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Articles   |    
Psychotropic Prescribing for Persons With Intellectual Disabilities and Other Psychiatric Disorders
Gail A. Edelsohn, M.D., M.S.P.H.; James M. Schuster, M.D., M.B.A.; Kim Castelnovo, R.Ph.; Lauren Terhorst, Ph.D.; Meghna Parthasarathy, M.S.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300029
View Author and Article Information

All authors are with the Community Care Behavioral Health Organization, Pittsburgh (e-mail: edelsohnga@ccbh.com).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Prescribing patterns of psychotropic medication over a five-year period for Medicaid recipients (adults and children) with codiagnoses of an intellectual disability and a mental disorder were compared with patterns for those with sole mental disorder diagnoses.

Methods  Each group was identified through paid behavioral health services claims. Four classes of medications (antidepressants, antipsychotics, benzodiazepines, and mood stabilizers) were examined in paid pharmacy claims. Diagnostic categories, rates of psychotropic prescription, and polypharmacy (three or more medications concurrently for 90 days or more) were compared by age group (child or adult).

Results  Adults with mental disorders only (N=793 to 883; the range reflects the five study years) were prescribed antidepressants at a significantly higher rate compared with adults in the codiagnosis group (N=184 to 217). For three of the five study years, antipsychotics were prescribed to the sole-diagnosis group of adults at a significantly higher rate than to those with codiagnoses. Children in the group with codiagnoses (N=108 to141) were prescribed mood stabilizers at a significantly higher rate than the comparison group (N=638 to 728) in all five study years. Rates of antipsychotics prescribed were not statistically different between the two groups of children. Polypharmacy rates for both adults and children were higher for the codiagnosis group compared with the group with a sole mental disorder, but the difference did not reach statistical significance.

Conclusions  Psychotropic prescribing patterns in the two groups studied varied by class of medication and age. Although evidence exists for using psychotropics to treat psychopathology and challenging behaviors among individuals with intellectual disabilities, consideration of behavioral intervention alternatives and careful monitoring of psychotropic effectiveness and side effects are recommended.

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Table 1Baseline demographic characteristics of Medicaid recipients with a mental disorder and with or without an intellectual disability
Table Footer Note

a Diagnosis of a mental disorder and an intellectual disability

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b Mental disorders only

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Table 2Top three diagnoses per fiscal year among adult Medicaid recipients with a mental disorder and with or without an intellectual disability
Table Footer Note

a Diagnosis of a mental disorder and an intellectual disability

Table Footer Note

b Mental disorders only

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c “Other” includes developmental delays, childhood disorders, neurological disorders, dissociative disorders, organic mental disorders, personality disorders, sleep disorders, and eating disorders.

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Table 3Top three diagnoses per fiscal year among child Medicaid recipients with a mental disorder and with or without an intellectual disability
Table Footer Note

a Diagnosis of a mental disorder and an intellectual disability

Table Footer Note

b Mental disorders only

Table Footer Note

c “Other” includes developmental delays, childhood disorders, neurological disorders, dissociative disorders, organic mental disorders, personality disorders, sleep disorders, and eating disorders.

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Table 4Psychotropic prescribing, by fiscal year, among adult Medicaid recipients with a mental disorder and with or without an intellectual disability
Table Footer Note

a Diagnosis of a mental disorder and an intellectual disability

Table Footer Note

b Mental disorders only

Table Footer Note

*p≤.0025 was considered significant

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Table 5Psychotropic prescribing, by fiscal year, among child Medicaid recipients with a mental disorder and with or without an intellectual disability
Table Footer Note

a Diagnosis of a mental disorder and an intellectual disability

Table Footer Note

b Mental disorders only

Table Footer Note

*p≤.0025 was considered significant

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