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Morbidity and mortality of women and men with intellectual and developmental disabilities newly initiating antipsychotic drugs

Published online by Cambridge University Press:  02 January 2018

Simone N. Vigod ,
Yona Lunsky ,
Virginie Cobigo ,
Andrew S. Wilton ,
Sarah Somerton  and
Dallas P. Seitz
Simone N. Vigod*
Affiliation:
Women's Mental Health Program, Women's College Hospital and Research Institute, Department of Psychiatry, University of Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Yona Lunsky
Affiliation:
The Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Virginie Cobigo
Affiliation:
The School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario, Canada
Andrew S. Wilton
Affiliation:
The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Sarah Somerton
Affiliation:
Women's Mental Health Program, Women's College Hospital and Research Institute, Toronto, Ontario, Canada
Dallas P. Seitz
Affiliation:
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Baycrest Health Sciences, Toronto, Ontario, Canada
*
Simone Vigod, Women's Mental Health Program, Women's College Hospital, 76 Grenville Street Room 7234, Toronto, Ontario M5S 1B2, Canada. Email: simone.vigod@wchospital.ca
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Abstract

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Background

While up to 45% of individuals with intellectual and developmental disabilities (IDD) have a comorbid psychiatric disorder, and antipsychotics are commonly prescribed, gender differences in the safety of antipsychotics have rarely been studied in this population.

Aims

To compare men and women with IDD on medical outcomes after antipsychotic initiation.

Method

Our population-based study in Ontario, Canada, compared 1457 women and 1951 men with IDD newly initiating antipsychotic medication on risk for diabetes mellitus, hypertension, venous thromboembolism, myocardial infarction, stroke and death, with up to 4 years of follow-up.

Results

Women were older and more medically complex at baseline. Women had higher risks for venous thromboembolism (HR 1.72, 95% CI 1.15–2.59) and death (HR 1.46, 95% CI 1.02–2.10) in crude analyses; but only thromboembolism risk was greater for women after covariate adjustment (aHR 1.58, 95% CI 1.05–2.38).

Conclusions

Gender should be considered in decision-making around antipsychotic medications for individuals with IDD.

Type
Research Article
Information
BJPsych Open , Volume 2 , Issue 2 , March 2016 , pp. 188 - 194
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Copyright
Copyright © The Royal College of Psychiatrists 2016

Footnotes

Declaration of interest

None.

