Use of antipsychotic drugs in individuals with intellectual disability (ID) in the Netherlands: prevalence and reasons for prescription.
One in three Dutch ID residents receives antipsychotics, mostly for behavior rather than psychosis, signaling continued off-label use.
01Research in Context
What this study did
de Kuijper et al. (2010) counted antipsychotic prescriptions in Dutch ID facilities.
They reviewed charts of 2,373 residents to learn why the drugs were ordered.
What they found
One in three residents took antipsychotics.
Doctors wrote the scripts for behavior problems 58% of the time, not for psychosis.
Evidence backing this practice was thin.
How this fits with other research
Boswell et al. (2023) repeated the count in all of Finland and saw the same heavy use.
de Kuijper et al. (2013) followed up the Dutch cohort and found half of long-term users had stiff or shaky movements.
Scheifes et al. (2016) added that 84% of adults on psychotropics for behavior felt worse side-effects and poorer quality of life.
Together the four papers show a steady line: high prescribing for behavior, then clear harm, yet little benefit.
Why it matters
If you support adults with ID, expect many to arrive on these drugs.
Before joining the team request a med review: ask if the target behavior is still present, if dose is lowest possible, and if a slow taper trial is an option.
Pair any change with solid behavior plans so you treat the cause, not just sedate the signal.
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02At a glance
03Original abstract
BACKGROUND: We investigated antipsychotic drug prescription practice of Dutch ID physicians, studying prevalence of antipsychotic drug use, reasons for prescription and the relationship between these reasons and patient characteristics. METHODS: A cross-sectional study of medical and pharmaceutical records in a population living in residential settings of three care providers for persons with IDs in the Netherlands (n = 2373). RESULTS: Prevalence of antipsychotic drug use was 32.2% (95% CI 30.1-33.9). Behavioural problems were the reason for prescription of antipsychotic drugs in 58% of cases and psychotic disorder or psychotic symptoms in 22.5%. In 11.7% the diagnosis of psychotic disorder was specified according to DSM-IV criteria. In 18.5% the reason for prescription was not noted in the medical record. Behavioural problems as reason for prescription was associated with profound and severe ID, living in a central location and male sex. Psychotic disorder specified according to DSM-IV as indication for prescription was negatively associated with profound and severe ID and with presence of an additional mental disorder. Absence of a noted reason for prescription was associated with female sex and with the presence of an additional mental disorder. DISCUSSION: Current prevalence and reason for prescription of antipsychotic drugs are similar with outcomes of previous studies. Our results show the continuing lack of evidence-based psychopharmacological treatment in mental health care for persons with IDs.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2010.01275.x