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 A pharmacist-led pilot using a performance dashboard to improve psychotropic medication use in a skilled nursing facility

2020 ◽  
Vol 9 (3) ◽  
pp. e000997
Author(s):  
Kristin Bell ◽  
Christine Hartmann ◽  
Amy Wisteria Baughman
Keyword(s):  
Psychotropic Medication ◽  
Clinical Care ◽  
Skilled Nursing Facility ◽  
Medication Use ◽  
Psychotropic Medications ◽  
Successful Implementation ◽  
Prescribing Practices ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Inappropriate Use

ObjectivesInappropriate use of psychotropic medications in the elderly, particularly those with dementia, is a critical safety and quality concern. This pilot quality improvement study used a novel Department of Veterans Affairs (VA) Psychotropic Drug Safety Initiative performance dashboard (PDSI dashboard) to implement a pharmacist-led intervention to improve psychotropic medication prescribing practices in a VA skilled nursing facility (SNF). While clinical dashboard data have become commonplace, literature describing successful implementation for improved clinical care is scant.MethodsThis study took place from November 2015 to February 2016 at a 112-bed VA SNF. A pharmacist used the PDSI dashboard to identify ‘actionable’ patients with potentially inappropriate psychotropic prescribing and then completed chart reviews to confirm clinical indications. The pharmacist provided recommendations to providers for dose reductions or deprescribing via in-person communication and notes written in the electronic medical record. SNF providers completed anonymous surveys about their experience in receiving recommendations.ResultsOver a 5-month period, the PDSI dashboard identified 21 patients with potentially inappropriate psychotropic medication use, with approximately one new patient identified each week. Prescribing recommendations were accepted 66% of the time. All seven SNF providers reported that recommendations were helpful in improving their psychotropic prescribing practices.ConclusionsThe PDSI dashboard was efficient and effective in identifying patients at risk for inappropriate use of psychotropic medications. A clinical pharmacist was essential for implementing and communicating recommendations from the dashboard to providers.

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

BJPsych Open ◽  
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.

Regular medication use by active scuba divers with a declared comorbid medical condition and victims of scuba and snorkelling-related fatalities

2021 ◽  
Vol 51 (3) ◽  
pp. 264-270
Author(s):  
Simone E Taylor ◽  
◽  
David McD Taylor ◽  
Daisy Pisasale ◽  
Kyle Booth ◽  
...  
Keyword(s):  
Medical Condition ◽  
Medication Use ◽  
Psychotropic Medications ◽  
Asia Pacific ◽  
Psychological Conditions ◽  
Scuba Divers ◽  
Australian State ◽  
Psychiatric Conditions ◽  
Medical Examinations ◽  
Comorbid Medical Condition

Introduction: The aim of this study was to describe the nature of regular medications taken by active comorbid scuba divers (having a declared medical comorbidity) and scuba divers and snorkellers who died following a diving incident. Methods: We undertook a retrospective, observational study from July to October, 2020. Data on 268 active comorbid divers were obtained through a 2013 survey of Divers Alert Network Asia-Pacific members. Data on 126 deceased scuba divers and 175 deceased snorkellers were obtained predominantly from 2001–2013 reports to Australian State Coronial Services. Results: The active comorbid divers were significantly older, less likely to be male, and more likely to be taking one or more medications than the two deceased subject groups (P < 0.001). Cardiovascular, endocrine and psychotropic medications accounted for 53.4%, 9.9% and 6.4% of all medications taken, respectively. Almost one tenth of the deceased divers took at least one psychotropic medication, a proportion significantly greater than the other groups (P = 0.01). Conclusions: Medication use among active comorbid divers is common which likely reflects their declared medical condition. Nevertheless, they appear to be diving relatively safely, often with conditions once thought to be absolute contradictions to scuba diving. The deceased divers took significantly more psychotropic medications. It is possible that their underlying psychological/psychiatric conditions rendered them more at risk of a diving incident. Increased vigilance for psychological conditions may need to be considered during diving medical examinations.

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

2020 ◽  
Vol 37 (3) ◽  
pp. 231-236 ◽  
Author(s):  
K. Courtenay ◽  
B. Perera
Keyword(s):  
Intellectual Disability ◽  
Infectious Diseases ◽  
Psychotropic Medication ◽  
Mental Stress ◽  
Cognitive Impairments ◽  
Social Effects ◽  
Rigorous Approach ◽  
Challenging Behaviours ◽  
Community Supports ◽  
Placement Breakdown

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.

