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Table 7 Summary table of included case studies

From: Deprescribing psychotropic medicines for behaviours that challenge in people with intellectual disabilities: a systematic review

Adams et al. 2017

U.K. [68]

Case study

n: 1 age: 30 gender: male ethnicity: not reported

ID = mild

Community

Intervention: Two psychotropic medicines and a beta blocker were deprescribed separately

Medication: olanzapine, carbamazepine, propranolol

Duration: 2 years

Length of follow up: ongoing; 2 years from when deprescribing process began

Discontinuation or reduction of dose of psychotropic medicines

General wellbeing

Weight

Olanzapine and carbamazepine were stopped

Propranolol was reduced and deprescribing process ongoing.

He is less tired, more alert, and better able to express himself. He has expanded his activities and increased his access to the community. He can cope better with changes to his routine. His behaviours are well managed by the behavioural strategies in place, and he has now been discharged by the psychiatrist to the GP.

Weight reduced form 82 kg to 56 kg which was within recommended

BMI 

Bastiampillai et al. 2014

Australia [69]

Case study

n: 1 age: 28 gender: male ethnicity: not reported

ID = moderate

Inpatient

Intervention: Following warning from CSM in UK, thioridazine withdrawn and patient changed to risperidone.

Medication: risperidone

Duration: not reported

Length of follow up: not reported

Behaviour and mental health symptomatology

Delusions and hallucinations reported within 2 weeks of stopping Thioridazine, hospitalised for 2 ½ years, unresponsive to several other Antipsychotics, prescribed clozapine and went into remission

Brahm et al. 2009

USA [70]

Case study

n: 1 age: 53 gender: male

ethnicity: white

ID = moderate

Inpatient

Intervention: deprescribing

Medication: ziprasidone

Duration: Not reported

Length of follow up: Not reported

Episodes of inappropriate sexual behaviour

Episodes of inappropriate sexual behaviour increased from 2 to 3 per month prior to discontinuation to 21 episodes the following month post discontinuation

Branford D 2019

U.K. [14]

Case studies ×  3

1. n: 1 age: 35 gender: male ethnicity: not reported

ID = not reported

2. n: 1

age: not reported gender: not reported ethnicity: not reported

ID = not reported

3. n: 1

age: not reported gender: male ethnicity: not reported

ID = not reported

1. Community

2. Community

3. Community

 

1. Successful discontinuation, quality of life observations 

2. Successful discontinuation

3. Successful discontinuation, quality of life observations 

1. Antipsychotic discontinued post discontinuation he was more lively, wanting to go on more outings and tackle new activities. Staff aware to offer active support to meet his needs and his grabbing behaviours are understood.

2. Chlorpromazine discontinued

3. Antipsychotic discontinued Patient is now reported to be very positive. He enjoys walks, his self-confidence has gone up and his life is changing. He is cooking for himself and is keen to find work.

Connor 1998 USA [71]

Case study

n: 1 age: 11 gender: not reported ethnicity: not reported

ID = moderate

Community

Intervention: deprescribing

Medication: thioridazine

Duration: 3 weeks

Length of follow up: 12 weeks

AIMS

Within 1 week of discontinuation patient developed new onset multiple involuntary movements consisting of jaw grinding, oral dyskinesias, bilateral hand rolling, vermiform tongue movements. and bilateral choreiform movements of his digits. When methylphenidate that was being co prescribed was also discontinued the movement disorder resolved.

Dillon 1990

USA [72]

Case study

n: 1

age: 7 yrs. 11 months gender: male ethnicity: not reported

ID = borderline

Community

Intervention: deprescribing

Medication: clonidine

Duration: 4 weeks

Length of follow up: not reported

Adverse behaviours

When withdrawn from clonidine over 4 weeks multiple self-destructive behaviours involving the theme of suffocation were reported

Faisal et al. 2021

Ireland [73]

Case study

n:1 age:13 gender: female ethnicity: not reported

ID = moderate

Community

Intervention: deprescribing

Medication: risperidone

Duration: unclear

Length of follow up: unclear

Overall clinical presentation, BFCRS

In first week following risperidone discontinuation nursing staff observed gradual change in behaviour, insomnia, increased salivation, mutism, echopraxia, immobility. Catatonic symptoms occurred over 8 weeks following discontinuation followed by admission to paediatric high dependency unit. Responded to im lorazepam, Resolution of catatonic symptoms after 7 weeks in hospital

Ghaziuddin et al. 1990

USA [74]

Case study

n: 1 age: 34 gender: female ethnicity: not reported

ID = moderate

Inpatient

Intervention: deprescribing

Medication: diazepam

Duration: 6 weeks

Length of follow up: 6 months

Challenging behaviour mental health symptomatology dose of medication

10 days after discontinuation of diazepam resembling mania reported. Improvement noted when diazepam represcribed.

Lee et al. 2019

U.K. [75]

Case study

n: 1 age: early 40s gender: female

ethnicity: not reported

ID = moderate

Community

Intervention: Flexible medication reduction in collaboration with PBS framework Involving an initial 25% reduction with further changes dictated by behavioural data, the impact of any side effects, the opinions of care staff and of family members

Medication: risperidone

Duration: 6 months

Length of follow up: not reported

Dose of medication challenging behaviour

Reduction slowed down in response to increase in grabbing behaviours.

Risperidone stopped

PBS supported medication reduction reduced challenging behaviour

McLennan 2019

Canada [76]

Case study

n: 1 age: 15 gender: male ethnicity: white ID = moderate

Community

Intervention: deprescribing 6 psychotropic medicines,

Medication: quetiapine, lamotrigine, clonidine, olanzapine, sertraline, and ziprasidone

Duration: whole process over approx.18 months

Length of follow up: not reported

Number of medicines stopped

Quetiapine, lamotrigine, clonidine, olanzapine, sertraline successfully discontinued ziprasidone added

trazadone prn added for sleep

ziprasidone associated with unsuccessful attempt to deprescribe

  1. Key: a Possibility of potential overlap of participants with other included studies by the same author(s)
  2. AIMS Abnormal Involuntary Movement Scale, ABC Aberrant Behavior Checklist, ABS Agitated Behaviour Scale, BARNES Barnes Akathisia Rating Scale, BFCRS Bush-Francis Catatonia Rating Scale, BP Blood Pressure, CARS Childhood Autism Rating Scale CGAS: Children’s Global Assessment Scale (CGAS) CGI: Clinical Global Impressions, CSM Committee on Safety of Medicines, CPRS Comprehensive Psychopathological Rating Scale, DAS Disability Assessment Schedule, DISCUS Dyskinesia Identification System Condensed User Scale, DISCO Dyskinesia Identification System-Coldwater, ECG Electrocardiogram, FBC Full Blood Count, HbA1c Glycated Haemoglobin, Kiddie SAD-PL Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetyime Version LFTs: Liver Function Tests, MOAS Modified Overt Aggression Scale, NOSIE Nurses’ Observation Scale for Inpatient Evaluation, PAS-ADD Psychiatric Assessment Schedule for Adult with Developmental Disability, PBS Positive Behaviour Support, PTH Parathyroid Hormone, RAND-36 measure of health related quality of life, U + Es Urea and elelctrolytes, UPDRS Unified Parkinson’s Disease Rating Scale, SCOPA-AUT Scales for Outcomes in Parkinson’s Disease - Autonomic Dysfunction