Understanding Health Disparities Among People with Intellectual Disabilities

People with intellectual disabilities (ID), defined by an IQ below 70, face significant health disparities. This vulnerable group experiences higher rates of chronic health conditions, mental illness, and premature mortality. One notable concern is the frequent prescription of antipsychotic medications to manage behaviors like aggression or irritability, often without a corresponding mental health diagnosis. This practice is especially common in group homes or non-familial living situations, where antipsychotics may be overprescribed.

Inappropriate Use of Antipsychotic Medications

Research has shown that individuals with ID are at a higher risk for inappropriate medication use, including overprescription of antipsychotics for behavioral issues rather than mental health diagnoses outlined in the DSM-5. This trend is concerning because these medications carry risks of severe side effects, such as metabolic issues and tardive dyskinesia. Furthermore, many patients lack a clear understanding of their medications and their purpose.

The Role of Living Situations in Medication Prescriptions

Living situations play a critical role in determining the likelihood of antipsychotic prescriptions. Patients residing in group homes or under non-familial support are more likely to be prescribed these medications, while those living with biological families are less likely to receive them. However, factors like gender and the total number of medications prescribed are stronger predictors of antipsychotic use. Males, in particular, are more likely to be prescribed antipsychotics.

Concerns Over Polypharmacy in People with Intellectual Disabilities

Polypharmacy, or the use of multiple medications, is another concern for individuals with ID. Most patients in the study were prescribed five or more medications, highlighting the need for careful monitoring of medication regimens.

Addressing the Overprescription of Antipsychotics: A Path Forward

While there are efforts in countries like the UK to reduce inappropriate antipsychotic use through initiatives like STOMP (Stopping Over-Medication of People with a Learning Disability), the U.S. lacks a cohesive policy addressing this issue. Moving forward, a more comprehensive, patient-centered approach is needed to ensure medications are prescribed appropriately, considering both the physical and mental health needs of individuals with ID.

Reference:
Plenn, E., Long, C., Acri, S., & Richardson, C. (2024). Exploring Connections Between Living Situations and Antipsychotic Prescribing Practices for People With Intellectual Disabilities. Psychiatric Research and Clinical Practice, 0(0). https://doi.org/10.1176/appi.prcp.20240050