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Trinity Centre for Ageing and Intellectual Disability

February TCAID: Psychotropic use in the management of mental and behavioural disorders in people with intellectual disability, Insights from Dr. Vilma Maria Vera Pezo

 

Dr. Vilma Maria Vera Pezo

A recent study led by Dr. Vilma Maria Vera Pezo, Senior Registrar, Home-Based Treatment Team, South Lee Mental Health Services, Cork University Hospital (HSE), utilizing data from the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), sheds light on the use of psychotropic medications in adults with intellectual disabilities. The findings highlight key concerns regarding prescribing patterns and associated health risks in this vulnerable population.

Intellectual disabilities are common and lifelong, with mental ill-health affecting 40.9% of adults with an intellectual disability. Antipsychotics are among the most prescribed psychotropic medications for those with intellectual disability, yet prior research suggests their use often exceeds the recorded prevalence of severe mental illness.

This study aimed to examine the prevalence of psychotropic use in adults with intellectual disability and its association with mental health conditions and challenging behaviour. Additionally, the study explored the prevalence of physical health risk factors in this population. Data was drawn from Wave 3 of IDS-TILDA, a sample 753 individuals with ID aged 41–90 years. Self-reported doctor diagnoses provided information on mental illness, with self-report questionnaires completed by participants where possible, carers, or staff.

Results from the sample, of which 44.2% were male, and 55.8% female, showed:

  • Severe mental illness was reported in 17.3% of cases, including schizophrenia (7.1%), other psychosis (6.7%), and bipolar disorder (3.5%).
  • 62.5% of participants reported anxiety and 30.4% reported depression.
  • A history of challenging behaviour was reported by 60% of participants.
  • Psychotropic medications were prescribed to 56% of participants, with antipsychotics (40.4%) and antidepressants (30.2%) being the most common.
  • Among those prescribed antipsychotics (n= 199), 75.9% did not have a recorded diagnosis of severe mental illness.
  • Of those with challenging behaviour (n=287), 70.7% received psychotropics, and 54% were prescribed antipsychotics.
  • Physical risk factors identified included, 48.1% of participants being overweight and obese, with 74.9% of participants displaying a significantly increased waist circumference.

People with ID are prescribed psychotropics for various reasons, with antipsychotics frequently used for managing challenging behaviours. The study highlights significant health risks associated with psychotropic use. People who are overweight or obese are at increased risk for serious conditions including depression, anxiety, hypertension, diabetes, cardiovascular disease and cancer. Furthermore, psychotropic drug-related weight gain is a common occurrence.

Despite these risks, health promotion strategies have rarely targeted this population. The findings emphasize the need for improved prescribing practices and tailored health interventions to mitigate physical health risks, enhance well-being, and prevent early mortality among individuals with intellectual disability. 

If you are interested in collaborating with us, exploring our research, or analysing our data, please contact Mr. Gavin Dann at danng@tcd.ie or Ms. Pavithra P. at PAVITHRP@tcd.ie.