title: Determinants of physical health parameters in individuals with intellectual disability who use long-term antipsychotics.
abstract: Individuals with intellectual disability frequently use antipsychotics for many years. This may have detrimental health effects, including neurological symptoms and metabolic and hormonal dysregulation, the latter possibly affecting bone metabolism. There is large variability in the degree in which antipsychotic agents lead to these health problems. In the current study we investigated potential determinants of physical symptoms and biological parameters known to be associated with use of antipsychotics in a convenience sample of 99 individuals with intellectual disability who had used antipsychotics for more than one year for behavioural symptoms. We focused on extrapyramidal symptoms; on overweight and presence of components of the metabolic syndrome; and on elevated plasma prolactin and bone turnover parameters. As predictor variables, we used patient (sex, age, genetic polymorphisms, and severity of intellectual disability) and medication use (type and dosage) characteristics. We found extrapyramidal symptoms to be present in 53%, overweight or obesity in 46%, and the metabolic syndrome in 11% of participants. Hyperprolactineaemia and one or more elevated bone turnover markers were present in 17% and 25%, respectively. Higher age and more severe intellectual disability were associated with dyskinesia and a higher dosage of the antipsychotic drug was associated with parkinsonism. Less severe intellectual disability was related to higher Body Mass Index. Use of atypical antipsychotics was associated with higher diastolic blood pressure and elevated fasting glucose. Clinicians who prescribe antipsychotics in individuals with intellectual disability should carefully balance the potential benefits of prolonged treatment against the risk of health hazards associated with the use of antipsychotics.
authors.affiliation: Vanboeijen, Intellectual Disability Centre, Assen, The Netherlands. gerda.dekuijper@vanboeijen.nl
authors.forename: Gerda
authors.initials: G
authors.lastname: de Kuijper
authors.forename: Hans
authors.initials: H
authors.lastname: Mulder
authors.forename: Heleen
authors.initials: H
authors.lastname: Evenhuis
authors.forename: Frans
authors.initials: F
authors.lastname: Scholte
authors.forename: Frank
authors.initials: F
authors.lastname: Visser
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Hoekstra
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000235:genetics; D015415:Biomarkers; D001786:Blood Glucose / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D001842:Bone and Bones / Q000378:metabolism; D005260:Female; D006304:Health Status; D006801:Humans; D008607:Intellectual Disability / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics; D008297:Male; D024821:Metabolic Syndrome / Q000139:chemically induced / Q000453:epidemiology / Q000235:genetics; D008875:Middle Aged; D050177:Overweight / Q000139:chemically induced* / Q000453:epidemiology / Q000235:genetics; D011110:Polymorphism, Genetic; D011388:Prolactin / Q000097:blood; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D015415:Biomarkers; D001786:Blood Glucose; D011388:Prolactin
keywords: Antipsychotics; Bone markers; Determinants; Extrapyramidal symptoms; Genetic polymorphisms; Intellectual disability; Long-term use; Metabolic symptoms