title: Safety of antipsychotics in people with intellectual disability.
abstract: BACKGROUND
  Despite frequent use, little is known about the metabolic and endocrine side-effects of antipsychotics in individuals with intellectual disability.
  
  
  OBJECTIVE
  To compare indices of obesity, glucose, lipids and prolactin between antipsychotic-treated and antipsychotic-naive individuals with intellectual disability and also between participants with intellectual disability and controls from the general population.
  
  
  METHODS
  Observational study comparing 138 antipsychotic-treated and 64 antipsychotic-naive participants with intellectual disability in one National Health Service trust with general population controls.
  
  
  RESULTS
  Antipsychotic treatment comprised: risperidone 48%,olanzapine 18%, thioxanthenes 10%, other 24%; monotherapy 95% of participants; mean treatment duration 8 years;median daily chlorpromazine equivalent dose 108 mg(range 16–667). Metabolic indices were the same or more favourable in the intellectual disability group than the general population control group but overweight/obesity and type 2 diabetes were more prevalent in the women in the intellectual disability group than the control group. Metabolic indices were similar, statistically or clinically, between the antipsychotic-treated and the antipsychotic-naive groups but there was a non-significant trend towards a higher rate of type 2 diabetes in the antipsychotic group. A total of 100%and 70% of participants on amisulpride/sulpiride and risperidone respectively had hyperprolactinaemia, with secondary hypogonadism in 77% and 4% of affected women and men.
  
  
  CONCLUSIONS
  Antipsychotics, on average, did not increase metabolic risk,although the existence of a susceptible subgroup at risk of diabetes cannot be excluded. Some antipsychotics induced hyperprolactinaemic hypogonadism, requiring active management. However, our findings suggest that antipsychotics at the low doses routinely prescribed for people with intellectual disability are generally safe in relation to metabolic adverse effects, even if efficacy remains poorly defined.
authors.affiliation: Department of Psychiatry, University of Oxford and Ridgeway Partnership (Oxfordshire Learning Disability NHS Trust), Oxford, UK. valeria.frighi@psych.ox.ac.uk
authors.forename: Valeria
authors.initials: V
authors.lastname: Frighi
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Stephenson
authors.forename: Alireza
authors.initials: A
authors.lastname: Morovat
authors.forename: Iain E
authors.initials: IE
authors.lastname: Jolley
authors.forename: Marialena
authors.initials: M
authors.lastname: Trivella
authors.forename: Christina A
authors.initials: CA
authors.lastname: Dudley
authors.forename: Ezhil
authors.initials: E
authors.lastname: Anand
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: White
authors.forename: Crhistina V
authors.initials: CV
authors.lastname: Hammond
authors.forename: Rena A
authors.initials: RA
authors.lastname: Hockney
authors.forename: Beryil
authors.initials: B
authors.lastname: Barrow
authors.forename: Rehana
authors.initials: R
authors.lastname: Shakir
authors.forename: Guy M
authors.initials: GM
authors.lastname: Goodwin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002784:Cholesterol / Q000378:metabolism; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000139:chemically induced / Q000453:epidemiology*; D007006:Hypogonadism / Q000453:epidemiology / Q000209:etiology; D008607:Intellectual Disability / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012449:Safety; D017678:Sex Distribution; D014280:Triglycerides / Q000378:metabolism; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D001786:Blood Glucose; D014280:Triglycerides; D002784:Cholesterol