Janowsky David S, Barnhill L Jarrett, Khalid Abdul S, Davis John M
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7175, USA.
J Clin Psychiatry. 2006 Aug;67(8):1272-7. doi: 10.4088/jcp.v67n0815.
Mental retardation is frequently associated with aggression toward self and others. Antipsychotic medications are frequently used as a major treatment of such aggression. However, national and state policies and guidelines are weighted toward stopping or decreasing the doses of these medications whenever possible, although exceptions are permitted. The purpose of this study was to determine if relapse during or after antipsychotic drug withdrawal in mentally retarded adults predicts continuing antipsychotic drug use an average of a decade later.
We report here on a 6- to 13-year (average 10-year) follow-up of 151 institutionalized mentally retarded adults. During the period 1990-1997, the subjects had been prescribed antipsychotic medications to treat maladaptive behaviors, primarily consisting of aggression, disruptive/destructive behaviors, or a combination of these. We compared subjects' psychotropic medication profiles in 2003 as they related to outcome during the earlier period. Our goal was to determine if rapid relapse (a clinically significant increase in maladaptive target symptoms, beginning 3 months or less after antipsychotic drug termination or dosage reduction, that was reversed by antipsychotic drug reinstitution or dosage increases) during or after routine withdrawal of an antipsychotic predicted psychotropic drug use in 2003.
For those individuals successfully withdrawn from antipsychotic medications, 66.3% (55/83) were still psychotropic drug free in 2003. For those who rapidly relapsed during the period 1990-1997 following antipsychotic drug withdrawal or dosage decreases, only 9.0% (5/55) were psychotropic medication free in 2003.
These observations support policies and guidelines indicating that attempts to stop treatment with antipsychotic medications in mentally retarded individuals are worthwhile. However, the results also indicate that eventual discontinuation of antipsychotic medications in institutionalized mentally retarded adults who have previously relapsed upon such withdrawal is unlikely to be successful. Rigid adherence to drug withdrawal policies and guidelines in such individuals should be reconsidered.
智力迟钝常与对自己及他人的攻击行为相关。抗精神病药物常被用作此类攻击行为的主要治疗手段。然而，国家和州的政策及指南倾向于尽可能停用或减少这些药物的剂量，不过也允许有例外情况。本研究的目的是确定智力迟钝的成年人在停用抗精神病药物期间或之后复发是否能预测平均十年后仍继续使用抗精神病药物。
我们在此报告对151名机构收容的智力迟钝成年人进行的6至13年（平均10年）的随访情况。在1990年至1997年期间，这些受试者曾被开具抗精神病药物以治疗适应不良行为，主要包括攻击行为、破坏/捣乱行为或这些行为的组合。我们比较了2003年受试者的精神药物使用情况与早期的结果之间的关系。我们的目标是确定在常规停用抗精神病药物期间或之后出现的快速复发（在抗精神病药物停药或减量后3个月或更短时间内，适应不良目标症状出现临床上显著增加，且通过重新使用抗精神病药物或增加剂量可逆转）是否能预测2003年的精神药物使用情况。
对于那些成功停用抗精神病药物的个体，2003年有66.3%（55/83）仍未使用精神药物。对于那些在1990年至1997年期间抗精神病药物停药或减量后快速复发的个体，2003年只有9.0%（5/55）未使用精神药物。
这些观察结果支持相关政策和指南，表明尝试停用智力迟钝个体的抗精神病药物治疗是值得的。然而，结果也表明，对于之前在停药时复发过的机构收容智力迟钝成年人，最终停用抗精神病药物不太可能成功。对此类个体严格遵守停药政策和指南应重新考虑。
