A new study in the Canadian Journal of Psychiatry reported that 39.2 percent of Ontario adults who have an intellectual disability had been prescribed antipsychotic medications over a six-year period. Nearly one third of the adults did not have a psychiatric diagnosis.
Yona Lunsky, lead author of Antipsychotic Use With and Without Comorbid Psychiatric Diagnosis Among Adults with Intellectual and Developmental Disabilities, is a professor of psychiatry at the University of Toronto and the Director of Health Care Access Research and Developmental Disabilities (H-CARDD) at the Centre for Addiction and Mental Health.
H-CARDD and the Ontario Drug Policy Research Network (ODPRN) studied the use of antipsychotics in 51,881 adults who were part of the Ontario Disability Support Program between 2010 and 2016.
“I think 40% of people with developmental disabilities taking these medications is too many,” she explained in an interview. That rate rose to 56 percent of the 7,219 people living in group homes.
One in five people from the studied group had hypertension, and one in six had diabetes, both of which can be associated with the use of antipsychotics. It is very important to watch for symptoms of these health problems in people taking antipsychotics.
Lunsky strongly believes that, just because the numbers are disconcerting, it doesn’t mean everyone should stop taking their antipsychotics.
“In the right circumstance, these medications are extremely beneficial.”
However, she cautioned that there is a risk that they may be prescribed to some people when they don’t need to be. Given how commonly people get these prescriptions, she said, there needs to be a more careful examination as to why they are prescribed and assurances that they are being safely monitored.
“Sometimes somebody might be given an antipsychotic for behaviour, like aggression, but that aggression could be caused by many things,” she said.
The medication can’t help if the reason for the aggression is pain from an unrecognized medical issue, such as an abscessed tooth,” she said.
A person’s aggression can be their way of communicating their distress. The medication also may not be helpful if the person is behaving that way because they are reacting to a major change in their life, like illness or the death of a loved one, or a work or home environment that is very stressful.
When someone is experiencing distress and showing it through their behaviour, Lunsky believes it’s important to try other avenues before prescribing antipsychotics.
“We need to make sure that adults with developmental disabilities get the right medication if they need it,” according to Lunsky, “but that they can get other kinds of help they need as well, like counseling or behaviour therapy.”
It is important, when an antipsychotic is prescribed, that the patient knows what it is for, and that they understand the side effects to look for. Regular monitoring to make sure the medication is helping and that the side effects are being well managed is also essential.
If someone is taking an antipsychotic medication and they are not sure why or they are not regularly checking that the medication is working well, it is important that they discuss it with their doctor.
In the United Kingdom, STOMP (or Stopping Over Medication of People) has been focused on bringing people together to reduce medication overprescribing. Click here to learn more about this effort.
Lunksy believes it is important that we explore ways to develop similar resources to be used here in Ontario.
“We need to work together,” she said. “People in policy, people in practice, people with disabilities who receive these medications, families, advocates—to better understand why antipsychotics use is so common and figure out what we’re going to do about it.”
Daniel Share-Strom, Community Living Ontario