypes related to SIN3A-haploinsufficiency in 28 unreported patients. Patients with SIN3A variants adversely affecting protein function have mild intellectual disability, growth and feeding difficulties. Involvement of a multidisciplinary team including a geneticist, paediatrician and neurologist should be considered in managing these patients. Patients described here were identified through a combination of clinical evaluation and gene matching strategies (GeneMatcher and Decipher). All patients consented to participate in this study. Mean age of this cohort was 8.2 years (17 males, 11 females). Out of 16 patients ≥ 8 years old assessed, eight (50%) had mild intellectual disability (ID), four had moderate ID (22%), and one had severe ID (6%). Four (25%) did not have any cognitive impairment. Other neurological symptoms such as seizures (4/28) and hypotonia (12/28) were common. Behaviour problems were reported in a minority. In patients ≥2 years, three were diagnosed with Autism Spectrum Disorder (ASD) and four with Attention Deficit Hyperactivity Disorder (ADHD). We report 27 novel variants and one previously reported variant. 24 were truncating variants; three were missense variants and one large in-frame gain including exons 10–12.


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