References

1 Lunsky, Y, Klein-Geltink, JE, Yates, EA, (eds). Atlas on the Primary Care of Adults with Developmental Disabilities in Ontario. Institute for Clinical Evaluative Sciences & Centre for Addiction and Mental Health, 2013.Google Scholar
2 Sheehan, R, Hassiotis, A, Walters, K, Osborn, D, Strydom, A, Horsfall, L. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ 2015; 351: h4326.Google Scholar
3 Cooper, S-A, Smiley, E, Morrison, J, Williamson, A, Allan, L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry 2007; 190: 27–35.Google Scholar
4 Morgan, VA, Leonard, H, Bourke, J, Jablensky, A. Intellectual disability co-occurring with schizophrenia and other psychiatric illness: population-based study. Br J Psychiatry 2008; 193: 364–72.Google Scholar
5 Brylewski, J, Duggan, L. Antipsychotic medication for challenging behaviour in people with learning disability. Cochrane Database Syst Rev 2004; 3: CD000377.Google Scholar
6 Glover, G, Bernard, S, Branford, D, Holland, A, Strydom, A. Use of medication for challenging behaviour in people with intellectual disability. Br J Psychiatry 2014; 205: 6–7.Google Scholar
7 Teeluckdharry, S, Sharma, S, O'Rourke, E, Tharian, P, Gondalekar, A, Nainar, F, et al. Monitoring metabolic side effects of atypical antipsychotics in people with an intellectual disability. J Intellect Disabil 2013; 17: 223–35.Google Scholar
8 Frighi, V, Stephenson, MT, Morovat, A, Jolley, IE, Trivella, M, Dudley, CA, et al. Safety of antipsychotics in people with intellectual disability. Br J Psychiatry 2011; 199: 289–95.Google Scholar
9 Newcomer, JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry 2007; 68(Suppl 1): 20–7.Google Scholar
10 Nasrallah, HA. The roles of efficacy, safety, and tolerability in antipsychotic effectiveness: practical implications of the CATIE schizophrenia trial. J Clin Psychiatry 2007; 68(Suppl 1): 5–11.Google Scholar
11 Azimi, K, Raina, P, Lunsky, Y. Brief report: occurrence of metabolic syndrome in patients with intellectual disability treated with atypical antipsychotics. J Dev Disabil 2011; 17: 47–50.Google Scholar
12 Gazizova, D, Puri, BK, Singh, I, Dhaliwal, R. The overweight: obesity and plasma lipids in adults with intellectual disability and mental illness. J Intellect Disabil Res 2012; 56: 895–901.Google Scholar
13 Lin, E, Balogh, R, Cobigo, V, Ouellette-Kuntz, H, Wilton, AS, Lunsky, Y. Using administrative health data to identify individuals with intellectual and developmental disabilities: a comparison of algorithms. J Intellect Disabil Res 2013; 57: 462–77.Google Scholar
14 Levy, AR, O'Brien, BJ, Sellors, C, Grootendorst, P, Willison, D. Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol 2003; 10: 67–71.Google Scholar
15 Juurlink, D, Preyra, C, Croxford, R, Chong, A, Austin, P, Tu, J, et al. Canadian Institute for Health Information Discharge Abstract Database: A Validation Study. Canadian Institute for Health Information, 2006.Google Scholar
16 Hirdes, JP, Smith, TF, Rabinowitz, T, Yamauchi, K, Perez, E, Telegdi, NC, et al. The Resident Assessment Instrument-Mental Health (RAI-MH): inter-rater reliability and convergent validity. J Behav Health Serv Res 2002; 29: 419–32.Google Scholar
17 Urbanoski, KA, Mulsant, BH, Willett, P, Ehtesham, S, Rush, B. Real-world evaluation of the Resident Assessment Instrument-Mental Health assessment system. Can J Psychiatry 2012; 57: 687–95.Google Scholar
18 Government of Ontario. Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (https://www.ontario.ca/laws/statute/08s14). Government of Ontario, 2008.Google Scholar
19 American Association on Intellectual & Developmental Disabilities. Intellectual Disability: Definition, Classification, and Systems of Supports, 11th ed. American Association on Intellectual & Developmental Disabilities, 2011.Google Scholar
20 Quan, H, Khan, N, Hemmelgarn, BR, Tu, K, Chen, G, Campbell, N, et al. Validation of a case definition to define hypertension using administrative data. Hypertension 2009; 54: 1423–8.Google Scholar
21 Hux, JE, Ivis, F, Flintoft, V, Bica, A. Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 2002; 25: 512–6.Google Scholar
