The use of medications to manage problem behaviours is widespread. However, robust evidence to support their use seems to be lacking. The aim was to review research evidence into the efficacy of atypical antipsychotic medication in managing problem behaviour in children with intellectual disabilities and borderline intelligence. A systematic review was conducted for placebo-controlled randomised double-blind trials. The included studies (N = 6) showed that risperidone was significantly more effective than placebo in managing problem behaviours. However, most studies highlighted adverse events primarily somnolence and weight gain. There is now some evidence in favour of the use of risperidone. However, because of possible adverse events, these medications have to be used with caution.
"Another problem with lithium prescribing is that in some people with severe ID it may not be possible to carry out recommended blood tests. A prospective 12 months follow-up study found little evidence of use of lithium in ID by UK psychiatrists (Unwin et al., 2011). There is not as yet much evidence for the effectiveness of other mood stabilizers such as sodium valproate, carbamazepine, and lamotrigine, which may provide a better alternative to lithium. "
[Show abstract][Hide abstract] ABSTRACT: This review of research into mental disorders in people with intellectual disabilities (ID) focuses on research in this field that has originated from the United Kingdom in the last 2 decades. It considers research developments into the epidemiology of mental disorders and problem behaviors, psychopharmacology, psychosocial interventions, and services for people with ID.
Journal of Mental Health Research in Intellectual Disabilities 04/2013; 6(2):127-158. DOI:10.1080/19315864.2012.708100
[Show abstract][Hide abstract] ABSTRACT: To describe the relationship between mental health diagnosis and treatment with antipsychotics among U.S. Medicaid-enrolled children over time.
Medicaid Analytic Extract (MAX) files for 50 states and the District of Columbia from 2002 to 2007.
Repeated cross-sectional design. Using logistic regression, outcomes of mental health diagnosis and filled prescriptions for antipsychotics were standardized across demographic and service use characteristics and reported as probabilities across age groups over time.
Center for Medicaid Services data extracted by means of age, ICD-9 codes, service use intensity, and National Drug Classification codes.
Antipsychotic use increased by 62 percent, reaching 354,000 youth by 2007 (2.4 percent). Although youth with bipolar disorder, schizophrenia, and autism proportionally were more likely to receive antipsychotics, youth with attention deficit hyperactivity disorder (ADHD) and those with three or more mental health diagnoses were the largest consumers of antipsychotics over time; by 2007, youth with ADHD accounted for 50 percent of total antipsychotic use; 1 in 7 antipsychotic users were youth with ADHD as their only diagnosis.
In the context of safety concerns, disproportionate antipsychotic use among youth with nonapproved indications illustrates the need for more generalized efficacy data in pediatric populations.
Health Services Research 09/2012; 47(5):1836-60. DOI:10.1111/j.1475-6773.2012.01461.x · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Physical and verbal aggression is a significant problem for some individuals with mild intellectual disabilities who reside in the community. We assessed the effectiveness of a mindfulness-based procedure, Meditation on the Soles of the Feet, to control both physical and verbal aggression. The design was a two-group (experimental and waiting list control) randomized controlled trial with four 12-week phases. A total of 57 individuals were referred to the trial, with 34 eligible for random assignment to the experimental and control conditions. Results showed a significant reduction in physical and verbal aggression commensurate with mindfulness-based training, when compared to the waiting list control condition. Similar reductions in physical and verbal aggression were evident when the same training was introduced in the control condition. The results demonstrate the effectiveness of the mindfulness-based procedure for assisting individuals with mild intellectual disabilities to control their physical and verbal aggression.
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