School of Medicine, University of Limerick, Limerick, Ireland.
Intellectual Disabilities, Nua Healthcare Services, Naas, Ireland.
Ann Med. 2022 Dec;54(1):2486-2499. doi: 10.1080/07853890.2022.2121853.
BACKGROUND/OBJECTIVE(S): Psychotropic medications are commonly prescribed among adults with intellectual disability, often in the absence of a psychiatric diagnosis. The aim of this scoping review is to provide an overview of the extent, range, and nature of the available research on medication use and practices and medication management in people with intellectual disability taking psychotropic medications for behaviours that challenge.
A scoping review of research studies (qualitative, quantitative, and mixed design) and Grey Literature (English) was carried out. Databases included: Ovid MEDLINE, Embase, CINAHL, JBI Evidence Synthesis, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Scopus. A three-step search strategy was followed, with results screened by two independent reviewers. Data was extracted independently by two reviewers using a data extraction tool with results mapped and presented using a narrative form supported by tables and diagrams to the research questions.
Following the removal of duplicates, records were screened, full texts assessed, and 49 studies were included. Medication outcomes included reduced repetitive, stereotypic, and/or aggressive behaviours. High dosing/prescribing in the setting of an absent/unclear clinical indication was associated with worsening of symptoms for which psychotropics were prescribed. While psychotropics had a role in managing behaviours that challenge, reducing or discontinuing psychotropics is sometimes warranted. Study designs were frequently pragmatic resulting in small sample sizes and heterogeneous cohorts receiving different doses and combinations of medications. Access to multidisciplinary teams, guidelines, medication reviews, staff training, and enhanced roles for carers in decision-making were warranted to optimize psychotropic use.
These findings can inform prescribing interventions and highlight the need for timely and comprehensive patient outcome data, especially on long-term use of high doses of psychotropics and what happens when reduce or stop prescribing these doses.KEY MESSAGESPsychotropic medications are frequently prescribed for people with intellectual disabilities, often at high doses and these medications are associated with both positive and negative patient outcomes.Work to rationalize psychotropic use has been reported with interventions aiming to reduce polypharmacy or deprescribe a single psychotropic medicine. These interventions had mixed success and risk of relapse was documented in some studies.Limitations in sample size and heterogenous patient cohorts make it challenging to understand the risks and benefits associated with reducing or stopping psychotropic medicines.Patient, carer, and clinician partnerships are critical to advance medication management.
背景/目的：精神药物在智障成年人中经常被处方使用，而通常没有精神科诊断。本研究的目的是提供一个关于使用精神药物治疗行为挑战的智障患者的药物使用和实践以及药物管理的研究范围、范围和性质的概述。
对研究论文（定性、定量和混合设计）和灰色文献（英文）进行了范围综述。数据库包括：Ovid MEDLINE、Embase、CINAHL、JBI 证据综合、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、PsycINFO 和 Scopus。采用三步搜索策略，由两名独立审查员筛选结果。两名审查员使用数据提取工具独立提取数据，结果以表格和图表形式呈现，支持研究问题的叙述形式。
在去除重复项后，筛选记录，评估全文，并纳入 49 项研究。药物治疗结果包括减少重复、刻板和/或攻击性行为。在没有/不清楚临床指征的情况下高剂量/处方与所开精神药物治疗的症状恶化有关。虽然精神药物在治疗行为挑战方面有一定作用，但有时需要减少或停止使用精神药物。研究设计通常是实用的，导致样本量小且接受不同剂量和组合药物的异质队列。需要获得多学科团队、指南、药物审查、人员培训以及增强护理人员在决策中的作用，以优化精神药物的使用。
这些发现可以为处方干预提供信息，并强调需要及时和全面的患者结果数据，特别是关于长期使用高剂量精神药物以及减少或停止使用这些剂量时会发生什么情况。
精神药物经常被开给智障人士，通常剂量较高，这些药物与患者的积极和消极结果都有关联。已经报道了旨在减少多种药物或停止单一精神药物的药物使用合理化工作。这些干预措施的效果不一，一些研究记录了复发的风险。由于样本量和异质患者队列的限制，很难了解减少或停止使用精神药物相关的风险和益处。患者、护理人员和临床医生的合作对于推进药物管理至关重要。
