Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik

1. PsychotropicMedication Use & Dual Diagnosis: A Project Overview Morag Budiselik Senior Clinical Psychologist Accommodation Behaviour Support Team

2. PROJECT RESEARCHERS 2001: • Wendy O’Connor, Clinical Psychologist, Accommodation Services Directorate 2008: • Samantha Barnes, Clinical Psychologist Accommodation Behaviour Support Team

3. Current Project overview • being conducted within WA DSC Accommodation Services Directorate • aims to increase understanding of local - patterns of dual diagnosis - trends in psychotropic prescription

4. Definitions • Dual diagnosis – “the coexistence of an intellectual disability and a psychiatric disorder or mental health problem” (Sturmey et al. 2007) • Psychotropic medication - primarily indicated for the treatment of diagnosed psychiatric illnesses • Polypharmacy/poly-prescribing – “the prescribing of more than one medication for a particular indication” (Deb et al. 2006)

5. Prevalence of dual diagnosis reported in research literature • difficult to determine prevalence • community population studies cite prevalence ranging from 20-60% (Bailey, 2007) • some argue rate higher than that of the general population (Chaplin 2004)

6. Rates of psychotropic use from literature • 20-45% of people with ID are on psychotropic medication • 14-30% for behaviour management • antipsychotics most commonly used psychotropic medication for behaviour management (Clarke et al., 1990; Deb, 2007; Deb et al., 2006; Deb et al., 1994)

7. Background to current project 2001 Survey • sample - residents living in DSC Accommodation Services - 579 adults with ID • survey reported on • number of residents on psychotropic medications • what medications were prescribed

8. 2001 findings

9. 2001 findings

10. 2001 findings

11. Following questions raised by 2001 Project Summary:

12. 2008 Project PHASE ONE Comparison 2001 data PHASE TWO Diagnosis, prescribing, monitoring

13. Phase one • Aim current prescription of psychotropics & comparison of 2001/2008 data • Source resident medication records (now computerised) • Sample 553 adults with ID living in DSC Accommodation Services

14. 2008 findings

15. 2008 findings

16. 2008 findings

17. 2008 findings

18. 2008 findings

19. 2008 findings Most commonly prescribed psychotropics were the antipsychotics: • Zyprexa (Olanzapine) • Risperdal (Risperidone) • Seroquel (Quetiapine)

20. Key findings • increase in the number of residents being prescribed psychotropic medication • increased prescription of each type of medication • antipsychotics most common followed by antidepressants • increase in the number of people being prescribed anti-depressant plus antipsychotic • increase in polypharmacy

21. Phase Two • Aim identify diagnosis, prescribing, monitoring • Source resident records • Sample 553 adults with ID living in DSC Accommodation Services

22. Where to from here Identifying: • Formal psychiatric diagnosis/likely mental health problems? • Who is prescribing? GP or psychiatrist? • Why prescribing? Mental health problems or behaviour management? • Monitoring and review process?

23. Preliminary themes • few residents have an ‘official’ psychiatric diagnosis • common hypothesised diagnoses are bipolar disorder & psychosis • few DSC residents are in the public mental health system – primarily private

24. Challenges facing service providers • access to specialist psychiatric opinion • prescription in the absence of psychiatric assessment / diagnosis • medication for behaviour control / restraint

25. Summary of Issues • assessment, diagnosis, prescription and review process • access to specialist psychiatric opinion • medication as an adjunct to behaviour support interventions • inclusion of medication within considered treatment plan when indicated

26. References Bailey N. M. (2007) Prevalence of psychiatric disorders in adults with moderate to profound learning disabilities. Advances in Mental Health and Learning Disabilities, 1 (2), 36-44 Chaplin R. (2004) General psychiatric services for people with intellectual disability and mental illness. Journal of Intellectual Disability Research, 48, 1-10 Clarke D. J., Kelley S., Thinn K. & Corbett J. A. (1990) Psychotropic drugs and mental retardation: Disabilities and the prescription of drugs for behaviour and for epilepsy in 3 residential settings. Journal of Mental Deficiency Research, 28 (3) 229-233 Deb S. (2007) The role of medication in the management of behaviour problems in people with learning disabilities. Advances in Mental Health and Learning Disabilities, 1 (2), 26-31 Deb S., Clarke D. & Unwin G. (2006) Using Medication to Manage Behaviour Problems Among Adults with a Learning Disability: Quick Reference Guide. Birmingham and London: University of Birmingham, Royal College of Psychiatrists and Mencap. Available from: www.ld-medication.bham.ac.uk Deb S. & Fraser W. I. (1994) The use of psychotropic medication in people with learning disability: towards rational prescribing. Human Psychopharmacology 9 259-272 Sturmey P., Lindsay W. R. & Didden R. (2007) Editorial special issues: dual diagnosis. Journal of Applied Research in Intellectual Disabilities, 20, 379-383