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

2021 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n=31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals Experiences of psychotropic medication use and decision-making for adults with intellectual disability: a multistakeholder qualitative study in the UK

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032861 ◽  
Author(s):  
Rory Sheehan ◽  
Angela Hassiotis ◽  
André Strydom ◽  
Nicola Morant
Keyword(s):  
Decision Making ◽  
Intellectual Disability ◽  
Psychotropic Medication ◽  
Stakeholder Involvement ◽  
Medication Use ◽  
Care Providers ◽  
Family Carers ◽  
Joint Decisions ◽  
The Uk ◽  
Medication Decisions

ObjectivesUnderstanding patient and carer perspectives is essential to improving the quality of medication prescribing. This study aimed to explore experiences of psychotropic medication use among people with intellectual disability (ID) and their carers, with a focus on how medication decisions are made.DesignThematic analysis of data collected in individual semistructured interviews.Participants and settingFourteen adults with ID, 12 family carers and 12 paid carers were recruited from specialist psychiatry services, community groups, care providers and training organisations in the UK.ResultsPeople with ID reported being highly compliant with psychotropic medication, based on a largely unquestioned view of medication as important and necessary, and belief in the authority of the psychiatrist. Though they sometimes experienced medication negatively, they were generally not aware of their right to be involved in medication decisions. Paid and family carers reported undertaking a number of medication-related activities. Their ‘front-line’ status and longevity of relationships meant that carers felt they possessed important forms of knowledge relevant to medication decisions. Both groups of carers valued decision-making in which they felt they had a voice and a genuine role. While some in each group described making joint decisions about medication with psychiatrists, lack of involvement was often described. This took three forms in participants’ accounts: being uninformed of important facts, insufficiently included in discussions and lacking influence to shape decisions. Participants described efforts to democratise the decision-making process by gathering information, acting to disrupt perceived power asymmetries and attempting to prove their credibility as valid decision-making partners.ConclusionsStakeholder involvement is a key element of medication optimisation that is not always experienced in decisions about psychotropic medication for people with ID. Forms of shared decision-making could be developed to promote collaboration and offer people with ID and their carers greater involvement in medication decisions.

Direct care staff knowledge about medication for individuals with intellectual disabilities

2019 ◽  
Vol 13 (3/4) ◽  
pp. 144-151
Author(s):  
Amanda Sawyer ◽  
Johanna Lake ◽  
Yona Lunsky
Keyword(s):  
Intellectual Disabilities ◽  
Psychotropic Medication ◽  
Medication Use ◽  
Medication Administration ◽  
Psychotropic Medications ◽  
Direct Care ◽  
Care Staff ◽  
Direct Care Staff ◽  
Content Type ◽  
Adults With Intellectual Disabilities

Purpose The majority of adults with intellectual disabilities (ID) are prescribed at least one, if not multiple medications, with psychotropic medications being the most commonly prescribed. Direct care staff play an important role in psychotropic medication administration and monitoring, yet little is known about their knowledge and comfort with medication. The paper aims to discuss this issue. Design/methodology/approach A 15-item survey, focusing on self-reported knowledge and comfort with psychotropic medication, was completed by 152 direct care staff employed at three agencies providing residential services for individuals with ID across Ontario. Findings In total, 62 per cent of staff respondents reported that psychotropic medications were among the top medications regularly taken by the individuals they support, with behaviour listed as the most commonly reported reason for taking this medication. The majority of staff reported monitoring medication, however, the frequency of monitoring varied considerably. Generally, staff reported feeling comfortable and knowledgeable about medication use, but, most reported a desire for additional medication training. Originality/value This is the first Canadian study to examine staff knowledge and comfort regarding medication use, and the first study to assess PRN (“as needed”) as well as regularly administered medications.

scholarly journals Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 74
Author(s):  
Mohsen Bazargan ◽  
Sharon Cobb ◽  
Cheryl Wisseh ◽  
Shervin Assari
Keyword(s):  
Older Adults ◽  
African American ◽  
Back Pain ◽  
Psychotropic Medication ◽  
Economically Disadvantaged ◽  
Severe Pain ◽  
Medication Use ◽  
Psychotropic Medications ◽  
Self Rated Health ◽  
African American Older Adults

African-American older adults, particularly those who live in economically deprived areas, are less likely to receive pain and psychotropic medications, compared to Whites. This study explored the link between social, behavioral, and health correlates of pain and psychotropic medication use in a sample of economically disadvantaged African-American older adults. This community-based study recruited 740 African-American older adults who were 55+ yeas-old in economically disadvantaged areas of South Los Angeles. Opioid-based and psychotropic medications were the outcome variables. Gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), continuity of medical care, health management organization membership, sleeping disorder/insomnia, arthritis, back pain, pain severity, self-rated health, depressive symptoms, and major chronic conditions were the explanatory variables. Logistic regression was used for data analyses. Arthritis, back pain, severe pain, and poor self-rated health were associated with opioid-based medications. Pain severity and depressive symptoms were correlated with psychotropic medication. Among African-American older adults, arthritis, back pain, poor self-rated health, and severe pain increase the chance of opioid-based and psychotropic medication. Future research should test factors that can reduce inappropriate and appropriate use and prescription of opioid-based and psychotropic medication among economically disadvantaged African-American older adults.

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.

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