Text adapted from "Intellectual and developmental disabilties" in Psychiatry in primary care by Yona Lunsky and Johanna Lake, (CAMH, 2019).
People with IDD can have greater sensitivity to medication effects, as well as challenges in describing or reporting side-effects. There is limited evidence about which medications work based on trials with this population, so using standards and evidence from the general population is required.
Adults with IDD are highly likely to experience psychotropic polypharmacy, even though there are adverse effects associated with using multiple medications. In Ontario, antipsychotic medications are the most common medication class prescribed to adults with IDD, often in the absence of a serious mental illness diagnosis (Lunsky et al., 2018).
The primary care IDD guidelines (Sullivan et al., 2018) offer medication- specific guidelines and tools, some of which are summarized below:
- Consider disorder-specific medications as you would for patients without IDD.
- Start low and go slow with medication dosing because people with IDD can be more sensitive to medication side-effects and because it can be more challenging for them to report on these effects.
- Seek informed consent, remembering that if your patient has difficulty understanding the risks and benefits of medication treatment, paid staff would not be able to make decisions about medication. The Decision-Making Checklist (Sullivan et al., 2019) posted on the Surrey Place website is a useful tool to assist with this (see the resources section).
- Arrange to get feedback from patients and caregivers during medication trials. Operationalize how to measure medication side-effects and benefits, and collect information before initiating the medication for later comparison.
- Review response to medication, including adverse reactions and side- effects, every three months. Review the appropriateness of medications if the patient does not respond to them, symptoms get worse, behavioural changes occur or the patient or caregiver requests a review. Consider reducing or tapering the dose or switching medications to address adverse reactions.
Another useful resource is STOMP—Stopping Over-Medication of People with Learning Disability, Autism or Both—a U.K.-based project that has developed material about prescribing and monitoring psychotropic medication.