Personal Quality of Life as an Outcome Measure of Antipsychotic Drug Management of Problem Behaviours in Adults with Intellectual Developmental Disorders with or Without Autism Spectrum Disorder.

Abstract

Background/Objectives: First-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) are frequently prescribed for the management of problem behaviours (PBs) in people with intellectual developmental disorders (IDDs) with or without autism spectrum disorder (ASD). However, the different effectiveness of these two groups of drugs has not been adequately investigated, especially in terms of person-centred outcomes, such as quality of life (QoL). The aim of the present observational study was to compare the personal QoL of two groups of people with IDDs with and without ASD, attending the same residential facility, but receiving FGAs and SGAs, respectively, for the management of PBs. Methods: Twenty-two people with IDDs (ten with ASD) receiving FGAs and twenty-three (eleven with ASD) receiving SGAs for the management of PBs were consecutively recruited. The participants underwent a complex clinical and instrumental evaluation, including the systematic psychopathological assessment for persons with intellectual and developmental disabilities-general screening (SPAIDD-G), the Wing's handicaps, behaviours, and skills schedule (HBS), the DOTES, and the BASIQ (QoL Assessment tool battery). Follow-up evaluations were carried out after 6, 12, and 18 months. Results: The use of antipsychotics was withdrawn only in 16 cases, of which only 4 were for significant improvement. Treatment with FGAs was associated with more frequent discontinuation, a higher incidence of side effects, and a trend toward a lower efficacy on PBs than treatment with SGAs. FGAs also improved generic QoL significantly less than SGAs. Conclusions: The present pilot study is the first to compare FGAs and SGAs with respect to the generic QoL in people with IDDs and PBs. SGAs resulted to have a significantly greater positive impact on QoL than FGAs, despite demonstrating similar efficacy in treating PBs.