Less antipsychotics, more Quality of Life tapering strategies for adults with intellectual disabilities and challenging behaviour

IF 2.9 2区医学 Q1 EDUCATION, SPECIAL

Research in Developmental Disabilities Pub Date : 2025-04-22 DOI:10.1016/j.ridd.2025.105020

P. Laermans , F. Morisse , C. Claes , M. Lombardi , S. Vandevelde , K. Audenaert , P. Persoons , G. de Kuijper

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引用次数: 0

Abstract

Background

The long-term off-label use of antipsychotics to manage challenging behaviour in adults with intellectual disabilities is common practice. However, there is limited evidence supporting its effectiveness and safety. Additionally, individuals who use off-label antipsychotics are at risk of experiencing side effects that may negatively impact their Quality of Life.

Aims

This study investigates the impact of tapering off-label antipsychotics on Quality of Life, challenging behaviour, general functioning, and side effects in adults with intellectual disabilities.

Materials and methods

Twenty-five adults with intellectual disabilities and challenging behaviour were monitored over a 40-week period during which off-label antipsychotic medications were gradually tapered. The tapering process was guided by a multidisciplinary team. The primary outcome was Quality of Life, measured using the Anamnestic Comparative Self-Assessment (ACSA), supplemented by a self-designed instrument tailored to the individual.

Secondary outcomes included challenging behaviour, general functioning, and side effects, assessed using the Aberrant Behaviour Checklist (ABC), World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), Section 3B of the Supports Intensity Scale (SIS), and Matson’s Evaluation of Drug Side Effects (MEDS).

Results

At the end of the study (40 weeks), 22 participants were taking lower dosages of antipsychotic medication, with two participants tapering off the antipsychotic drugs entirely. On average, participants reduced their medication dosage by 39.7 %. Following tapering, improvements were observed in Quality of Life and overall functioning, alongside reductions in challenging behaviour and side effects.

Conclusion

The tapering of off-label antipsychotics in adults with intellectual disabilities resulted in a positive impact on Quality of Life. These findings suggest that Quality of Life could serve as a useful outcome measure to support the consideration of more limited off-label use of antipsychotics.

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少用抗精神病药物，多用生活质量递减策略治疗智力残疾和行为困难的成年人

背景：长期在说明书外使用抗精神病药物来管理智力残疾成人的挑战性行为是一种常见的做法。然而，支持其有效性和安全性的证据有限。此外，使用标签外抗精神病药物的人有可能出现副作用，这可能会对他们的生活质量产生负面影响。目的：本研究探讨了逐渐减少说明书外抗精神病药物对智力残疾成人的生活质量、挑战性行为、一般功能和副作用的影响。材料和方法对25名智力残疾且行为具有挑战性的成年人进行了为期40周的监测，在此期间，非标签抗精神病药物逐渐减少。减径过程由一个多学科团队指导。主要结果是生活质量，使用记忆比较自我评估（ACSA）来测量，辅以为个人量身定制的自行设计的工具。次要结局包括挑战行为、一般功能和副作用，采用异常行为检查表（ABC）、世界卫生组织残疾评估表2.0 （WHODAS 2.0）、支持强度量表（SIS）第3B部分和Matson药物副作用评估（MEDS）进行评估。结果在研究结束时（40周），22名参与者服用较低剂量的抗精神病药物，2名参与者完全逐渐停止服用抗精神病药物。参与者平均减少了39.7% %的药物剂量。减量后，观察到生活质量和整体功能的改善，以及挑战性行为和副作用的减少。结论成人智障患者超说明书抗精神病药物的逐渐减少对生活质量有积极影响。这些发现表明，生活质量可以作为一种有用的结果衡量标准，以支持考虑更有限的抗精神病药物的说明书外使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Research in Developmental Disabilities Multiple-

CiteScore

5.50

自引率

6.50%

发文量

178

期刊介绍： Research In Developmental Disabilities is aimed at publishing original research of an interdisciplinary nature that has a direct bearing on the remediation of problems associated with developmental disabilities. Manuscripts will be solicited throughout the world. Articles will be primarily empirical studies, although an occasional position paper or review will be accepted. The aim of the journal will be to publish articles on all aspects of research with the developmentally disabled, with any methodologically sound approach being acceptable.