Effects of controlled discontinuation of long-term used antipsychotics for behavioural symptoms in individuals with intellectual disability.
Adults with intellectual disability can taper antipsychotics for challenging behavior in 14 weeks and still see behavior improve.
01Research in Context
What this study did
de Kuijper et al. (2014) asked if adults with intellectual disability can safely stop antipsychotics used for challenging behavior.
They split 98 adults into two groups. One group tapered off over 14 weeks. The other group tapered over 28 weeks.
All participants had taken the drugs long-term for behavior issues, not for psychosis.
What they found
Both groups had less challenging behavior after the taper, even if they did not stop the drug completely.
The longer 28-week taper gave no extra benefit. A 14-week schedule worked just as well.
No one had serious medical problems from stopping or reducing the drug.
How this fits with other research
Lerman et al. (1995) showed that nearly half of adults with learning disabilities and challenging behavior were on antipsychotics, often for convenience. de Kuijper et al. (2014) now shows many of those same people can come off the drugs without harm.
Rieth et al. (2022) found that adults in group homes with fewer daily choices are more likely to be medicated. de Kuijper et al. (2014) adds proof that medication can be reduced when a careful behavioral plan is in place.
Tassé et al. (2013) cut restraint use by 79% using behavioral programs. Together with de Kuijper et al. (2014), the picture is clear: behavior can improve when teams use structured behavioral support instead of, or alongside, medication.
Why it matters
You can tell prescribing doctors that a 14-week taper is safe for adults with ID who take antipsychotics for behavior. Track challenging behavior daily during the taper. Use behavioral skills training and choice-making to fill the gap left by lower doses. This study gives you data to back up the plan and protect your client from unnecessary long-term drug use.
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02At a glance
03Original abstract
BACKGROUND: Antipsychotics are frequently and often long-term used for challenging behaviour in persons with intellectual disability (ID), but the evidence base for this is meagre. As these agents may cause harmful side effects, discontinuation should be considered. Previous studies regarding discontinuation of long-term used antipsychotics mostly were uncontrolled and involved small numbers. The primary objective was to investigate the effects of controlled discontinuation of antipsychotics prescribed for challenging behaviour. Secondary objectives were to compare the results of two discontinuation time schedules, to compare groups of participants who had and had not achieved complete discontinuation, and to identify patient and medication characteristics that might predict the outcomes. Our hypothesis was that discontinuation of antipsychotics used for behavioural symptoms would not lead to worsening in behaviour. METHODS: This was a multi-centre parallel-group study comparing two discontinuation schedules of 14 and 28 weeks. Allocation to the two discontinuation schedules took place in a 1:1 ratio. Antipsychotics were tapered off every 2 or 4 weeks with approximately 12.5% of the initial dosage. Follow-up was 12 weeks after the scheduled complete discontinuation, that is, 26 or 40 weeks after the first dose reduction, respectively. Discontinuation was stopped in case of significant behavioural worsening. Participants were 98 residents with ID of three care providing organisations in the Netherlands, aged 15-66 year, who had used for more than 1 year one or more of the six most frequently prescribed antipsychotics for challenging behaviour. Main outcome measure was the total score of the Aberrant Behaviour Checklist (ABC); also ABC sub-scales were used. RESULTS: Of 98 participants, 43 achieved complete discontinuation; at follow-up 7 had resumed use of antipsychotics. Mean ABC ratings improved significantly for those who achieved complete discontinuation (directly after discontinuation, P < 0.01 and at follow-up, P = 0.03), and at follow-up (P = 0.03) for those who had not achieved complete discontinuation. Similar results were found with respect to most ABC sub-scales, including the 'irritability' sub-scale. There were no significant differences in improvement of ABC ratings between both discontinuation schedules. Higher ratings of extrapyramidal and autonomic symptoms at baseline were associated with less improvement of behavioural symptoms after discontinuation; higher baseline ABC rating predicted higher odds of incomplete discontinuation. CONCLUSIONS: Discontinuation of antipsychotics prescribed for challenging behaviour in patients with ID is associated with improved behavioural functioning. There is no need to taper off in a time frame longer than 14 weeks.
Journal of intellectual disability research : JIDR, 2014 · doi:10.1111/j.1365-2788.2012.01631.x