Psychoactive drug use in an institution for intellectually handicapped persons

Area of Science:

• Psychiatry
• Developmental Disabilities
• Clinical Pharmacology

Background:

• Long-stay institutions for individuals with developmental disabilities often face challenges in psychotropic medication management.
• Previous research has indicated a persistent issue of overmedication in this population over several decades.

Purpose of the Study:

• To investigate the patterns and appropriateness of psychoactive drug use in long-term institutionalized individuals with developmental disabilities.
• To assess the relationship between psychotropic medication, problem behaviors, and neurological side effects.

Main Methods:

• A cross-sectional study involving 53 residents in three wards of a psychiatric hospital in New South Wales.
• Comprehensive review of medical charts and medication records, clinical examinations, and standardized assessments for behavioral problems and movement disorders.
• Classification of intellectual disability using DSM-III-R criteria.

Main Results:

• Neuroleptics were the most frequently prescribed psychoactive drugs, with 60.4% of residents receiving them, often at high doses.
• Neuroleptic use correlated with the severity of problem behaviors, not with psychiatric diagnoses.
• Significant prevalence of movement disorders, including tardive dyskinesia (34%) and tremor (30%), was observed in residents on neuroleptics.

Conclusions:

• Despite decades of research highlighting overmedication, the problem persists in some institutions for individuals with developmental disabilities.
• The findings suggest a need for re-evaluation of psychotropic prescribing practices and improved management of behavioral issues in institutionalized populations.
• Suboptimal management of epilepsy was also noted, indicating broader therapeutic challenges.