Determinants of physical health parameters in individuals with intellectual disability who use long-term antipsychotics.
Higher antipsychotic dose and greater ID severity predict specific movement disorders and metabolic harm in chronic users.
01Research in Context
What this study did
The team asked 99 adults with intellectual disability about their health. All had taken antipsychotic drugs for years.
Doctors checked weight, blood pressure, and looked for movement problems. They also noted drug dose and how severe the ID was.
What they found
Half had stiff or jerky movements called extrapyram. Half were overweight or obese.
Higher pill dose meant more parkinson-like stiffness. More severe ID meant more jerky dyskinesia.
How this fits with other research
Hilton et al. (2010) used the MEDS scale and also saw tardive dyskinesia in ID adults on antipsychotics. The new study adds that dose and ID level predict which movement problem shows up.
Murthy et al. (2021) followed the adults for five years and found obesity plus diabetes drove high cholesterol. The 2013 snapshot shows the same obesity risk but does not track it over time.
Hastings et al. (2002) surveyed older adults with ID and saw fewer heart risks than the general public. The new study finds high obesity and metabolic problems in chronic antipsychotic users, pointing to under-recognition when drugs are involved.
Why it matters
If you serve adults with ID on long-term antipsychotics, screen for stiff or jerky movements at every visit. Check weight, blood sugar, and lipids. When dose is high or ID is severe, talk to the prescriber about tapering or switching drugs early to cut future harm.
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02At a glance
03Original abstract
Individuals with intellectual disability frequently use antipsychotics for many years. This may have detrimental health effects, including neurological symptoms and metabolic and hormonal dysregulation, the latter possibly affecting bone metabolism. There is large variability in the degree in which antipsychotic agents lead to these health problems. In the current study we investigated potential determinants of physical symptoms and biological parameters known to be associated with use of antipsychotics in a convenience sample of 99 individuals with intellectual disability who had used antipsychotics for more than one year for behavioural symptoms. We focused on extrapyramidal symptoms; on overweight and presence of components of the metabolic syndrome; and on elevated plasma prolactin and bone turnover parameters. As predictor variables, we used patient (sex, age, genetic polymorphisms, and severity of intellectual disability) and medication use (type and dosage) characteristics. We found extrapyramidal symptoms to be present in 53%, overweight or obesity in 46%, and the metabolic syndrome in 11% of participants. Hyperprolactineaemia and one or more elevated bone turnover markers were present in 17% and 25%, respectively. Higher age and more severe intellectual disability were associated with dyskinesia and a higher dosage of the antipsychotic drug was associated with parkinsonism. Less severe intellectual disability was related to higher Body Mass Index. Use of atypical antipsychotics was associated with higher diastolic blood pressure and elevated fasting glucose. Clinicians who prescribe antipsychotics in individuals with intellectual disability should carefully balance the potential benefits of prolonged treatment against the risk of health hazards associated with the use of antipsychotics.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.05.016