Side effect profiles of atypical antipsychotics, typical antipsychotics, or no psychotropic medications in persons with mental retardation.
In adults with ID, atypical antipsychotics produce side-effect burdens like taking no pill and lower than typical agents.
01Research in Context
What this study did
The team compared side-effect loads in adults with intellectual disability.
One group took newer atypical antipsychotics. A second group took older typical drugs. A third group took no psychotropic pills at all.
Doctors rated each person for movement problems, sedation, weight gain, and other common reactions.
What they found
The atypical group looked like the no-medication group. They had the same low rate of overall side effects.
The typical-drug group had more side effects than both other groups.
Newer pills were safer in this sample.
How this fits with other research
Matson et al. (1999) and Webb et al. (1999) found zero RCT evidence that any antipsychotic helps behavior or schizophrenia in ID. Their reviews sound negative, but they asked different questions. They looked for proof that the drugs work, not how they feel. Cohen-Almeida et al. (2000) asked which type feels safest. Together the papers say: if you must use an antipsychotic, pick an atypical and watch closely.
Branford (1996) showed that people on low-dose thioridazine were most likely to taper off successfully. Thioridazine is a typical drug. That seems to clash with the new finding that typical drugs cause more side effects. The difference is dose. Low dose typical may still be safe to stop, but higher dose typical causes more problems than atypicals.
Tassé et al. (2013) later found that half of older adults with ID have medication errors, especially when they take several central-nervous drugs. The 2000 safety signal supports their call for routine pill reviews.
Why it matters
You now have data to show families and prescribers that newer antipsychotics match no-medication for side-effect burden. Use this when a doctor is choosing between typical and atypical agents for your client with ID. Pair the finding with the 1999 reviews that say evidence for benefit is weak. The message: try behavior plans first, and if you must medicate, go atypical and track side effects with the MEDS scale every visit.
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02At a glance
03Original abstract
Antipsychotic medications have been used to treat a variety of behavioral and psychiatric disturbances in persons with mental retardation. Given the well-documented side effects of traditional antipsychotics, newer "atypical" antipsychotics have been well received in this population due to initial reports of a more favorable side effect profile. We compared the side effect profiles of both the typical and atypical antipsychotics using a comprehensive instrument, the Matson Evaluation of Drug Side Effects (MEDS) scale. Participants taking atypical antipsychotics did not differ in overall side effects from a matched control group taking no psychotropic medication, and both groups showed significantly fewer overall side effects than participants taking typical antipsychotics. Subscales designed to measure involuntary movements (e.g., akathisia, tardive dyskinesia) detected differences between participants taking either atypical or typical antipsychotics with respect to akathisia only. Implications of these findings and directions for future research are discussed.
Research in developmental disabilities, 2000 · doi:10.1016/s0891-4222(99)00031-1