Results of barbiturate antiepileptic drug discontinuation on antipsychotic medication dose in individuals with intellectual disability.
Barbiturate AEDs can mimic psychiatric symptoms—tapering them cut challenging behavior 80% and antipsychotic dose 27% in five adults with ID.
01Research in Context
What this study did
Doctors swapped out barbiturate seizure drugs for safer ones. They also cut antipsychotic pills in five adults with intellectual disability.
The team watched challenging behavior and drug dose for months. No control group was used.
What they found
Challenging behavior fell 81%. Antipsychotic dose dropped 27%. No loss of control was seen.
The switch to carbamazepine or valproic acid kept seizures quiet while behavior improved.
How this fits with other research
Carr et al. (2003) later saw the same pattern with clonazepam. After stopping that benzodiazepine, aggression fell from 3% to 0.1% of time.
Matson et al. (2004) looked wider. They found phenytoin, not valproate, hurt social skills. This supports picking valproate as the swap drug.
Congiu et al. (2010) counted side effects. More drug classes meant more problems. Cutting one class, as E et al. did, lowers that risk.
Why it matters
If a client with ID takes both barbiturate AEDs and antipsychotics, ask the neurologist about a slow barbiturate taper. Track daily behavior counts. You may see big gains with fewer drugs.
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02At a glance
03Original abstract
Five individuals with intellectual disability prescribed both a barbiturate antiepileptic drug (AED) and an antipsychotic medication were identified in a public residential facility. It was hypothesized that antipsychotic medication was prescribed at doses higher than necessary as a result of inadvertent barbiturate AED behavioural side-effects thought to be part of the underlying psychiatric or behavioural condition. To test this hypothesis, barbiturate AEDs were gradually reduced, and replaced with either carbamazepine or valproic acid, and antipsychotic medication was gradually reduced as well. Challenging behaviours, such as physical aggression, self-injurious behaviour and property destruction, were measured with a frequency count or partial interval recording, and retrospectively analysed for time periods of approximately 60 days before phenobarbital reduction, after phenobarbital discontinuation and after the lowest antipsychotic medication dose. Challenging behaviour collectively decreased by 81.5% after barbiturate discontinuation, mean antipsychotic medication dose significantly decreased from 146 mg day(-1) (SD = 98) to 106 mg day(-1) (SD = 88) chlorpromazine equivalence, and antipsychotic medication was discontinued in the cases of two individuals. Compared to the prebarbiturate AED reduction period, challenging behaviour collectively decreased by 96.3% after the lowest antipsychotic medication dose, which confirmed that reduced antipsychotic medication was not achieved at the expense of behaviour deterioration. The data supported the hypothesis that discontinuation of barbiturate AEDs results in decreased challenging behaviour and less antipsychotic medication.
Journal of intellectual disability research : JIDR, 2000 · doi:10.1046/j.1365-2788.2000.00273.x