Psychotropic drug use in intellectually disabled group-home residents with behavioural problems

Little is known about psychiatric and behavioural factors associated with psychotropic drug use and how appropriately these drugs are prescribed in settings for people with intellectual disabilities. The aim of this study was to measure the point prevalence of psychotropic drug use in a problem-behaviour group (PBG) consisting of intellectually disabled residents of group homes compared to a random group (RG), and to gain insight in possible factors that are associated with group membership. From all group homes in the Netherlands, 573 problematic residents were selected by the staff (one resident from each home) and 1479 residents were randomly sampled from all of the homes. Mental health problems were measured using the Reiss Screen for Maladaptive Behaviour and the Psychopathology Instrument for Mentally Retarded Adults. The response rate in the PBG was 68.9 % and in the RG 71.7 %. Psychotropics (excluding anticonvulsants) were used by 52.6 % of the PBG and by 22.8 % of the RG. Young age, psychotic, anxiety, and aggression symptoms were significantly associated with the PBG, as was the use of antipsychotics and antidepressants. The PBG more often used multiple (three or more) drugs (17.3 %) than the RG (7.3 %). A low prevalence of antidepressants or mood stabilisers, antipsychotics, and anxiolytics was found in residents with affective, psychotic, or anxiety symptoms. We conclude that psychotropic drug use in the PBG compared to the RG was high. It is likely that the group-home staff finds it difficult to deal with young people with socially disruptive behaviour, which is underlined by our finding of high prevalence of antipsychotics and multiple-drug therapy in the PBG. Finally, our findings suggest that a considerable number of residents with psychiatric or behavioural symptoms are undertreated.