Henderson Angela, Mcskimming Paula, Kinnear Deborah, McCowan Colin, McIntosh Alasdair, Allan Linda, Cooper Sally-Ann
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
BMJ Open. 2020 Sep 10;10(9):e036862. doi: 10.1136/bmjopen-2020-036862.
To investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses.
Comparison of cross-sectional data in 2002-2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data.
General community.
1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data.
Encashed regular and as-required psychotropic prescriptions.
50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001).
Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews.
调查10年间智力残疾人群的精神药物处方情况以及相关的精神健康诊断。
对2002 - 2004年（T1）和2014年（T2）的横断面数据进行比较。在T1进行详细健康评估的纵向队列研究，并将记录与T2的处方数据相链接。
普通社区。
T1组有1190名成年智力残疾者，T2组有3906名成年智力残疾者。T1组中545/1190名成年智力残疾者存活，其记录与T2的处方数据相链接。
兑现的常规和按需使用的精神药物处方。
T1组中50.7%（603/1190）的成年人以及T2组中48.2%（1881/3906）的成年人至少开具了一种精神药物；抗精神病药物：T1组为24.5%（292/1190），T2组为16.7%（653/3906）；抗抑郁药物：T1组为11.2%（133/1190），T2组为19.1%（746/3906）。T1组中开具抗精神病药物的人里，21.2%（62/292）患有精神病或双相情感障碍，33.2%（97/292）没有精神健康问题或问题行为，20.6%（60/292）有问题行为但没有精神病或双相情感障碍。精神药物的使用从T1的47.0%（256/545）增加到T2的57.8%（315/545）（p<0.001）：抗精神病药物未变化（比值比1.18；95%可信区间0.87至1.60；p = 0.280），抗抑郁药物增加（比值比2.80；95%可信区间1.96至4.00；p<0.001），催眠药/抗焦虑药（比值比2.19；95%可信区间1.34至3.61；p = 0.002），以及抗癫痫药（比值比1.40；95%可信区间1.06至1.84；p = 0.017）。T1中有问题行为的人抗精神病药物处方增加（比值比6.45；95%可信区间4.41至9.45；p<0.001），比T1中患有其他精神健康问题的人增加得更多（比值比4.11；95%可信区间2.76至6.11；p<0.001）。
尽管对抗精神病药物处方存在担忧且指南建议停用，但似乎虽然T2时起始的抗精神病药物处方比T1时少，但人们一旦开始使用就没有停用。有问题行为的人处方增加。抗抑郁药物处方也显著增加。成年智力残疾者需要频繁且仔细的药物审查。
