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Off-Label Antipsychotic Withdrawal in People With Intellectual Disabilities: Development and Internal Validation of a

Joëlle Weijgertze-Lanser1,2, Maureen B G Wissing1,2, Roy G Elbers1,2

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Antipsychotic withdrawal attempts in individuals with intellectual disabilities are often unsuccessful. Higher intellectual disability severity, increased antipsychotic dosage, and stereotypy predict withdrawal failure.

Keywords:
antipsychoticschallenging behaviourintellectual disabilitiesoff‐labelwithdrawal

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Off-label antipsychotic medication use is prevalent in individuals with intellectual disabilities and challenging behaviors.
  • Antipsychotic withdrawal is clinically recommended but frequently unsuccessful in this population.
  • Predicting successful withdrawal is crucial for optimizing patient care and reducing polypharmacy.

Purpose of the Study:

  • To develop and internally validate a prediction model for unsuccessful antipsychotic withdrawal attempts.
  • To identify key predictors associated with incomplete antipsychotic withdrawal in people with intellectual disabilities.
  • To provide clinicians with tools to better anticipate and manage withdrawal attempts.

Main Methods:

  • Analysis of data from 141 participants with intellectual disabilities undergoing antipsychotic withdrawal.
  • Multivariable logistic regression with backward selection to identify significant predictors.
  • Internal validation using bootstrapping to assess model performance and generalizability.

Main Results:

  • Level of intellectual disability, defined daily dose (DDD) of antipsychotics, and Aberrant Behavior Checklist (ABC) stereotypy scores were significant predictors of unsuccessful withdrawal.
  • The model explained 20% of the variance in withdrawal success (Nagelkerke's R-square = 0.200).
  • The model demonstrated fair to good discrimination (AUC = 0.728), with an optimism-corrected AUC of 0.706.

Conclusions:

  • Increased odds of unsuccessful antipsychotic withdrawal are associated with more severe intellectual disability, higher antipsychotic DDD, and higher ABC stereotypy scores.
  • These findings offer valuable insights for healthcare providers to anticipate and support antipsychotic withdrawal attempts.
  • The validated prediction model can aid in personalized treatment strategies for individuals with intellectual disabilities.