Impact of the emotional development approach on psychotropic medication in adults with intellectual and developmental disabilities: a retrospective clinical analysis

IF 2.1 2区医学 Q1 EDUCATION, SPECIAL Journal of Intellectual Disability Research Pub Date : 2024-03-28 DOI:10.1111/jir.13136

B. F. Barrett, M. Wehmeyer, J. Kolb, T. Ostermann, T. Sappok

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Abstract

Background

Compared with the general population, adults with an intellectual developmental disorder (IDD) are more likely to develop mental health problems and to receive high levels of psychotropic medication, particularly antipsychotics. The emotional development (ED) approach may help to better understand the nature of challenging behaviour (CB) and tailor treatment and support accordingly. The aim of this retrospective study was to investigate the impact of the ED approach on the prescription of psychotropic medication during inpatient psychiatric treatment.

Methods

The clinical data of 1758 patients were analysed within a retrospective study design over a period of 12 years. ED level was assessed (1) for the first time (INITIAL-SEO), (2) during a previous hospital stay (PAST-SEO) or (3) not at all (NO-SEO). The effects of the ED assessment and the respective intervention during the current admission on the number of psychotropics and the number and dosage of antipsychotics were analysed for the total sample, including those with CB, autism spectrum disorders and psychosis. Group differences were analysed by a chi-square test and a one-factorial analysis of variance. For analysing the impact of the application of the ED approach on psychotropic medication, a covariance model was applied. Changes between the subsamples were analysed by t-tests for dependent samples.

Results

The ED approach had a significant impact on reducing the overall amount of psychotropic medication and the dosage of antipsychotics in all patients with IDD. These effects were mainly attributable to those showing CB. In patients with autism spectrum disorders, the developmental approach reduced the number of antipsychotics. No effects could be observed in patients with psychosis; in this subsample, both the number and dosage of antipsychotics increased.

Conclusions

The application of the ED approach in the current hospital stay reduced the number of psychotropic drugs and the number and dosage of antipsychotics, especially in those patients with IDD and CB, but also in those with autism spectrum disorders.

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情绪发展法对智力和发育障碍成人精神药物治疗的影响：回顾性临床分析。

背景：与普通人群相比，患有智力发育障碍（IDD）的成年人更容易出现心理健康问题，并接受大量的精神药物治疗，尤其是抗精神病药物。情绪发展（ED）方法可能有助于更好地了解挑战性行为（CB）的性质，并据此调整治疗和支持。这项回顾性研究旨在调查情绪发展法对精神病住院治疗期间精神药物处方的影响：方法：采用回顾性研究设计，分析了 1758 名患者 12 年来的临床数据。对急诊室水平进行了评估：(1) 首次评估（INITIAL-SEO）；(2) 前次住院期间评估（PAST-SEO）；(3) 完全未评估（NO-SEO）。我们对包括 CB、自闭症谱系障碍和精神病患者在内的所有样本进行了分析，以了解 ED 评估和本次入院期间的相应干预措施对精神药物使用数量以及抗精神病药物使用数量和剂量的影响。组间差异通过卡方检验和单因子方差分析进行分析。为了分析 ED 方法的应用对精神药物治疗的影响，采用了协方差模型。子样本之间的变化通过因果样本 t 检验进行分析：结果：ED 方法对减少所有 IDD 患者的精神药物总量和抗精神病药物剂量有显著影响。这些效果主要归功于那些表现为CB的患者。在自闭症谱系障碍患者中，发展疗法减少了抗精神病药物的用量。在精神病患者中未观察到任何效果；在该子样本中，抗精神病药物的数量和剂量均有所增加：结论：在目前的住院治疗中，采用发展性治疗方法减少了精神药物的数量以及抗精神病药物的数量和用量，尤其是在IDD和CB患者以及自闭症谱系障碍患者中。

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来源期刊

Journal of Intellectual Disability Research Multiple-

CiteScore

5.60

自引率

5.60%

发文量

期刊介绍： The Journal of Intellectual Disability Research is devoted exclusively to the scientific study of intellectual disability and publishes papers reporting original observations in this field. The subject matter is broad and includes, but is not restricted to, findings from biological, educational, genetic, medical, psychiatric, psychological and sociological studies, and ethical, philosophical, and legal contributions that increase knowledge on the treatment and prevention of intellectual disability and of associated impairments and disabilities, and/or inform public policy and practice. Expert reviews on themes in which recent research has produced notable advances will be included. Such reviews will normally be by invitation.