28 - References

References

Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 References

1. Deb S. The use of medications for the management of problem (challenging) behaviours in adults who have intellectual disabilities. University of Hertfordshire. 2012 (revised 2018, last accessed July 2024); https://www.intellectualdisability.info/mental-­health/articles/the-­use-­of- ­medications-­for-­the-­management-­of-­problem-­behaviours-­in-­adults-­who-­have-­intellectual-­disabilities.
2. Sheehan R, et al. Psychotropic prescribing in people with intellectual disability and challenging behaviour. BMJ 2017; 358:j3896.
3. Ji NY, et al. Pharmacotherapy for mental health problems in people with intellectual disability. Curr Opin Psychiatry 2016; 29:103–125.
4. Cooper SA, et  al. Mental ill-­health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry 2007; 190:27–35.
5. Sheehan R, et al. Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population-­based cohort study. BMJ Open 2017; 7:e017406.
6. Antochi R, et al. Psychopharmacological treatments in persons with dual diagnosis of psychiatric disorders and developmental disabilities. Postgrad Med J 2003; 79:139–146. Drug class Clinical applications Notes Anticonvulsants34 Aggression and self-­injury Some uncontrolled studies supporting sodium valproate35 in LD populations though evidence is not strong and research findings are contradictory. However, valproate remains best supported of the anticonvulsants for mood lability and aggression, partly because of positive studies in non-­LD groups.36 Limited studies of lamotrigine, mostly in children, suggest no effect, at least in autism and in the absence of affective instability.27 Data for carbamazepine also unconvincing, but it is still widely used.37 Lithium38 Licensed for the treatment of self-­injurious behaviour and aggression Some RCT evidence39 for LD but there have been no studies in this population for many years,3 although there has been one fairly recent positive RCT for its use in aggression in adolescents without developmental impairment.40 Experience suggests it can be very helpful in individual cases where other treatments have failed and is possibly underused, though adverse effects can be problematic. Perhaps best considered where there is a sub-­syndromal or non-­specific ‘affective component’. Some authorities suggest that, on close examination, challenging behaviour may occur in the context of very rapid cycling bipolar disorder in some individuals with severe and profound LD and that the diagnosis is easily missed. Some RCT evidence that short-­term use is reasonably well tolerated (at 6mg/kg).41 Methylphenidate Effective in ADHD associated with LD NICE13 conducted a meta-­analysis and found clear benefit for methylphenidate (and risperidone and clonidine) in ADHD in the context of LD. Insomnia is common. Naltrexone42 Has been used for severe self-­injurious behaviour43 Evidence not strong and results are inconsistent. Use may still be an option in severe and intractable cases. One case of successful treatment of kleptomania.44 Overall, clinical use has declined of late.45 FDA, Food and Drug Administration; LD, learning disability; OCD, obsessive compulsive disorder. Table 10.8  (Continued)

828 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 7. Lunsky Y, et al. Antipsychotic use with and without comorbid psychiatric diagnosis among adults with intellectual and developmental ­disabilities. Can J Psychiatry 2017; 63:361–369. 8. Deb S, et al. Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour. J Intellect Disabil Res 2015; 59:11–25. 9. Sheehan R, et al. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ 2015; 351:h4326. 10. Deb S, et al. The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilities. J Intellect Disabil Res 2007; 51:766–777. 11. Roy D, et al. Pharmacologic management of aggression in adults with intellectual disability. 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Antidepressant prescribing for adult people with an intellectual disability living in England. Br J Psychiatry 2022; 221:488–493. 17. Malone RP, et al. The role of antipsychotics in the management of behavioural symptoms in children and adolescents with autism. Drugs 2009; 69:535–548. 18. Malt UF, et al. Effectiveness of zuclopenthixol compared with haloperidol in the treatment of behavioural disturbances in learning disabled patients. Br J Psychiatry 1995; 166:374–377. 19. Hassler F, et  al. Treatment of aggressive behavior problems in boys with intellectual disabilities using zuclopenthixol. J Child Adolesc Psychopharmacol 2014; 24:579–581. 20. Nagaraj R, et  al. Risperidone in children with autism: randomized, placebo-­controlled, double-­blind study. J Child Neurol 2006; 21:450–455. 21. Pandina GJ, et al. Risperidone improves behavioral symptoms in children with autism in a randomized, double-­blind, placebo-­controlled trial. J Autism Dev Disord 2007; 37:367–373. 22. 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Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database Syst Rev 2013; 8:CD004677. 29. Reddihough DS, et al. Effect of fluoxetine on obsessive-­compulsive behaviors in children and adolescents with autism spectrum disorders: a randomized clinical trial. JAMA 2019; 322:1561–1569. 30. Myers SM. Citalopram not effective for repetitive behaviour in autistic spectrum disorders. Evid Based Ment Health 2010; 13:22. 31. Cook Jr, EH, et al. Fluoxetine treatment of children and adults with autistic disorder and mental retardation. J Am Acad Child Adolesc Psychiatry 1992; 31:739–745. 32. Oswald DP, et al. Medication use among children with autism spectrum disorders. J Child Adolesc Psychopharmacol 2007; 17:348–355. 33. Carminati GG, et al. Using venlafaxine to treat behavioral disorders in patients with autism spectrum disorder. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:85–95. 34. Deb S, et al. The effectiveness of mood stabilizers and antiepileptic medication for the management of behaviour problems in adults with intellectual disability: a systematic review. J Intellect Disabil Res 2008; 52:107–113. 35. Ruedrich S, et al. Effect of divalproex sodium on aggression and self-­injurious behaviour in adults with intellectual disability: a retrospective review. J Intellect Disabil Res 1999; 43 Pt 2:105–111. 36. Donovan SJ, et al. Divalproex treatment for youth with explosive temper and mood lability: a double-­blind, placebo-­controlled crossover design. Am J Psychiatry 2000; 157:818–820. 37. Unwin GL, et al. Use of medication for the management of behavior problems among adults with intellectual disabilities: a clinicians’ ­consensus survey. Am J Ment Retard 2008; 113:19–31. 38. Pary RJ. Towards defining adequate lithium trials for individuals with mental retardation and mental illness. Am J Ment Retard 1991; 95:681–691. 39. Craft M, et  al. 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Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 40. Malone RP, et  al. A double-­blind placebo-­controlled study of lithium in hospitalized aggressive children and adolescents with conduct ­disorder. Arch Gen Psychiatry 2000; 57:649–654. 41. Yuan J, et al. Lithium treatment is safe in children with intellectual disability. Front Mol Neurosci 2018; 11:425. 42. Campbell M, et al. Naltrexone in autistic children: an acute open dose range tolerance trial. J Am Acad Child Adolesc Psychiatry 1989; 28:200–206. 43. Barrett RP, et al. Effects of naloxone and naltrexone on self-­injury: a double-­blind, placebo-­controlled analysis. Am J Ment Retard 1989; 93:644–651. 44. Mouaffak F, et al. Kleptomania treated with naltrexone in a patient with intellectual disability. J Psychiatry Neurosci 2020; 45:71–72. 45. Sabus A, et  al. Management of self-­injurious behaviors in children with neurodevelopmental disorders: a pharmacotherapy overview. Pharmacotherapy 2019; 39:645–664.