Young People With IDD Are More Likely to Receive Antipsychotics, Metformin

Young people with intellectual/developmental disabilities (IDD) have significantly higher odds of being dispensed antipsychotics and metformin, relative to their peers without IDD. These findings were published in the Journal of Autism and Developmental Disorders.

Previous research has demonstrated that people with IDD receive antipsychotics at a young age and at substantially higher rates than the general population. While antipsychotics are sometimes used to treat mental health problems for this population, they are frequently prescribed without a mental health diagnosis to manage behaviors that caregivers or health care providers may view as difficult. Long-term use of antipsychotic medications is associated with serious side effects – particularly metabolic disruption that leads to weight gain, dyslipidemia, and type 2 diabetes. The aim of the current study was to evaluate the prevalence of antipsychotics and metformin use among young people (aged 15 to 24 years) with and without IDD.

Researchers conducted a retrospective cohort study using population-level data from the British Columbia (BC) Ministry of Health via Population Data BC. The researchers identified young people with IDD using International Classification of Diseases (ICD) codes who were aged 15 to 24 years from 2010 to 2019. Participants with an IDD diagnosis were further divided subcategorized (based on disorders) into those with fetal alcohol syndrome (FAS), autism spectrum disorder (ASD), Down syndrome, or other. All individuals with IDD were compared with all individuals without IDD of the same age range during the 10-year study period. The primary outcome of interest was the dispensation of antipsychotics and metformin among the study cohorts, analyzed using Pharmanet data.

Overall, the researchers included data from 20,591 young people with IDD and 1,293,791 individuals without IDD for the analysis. The IDD cohort had a significantly smaller percentage of girls/women (31.33%) than the non-IDD cohort (49.28%; P <.0001) and those with IDD were more likely to live in poverty (22.76%) relative to those without IDD (19.58%; P <.0001).  The most common type of IDD was ASD (54.90%), followed by other (30.91%), FAS (9.49%), and Down syndrome (4.70%).

Relative to young people without IDD, the researchers found that those with IDD were significantly more likely to be dispensed at least 1 prescription for an antipsychotic (odd ratio [OR] 10.93; 95% CI, 10.58-11.30). This likelihood remained elevated when adjusting for a diagnosis of psychiatric illness (adjusted odds ratio [aOR], 7.13; 95% CI, 6.82-7.44) and across each year of the study period. Additionally, individuals with multiple IDD diagnoses were at increased odds of receiving an antipsychotic (OR, 3.74; 95% CI, 3.35-4.17) relative to those with a single IDD diagnosis.

Young people with IDD also had higher odds of being dispensed metformin (OR 4.08; 95% CI 3.72-4.48) compared with youth without an IDD. These odds remained elevated when adjusting for a diagnosis of psychiatric illness (aOR, 3.74; 95% CI, 3.32-4.21).

These findings indicate that young people with IDD are more likely to receive both antipsychotics and metformin than their peers without IDD. The researchers concluded, “These results raise concerns about the long term use of antipsychotics in this population and risks of possible side effects such as weight gain and Type 2 diabetes.”

Primary limitations of the study include the reliance on ICD codes for IDD diagnoses and the lack of information about race, ethnicity, behavior problems, severity of disability, or caregiver support. Additionally, the dispensation data does not include information about medication adherence.

This article originally appeared on Psychiatry Advisor