Management of psychotropic medications in adults with intellectual disability: a scoping review

Figures & data

Figure 1. PRISMA flow diagram. From Page et al. [26]. For more information, visit: http://www.prisma-statement.org/.

Table 1. Inclusion exclusion criteria.

Inclusion criteria	Study design: all research designs including reviews (systematic, integrative, and narrative) and research (qualitative, quantitative, and mixed design studies). In addition, national and international policies, strategies, guidelines, and standards will also be examined. Year of publication: No restriction. Language: English language only.
Exclusion criteria	Article types: commentaries, editorials, opinion pieces, non-systematic literature reviews, case studies. Clinical trials of medicinal product.

Table 2. A summary of 15 studies that reported prevalence of psychotropic medication use.

References	Prevalence of psychotropic medication prescribed	Study setting
Branford [27]	49% (n = 98) thioridazine, 26% (n = 52) chlorpromazine, 17% (n = 34) zuclopenthixol, and 8% (n = 15) haloperidol of a sample of 198.	In-patient and community settings.
Bowring et al. [28]	37.73% (n = 100) of a sample of 265.	In-patient and community settings.
de Kuijper and Hoekstra [29]	9% (n = 88) of a sample of 88 prescribed 2 or more psychotropics.	Community setting.
Deb et al. [2]	88% (n = 88) of a sample of 100 at baseline (T1). 91% (n = 70) of a sample of 77 at 6 month follow up (T2).	Community setting.
Erickson [30]	86.7% (n = 13) of a sample of 15.	Community setting.
Espadas et al. [31]	48% (n = 40) antipsychotics, 22% (n = 18) anticonvulsants, 17% (n = 14) anxiolytics, and 13% (n = 11) antidepressant all of a sample of 83.	Community setting.
Holden and Gitlesen [32]	110 (37.4%) of a sample of 300.	Community setting.
Kastner et al. [33]	88.9% (n = 16) of a sample of 18.	Tertiary-care setting.
Niven et al. [34]	58% (n = 61) of a sample of 106.	Community setting.
Perry et al. [35]	90% (n = 322) of a sample of 358.	In-patient and community settings.
Sachdev [36]	60.4% (n = 32) of a sample of 53.	Inpatient setting.
Song et al. [37]	43% (n = 39) of a sample of 138 in 2002, 51% (n = 42) of a sample of 93 in 2006, 53% (n = 57) of a sample of 111 in 2007–2011, and 54% (n = 45) 2012–2015 of a sample of 92.	Community setting.
Tan et al. [38]	Antidepressants 71.2% (n = 2160), Antipsychotics 58.4% (n = 1772), Anxiolytics, sedatives, hypnotics 32.0% (n = 967), CNS stimulants 3.8% (n = 116), Miscellaneous CNS agents 0.7% (n = 22) all in a sample of 3033.	Community setting.
Tsakanikos et al. [39]	76.8% (n = 52) of a sample of 69.	Community setting.

Table 3. A summary of 15 studies that reported efficacy or side effects of psychotropic medication use in people with ID.

Study design		Key findings
Prospective cohort study	Deb et al. [2]	Risperidone, chlorpromazine, haloperidol, olanzapine, zuclopenthixol, quetiapine, SSRIs (citalopram, paroxetine, and fluoxetine), and mood stabilizers (carbamazepine and sodium valproate) in higher doses—more severe aggressive behaviour, physical aggression towards objects, self-injurious behaviour
	Drmic and Franic [46]	Olanzapine—improvement in disruptive behaviour
	Sachdev [36]	Neuroleptics—associated with tardive dyskinesia
Retrospective	Janowsky et al. [47]	Reduction of Haloperidol or Haloperidol equivalents in the case of Thiothixene and Loxapine—all relapses were clinically significant
	Ruedrich et al. [48]	Divalproex sodium or valproic acid—Improvement in self-injurious behaviour/disruptive behaviour
	Ruedrich et al. [49]	Risperidone, quetiapine, olanzapine—decreased aggression
Pragmatic trial with variety of design	Kastner et al. [33]	Valproic acid—improvement in problem behaviour
	Troisi et al. [50]	Fluoxetine—increased aggression
	Tyrer et al. [51]	Placebo, haloperidol, and risperidone—reduction in aggression was noted with all treatments after 4 weeks (greatest decrease was with placebo)
Randomized controlled trial	Schwarz et al. [52]	Zuclopenthixol—decreased aggression
	Hässler et al. [53]	Zuclopenthixol—improvement in disruptive behaviour
Systematic/narrative review	Aman and Singh [42]	Antipsychotic drugs—reduced adaptive behaviour and learning
	Ji and Findling [54]	Methylphenidate—reduction in ADHD symptoms Lithium—reduced aggression Antidepressants—sometimes poorly tolerated with limited evidence of efficacy
	de Leon et al. [11]	NGA drugs—less toxic than clozapine, less EPS. Metabolic syndrome complications may be worse with some NGAs vs. high-potency conventional antipsychotics.
	Sohanpal et al. [55]	Antidepressants, particularly SSRIs, improve aggression, SIB, and other behaviour problems on average in <50% of cases, and the rest show either no improvement or deterioration

NGA: next-generation antipsychotics; EPS: extrapyramidal side effects.

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Data availability statement

The dataset used and analyzed during the current study are available from the corresponding author upon reasonable request.