22 Tagalakis, V, Kahn, SR. Determining the test characteristics of claims-based diagnostic codes for the diagnosis of venous thromboembolism in a medical service claims database. Pharmacoepidemiol Drug Saf 2011; 20: 304–7.Google Scholar
23 The Johns Hopkins ACG System. Technical Reference Guide Version 9.0. Health Services Research & Development Center, Johns CHopkins University, Bloomberg USchool of Public Health, 2009.Google Scholar
24 Normand, ST, Landrum, MB, Guadagnoli, E, Ayanian, JZ, Ryan, TJ, Cleary, PD, et al. Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores. J Clin Epidemiol 2001; 54: 387–98.Google Scholar
25 Berry, SD, Ngo, L, Samelson, EJ, Kiel, DP. Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc 2010; 58: 783–7.Google Scholar
26 Fine, JP, Gray, RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999; 94: 496–509.Google Scholar
27 SAS Software. Version 9.3 of the SAS System for Unix. SAS Institute Incorporated, 2012.Google Scholar
28 Tsakanikos, E, Bouras, N, Sturmey, P, Holt, G. Psychiatric co-morbidity and gender differences in intellectual disability. J Intellect Disabil Res 2006; 50: 582–7.Google Scholar
29 Balogh, RS, Lake, JK, Lin, E, Wilton, A, Lunsky, Y. Disparities in diabetes prevalence and preventable hospitalizations in people with intellectual and developmental disability: a population-based study. Diabet Med 2015; 32: 235–42.Google Scholar
30 Lunsky, Y, Bradley, EA, Gracey, CD, Durbin, J, Koegl, C. Gender differences in psychiatric diagnoses among inpatients with and without intellectual disabilities. Am J Intellect Dev Disabil 2009; 114: 52–60.Google Scholar
31 Matson, JL, Neal, D. Psychotropic medication use for challenging behaviors in persons with intellectual disabilities: an overview. Res Dev Disabil 2009; 30: 572–86.Google Scholar
32 Leucht, S, Bradley, EA, Gracey, CD, Durbin, J, Koegl, C. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 2009; 373: 31–41.Google Scholar
33 Merriman, S, Haw, C, Kirk, J, Stubbs, J. Risk factors for coronary heart disease among inpatients who have mild intellectual disability and mental illness. J Intellect Disabil Res 2005; 49: 309–16.Google Scholar
34 Valdovinos, M, Parsa, R, Alexander, M. Results of a Nation-Wide survey evaluating psychotropic medication use in Fragile X Syndrome. J Dev Phys Disabil 2009; 21: 23–37.Google Scholar
35 Bhaumik, S, Watson, JM, Thorp, CF, Tyrer, F, McGrother, CW. Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study. J Intellect Disabil Res 2008; 52: 287–98.Google Scholar
36 Tenenbaum, A, Chavkin, M, Wexler, ID, Korem, M, Merrick, J. Morbidity and hospitalizations of adults with Down syndrome. Res Dev Disabil 2012; 33: 435–41.Google Scholar
37 Humphries, K, Traci, MA, Seekins, T. Nutrition and adults with intellectual or developmental disabilities: systematic literature review results. Intellect Dev Disabil 2009; 47: 163–85.Google Scholar
38 de Winter, CF, Bastiaanse, LP, Hilgenkamp, TI, Evenhuis, HM, Echteld, MA. Cardiovascular risk factors (diabetes, hypertension, hypercholesterolemia and metabolic syndrome) in older people with intellectual disability: results of the HAID study. Res Dev Disabil 2012; 33: 1722–31.Google Scholar
39 Hagg, S, Spigset, O. Antipsychotic-induced venous thromboembolism: a review of the evidence. CNS Drugs 2002; 16: 765–76.Google Scholar
40 Moores, L, Bilello, KL, Murin, S. Sex and gender issues and venous thromboembolism. Clin Chest Med 2004; 25: 281–97.Google Scholar
41 Aichhorn, W, Whitworth, AB, Weiss, EM, Marksteiner, J. Second-generation antipsychotics: is there evidence for sex differences in pharmacokinetic and adverse effect profiles? Drug Saf 2006; 29: 587–98.Google Scholar
42 de Kuijper, G, Mulder, H, Evenhuis, H, Scholte, F, Visser, F, Hoekstra, PJ. Determinants of physical health parameters in individuals with intellectual disability who use long-term antipsychotics. Res Dev Disabil 2013; 34: 2799–809.Google Scholar
43 Tyrer, P, Cooper, SA, Hassiotis, A. Drug treatments in people with intellectual disability and challenging behaviour. BMJ 2014; 349: g4323.Google Scholar
44 Baburaj, R, El Tahir, M. Monitoring for Metabolic Syndrome in People with Intellectual Disability on Antipsychotic Medication. Advances in Mental Health and Intellectual Disabilities, 2011.Google Scholar
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