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Psychopharmacology

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Handbook of Evidence-Based Practices in Intellectual and Developmental Disabilities

Part of the book series: Evidence-Based Practices in Behavioral Health ((EBPBH))

Abstract

Psychotropic medications are used regularly for the management of problem behavior including aggression and self-injurious behavior (SIB) in individuals with intellectual disabilities (ID) in the absence of a diagnosed psychiatric disorder. This practice is controversial because these medications are not licensed for this purpose, the scientific evidence to support their use is often lacking, these medications could potentially cause long-term adverse effects, and once started withdrawal of these medications are difficult. Psychotropic medications used for this purpose include antipsychotics, antidepressants, mood stabilizers including antiepileptics, psychostimulants, opioid antagonists, beta blockers, and antianxiety medications. Evidence for the efficacy of psychotropic medication based on systematic reviews is presented in this chapter. It appears that there are only three RCTs involving risperidone among adults with ID, of which two showed risperidone being effective when compared with placebo but one study showed no significant difference in the efficacy among placebo, risperidone, and haloperidol. Six RCTs involving children with ID and with and without autism spectrum disorder (ASD) showed risperidone being significantly more effective compared with the placebo. A number of open label longitudinal continuation studies following RCTs of risperidone have shown that the efficacy of risperidone had lasted over many months and the adverse effects were tolerable. In two pharmaceutical company run studies aripiprazole was shown to be significantly effective compared with placebo in children with ASD, some of whom also had ID. The improvement lasted for many weeks in an open label extension study. There is concern about adverse effects from risperidone such as somnolence and weight gain. It is, therefore, suggested that the use of psychotropic medication in this context should be monitored carefully and regularly using national and international guides.

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Acknowledgement

This chapter is adapted from Deb (2009) and Deb (2013).

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  1. Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK

    Shoumitro Deb

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    Nirbhay N. Singh

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Deb, S. (2016). Psychopharmacology. In: Singh, N. (eds) Handbook of Evidence-Based Practices in Intellectual and Developmental Disabilities. Evidence-Based Practices in Behavioral Health. Springer, Cham. https://doi.org/10.1007/978-3-319-26583-4_13

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