Psychotropic medication use for adults and older adults with intellectual disability; selective review, recommendations and future directions.

摘要: A growing expert consensus has emerged to guide prescribing behavior and monitoring of psychotropic medications in adults older with intellectual disability (ID). However, there is little empirically-derived evidence inform physician selection specific categories medication for treatment "challenging" behaviors this vulnerable population (such as aggression self, others objects; self-injurious behaviors; repetitive stereotypic hyperactivity). Difficulties application formal definitional diagnostic criteria reliable assignment psychiatric diagnoses ID, which often difficult due their poor communication skills, contribute confusion uncertainty surrounding selection. Long-term administration antipsychotic are commonly prescribed challenging spite questionable long-term efficacy, leading some suggest that "episodic" short-term imminent dangerousness self or when difficult-to-find residential placements threatened preferred administration. Further, literature supports engagement interdisciplinary teams seek causes behaviors, formulate non-pharmacological psychosocial behavioral plans amelioration and, if initiated, convene regular identify "drug-related problems". Medication important because medication-related adverse events cause can sometimes be improved by dose reduction, discontinuation and/or elimination polypharmacy co-pharmacy. Importantly, themselves may interfere self-reported measures Quality Life. The data clearly highlight the need well-designed randomized controlled clinical trials samples homogeneous respect severity ID setting; moreover, they should include a wider variety safety outcome measures. Preclinical studies have suggested novel pharmacological strategies prevent progressive worsening adaptive function Down syndrome particular, improvement cognition general, irrespective etiopathogenesis ID. Translational address pathogenic mechanisms well anticipated but raise societal issues pertaining protection enrolling prioritization urgent therapeutic targets (e.g., versus improving preserving functioning).