Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study
Objectives To describe factors associated with initiating antipsychotics and patterns of persistence to antipsychotic therapy in a large cohort of adults with intellectual and developmental disabilities.Design Population-based cohort study.Setting Ontario, Canada.Participants Adults with intellectua...
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| Format: | Article |
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/7/e028125.full |
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| author | Tara Gomes Simone Vigod Mina Tadrous Wayne Khuu Virginie Cobigo Yona Lunsky |
| author_facet | Tara Gomes Simone Vigod Mina Tadrous Wayne Khuu Virginie Cobigo Yona Lunsky |
| author_sort | Tara Gomes |
| collection | DOAJ |
| description | Objectives To describe factors associated with initiating antipsychotics and patterns of persistence to antipsychotic therapy in a large cohort of adults with intellectual and developmental disabilities.Design Population-based cohort study.Setting Ontario, Canada.Participants Adults with intellectual and developmental disabilities (IDD) in Ontario.Outcome measures We used multivariable logistic regression to investigate patient characteristics associated with antipsychotic initiation. Patient characteristics studied included sociodemographic characteristics, measures of clinical comorbidity and health service use.Results Among 39 244 individuals eligible for this study, 6924 (17.6%) initiated an antipsychotic over the accrual window, of whom 1863 (26.9%) had no psychiatric diagnosis in the prior 2 years. A number of factors were significantly associated with antipsychotic initiation, including male gender, residence in a group home, prior use of benzodiazepines, antidepressants or cognitive enhancers, a recent emergency department visit or mental health hospitalisation and a visit to a psychiatrist or family physician in the prior 90 days. In a secondary analysis, the association between antipsychotic initiation and age, prior diagnosis of diabetes or myocardial infarction and polypharmacy differed slightly on the basis of whether an individual had a previously diagnosed psychiatric disorder.Conclusions Factors associated with the initiation of an antipsychotic differ according to the presence of a psychiatric diagnosis. Given the long duration of antipsychotic use in this population, future research is needed to understand the appropriateness of antipsychotic initiation among adults with IDD and the safety implications of long-term use of these products. |
| format | Article |
| id | doaj-art-d29bf95d4fa44d62bbfe303eef0ecc69 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d29bf95d4fa44d62bbfe303eef0ecc692025-08-20T01:54:12ZengBMJ Publishing GroupBMJ Open2044-60552019-07-019710.1136/bmjopen-2018-028125Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort studyTara Gomes0Simone Vigod1Mina Tadrous2Wayne Khuu3Virginie Cobigo4Yona Lunsky5ICES, Toronto, Ontario, CanadaDepartment of Psychiatry, Women’s College Hospital, Toronto, Ontario, CanadaLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, CanadaICES, Toronto, Ontario, CanadaICES, Toronto, Ontario, CanadaAzrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaObjectives To describe factors associated with initiating antipsychotics and patterns of persistence to antipsychotic therapy in a large cohort of adults with intellectual and developmental disabilities.Design Population-based cohort study.Setting Ontario, Canada.Participants Adults with intellectual and developmental disabilities (IDD) in Ontario.Outcome measures We used multivariable logistic regression to investigate patient characteristics associated with antipsychotic initiation. Patient characteristics studied included sociodemographic characteristics, measures of clinical comorbidity and health service use.Results Among 39 244 individuals eligible for this study, 6924 (17.6%) initiated an antipsychotic over the accrual window, of whom 1863 (26.9%) had no psychiatric diagnosis in the prior 2 years. A number of factors were significantly associated with antipsychotic initiation, including male gender, residence in a group home, prior use of benzodiazepines, antidepressants or cognitive enhancers, a recent emergency department visit or mental health hospitalisation and a visit to a psychiatrist or family physician in the prior 90 days. In a secondary analysis, the association between antipsychotic initiation and age, prior diagnosis of diabetes or myocardial infarction and polypharmacy differed slightly on the basis of whether an individual had a previously diagnosed psychiatric disorder.Conclusions Factors associated with the initiation of an antipsychotic differ according to the presence of a psychiatric diagnosis. Given the long duration of antipsychotic use in this population, future research is needed to understand the appropriateness of antipsychotic initiation among adults with IDD and the safety implications of long-term use of these products.https://bmjopen.bmj.com/content/9/7/e028125.full |
| spellingShingle | Tara Gomes Simone Vigod Mina Tadrous Wayne Khuu Virginie Cobigo Yona Lunsky Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study BMJ Open |
| title | Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study |
| title_full | Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study |
| title_fullStr | Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study |
| title_full_unstemmed | Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study |
| title_short | Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study |
| title_sort | antipsychotic initiation among adults with intellectual and developmental disabilities in ontario a population based cohort study |
| url | https://bmjopen.bmj.com/content/9/7/e028125.full |
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