Psychotropic use and psychotropic polypharmacy in intellectual disability - a national cohort study

Abstract Introduction Psychotropic medication use and psychotropic polypharmacy are common in people with intellectual disabilities. However, representative, population-based studies on this topic are scarce. We evaluated the prevalence of psychotropic use and psychotropic polypharmacy in a Finnish nationwide cohort of people with intellectual disabilities. Methods This register-based study evaluated the annual prevalence of psychotropic use in 2019 among 37196 individuals with intellectual disabilities and an age- and sex-matched comparison cohort. Psychotropics included antipsychotics, antidepressants, anxiolytics, hypnotics and sedatives and antiepileptics which can be used to treat bipolar disorder (carbamazepine, valproic acid, lamotrigine, pregabalin and clonazepam). Prevalence of psychotropic polypharmacy (use from ≥2 different psychotropic groups) was evaluated in 4-month time window at the end of 2019. Results Prevalence of any psychotropic use was significantly higher in the intellectual disability cohort 42.3 %) than in the comparison cohort (15.0 %). Psychotropic use was more common in all age groups in the intellectual disability cohort, e.g., 21.9% in 0-17 year-olds compared with 2.9% of comparison cohort. The highest prevalence was observed in the oldest age group (≥75 years; 59.5% in intellectual disability, 36.4% in comparison cohort). A likely indication was identified for 52.9% of psychotropic users with intellectual disability (major psychiatric comorbidity 38.1%, disruptive behaviour 22.1%). Psychotropic polypharmacy was more common in the intellectual disability cohort (18.2%, 43.2% of psychotropic users), than in the comparison cohort (3.6%, 23.9% of the psychotropic users. Conclusions High prevalence of psychotropic use, particularly possible off-label use in intellectual disability is concerning. It is important to motivate better adherence to treatment recommendations on psychotropic use in this vulnerable group. Key messages • Nearly half of the psychotropic users with intellectual disability had no recod of major psychiatric comorbidity or special reimbursement for disruptive behaviour. • Interventions for reducing off-label use of psychotropics in people with intellectual disability is needed.