Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik
description
Transcript of Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik
![Page 1: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/1.jpg)
Psychotropic Medication Use & Dual Diagnosis:
A Project Overview
Morag BudiselikSenior Clinical PsychologistAccommodation Behaviour Support Team
![Page 2: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/2.jpg)
PROJECT RESEARCHERS
2001:
• Wendy O’Connor, Clinical Psychologist, Accommodation Services Directorate
2008:
• Samantha Barnes, Clinical Psychologist
Accommodation Behaviour Support Team
![Page 3: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/3.jpg)
Current Project overview
• being conducted within WA DSC Accommodation Services Directorate
• aims to increase understanding of local
- patterns of dual diagnosis - trends in psychotropic
prescription
![Page 4: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/4.jpg)
Definitions
• Dual diagnosis – “the coexistence of an intellectual disability and a psychiatric disorder or mental health problem” (Sturmey et al. 2007)
• Psychotropic medication - primarily indicated for the treatment of diagnosed psychiatric illnesses
• Polypharmacy/poly-prescribing – “the prescribing of more than one medication for a particular indication” (Deb et al. 2006)
![Page 5: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/5.jpg)
Prevalence of dual diagnosis reported in research literature
• difficult to determine prevalence
• community population studies cite prevalence ranging from 20-60% (Bailey, 2007)
• some argue rate higher than that of the general population (Chaplin 2004)
![Page 6: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/6.jpg)
Rates of psychotropic use from literature
• 20-45% of people with ID are on psychotropic medication
• 14-30% for behaviour management
• antipsychotics most commonly used psychotropic medication for behaviour management
(Clarke et al., 1990; Deb, 2007; Deb et al., 2006; Deb et al., 1994)
![Page 7: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/7.jpg)
Background to current project
2001 Survey •sample - residents living in DSC Accommodation Services
- 579 adults with ID•survey reported on
– number of residents on psychotropic medications
– what medications were prescribed
![Page 8: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/8.jpg)
2001 findings
Percentage of residents prescribed psychotropic and/or anti-convulsant medication
(2001 n=579)
74%
53%
0%10%20%30%40%50%60%70%80%
Psychotropic Psychotropic and/oranticonvulsant
![Page 9: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/9.jpg)
2001 findings
Percentage of residents prescribed various medication(2001 n=579)
48%38%
15% 13%4% 4%
0%10%20%30%40%50%60%
![Page 10: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/10.jpg)
2001 findings
Number of psychotropic medications per resident(2001 n=579)
188
89
25
7
0
20
40
60
80
100
120
140
160
180
200
1 2 3 4
No meds
No
res
iden
ts
2001
![Page 11: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/11.jpg)
Following questions raised by 2001 Project Summary:
Needs
Psychiatristaccess
Prescriber
Behavioursupport
Formaldiagnosis
?
![Page 12: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/12.jpg)
2008 Project
PHASE ONE
Comparison 2001 data
PHASE TWO Diagnosis, prescribing,
monitoring
![Page 13: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/13.jpg)
Phase one
• Aimcurrent prescription of
psychotropics & comparison of 2001/2008 data
• Sourceresident medication records
(now computerised)
• Sample553 adults with ID living in DSC Accommodation Services
![Page 14: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/14.jpg)
2008 findings
Percentage of residents on psychotropic medication
(2001 n=579; 2008 n=553)
67%
53%
0%
20%
40%
60%
80%
2001 2008
![Page 15: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/15.jpg)
2008 findings
Percentage of residents on psychotropic and/or anticonvulsant medication(2001 n=579; 2008 n=553)
74%
81%
70%
72%
74%
76%
78%
80%
82%
2001 2008
![Page 16: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/16.jpg)
2008 findings
Percentage of residents prescribed various medication(2001 n=579; 2008 n=553)
48%38%
15% 13%4% 4%
55%46%
28%21%
9% 8%
0%10%20%30%40%50%60%
2001
2008
![Page 17: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/17.jpg)
2008 findings
Number of psychotropic medications per resident(2001 n=579; 2008 n=553)
188
89
257 0 0 0 0
173
100
63
266 1 2 0
0
50
100
150
200
1 2 3 4 5 6 7 8
No medications
No re
side
nts
2001
2008
![Page 18: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/18.jpg)
2008 findings
Percentage of residents prescribed multiple psychotropic medications
(2001 n=309; 2008 n=371)
39%
53%
0%
10%
20%
30%
40%
50%
60%
2001 2008
![Page 19: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/19.jpg)
2008 findings
Most commonly prescribed psychotropics were the antipsychotics:
1. Zyprexa (Olanzapine)2. Risperdal (Risperidone)3. Seroquel (Quetiapine)
![Page 20: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/20.jpg)
Key findings• increase in the number of residents
being prescribed psychotropic medication
• increased prescription of each type of medication
• antipsychotics most common followed by antidepressants
• increase in the number of people being prescribed anti-depressant plus antipsychotic
• increase in polypharmacy
![Page 21: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/21.jpg)
Phase Two
• Aimidentify diagnosis, prescribing, monitoring
• Sourceresident records
• Sample553 adults with ID living in DSC Accommodation Services
![Page 22: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/22.jpg)
Where to from here
Identifying:
• Formal psychiatric diagnosis/likely mental health problems?
• Who is prescribing? GP or psychiatrist?
• Why prescribing? Mental health problems or behaviour management?
• Monitoring and review process?
![Page 23: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/23.jpg)
Preliminary themes
• few residents have an ‘official’ psychiatric diagnosis
• common hypothesised diagnoses are bipolar disorder & psychosis
• few DSC residents are in the public mental health system – primarily private
![Page 24: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/24.jpg)
Challenges facing service providers
• access to specialist psychiatric opinion
• prescription in the absence of psychiatric assessment / diagnosis
• medication for behaviour control / restraint
![Page 25: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/25.jpg)
Summary of Issues
• assessment, diagnosis, prescription and review process
• access to specialist psychiatric opinion
• medication as an adjunct to behaviour support interventions
• inclusion of medication within considered treatment plan when indicated
![Page 26: Psychotropic Medication Use & Dual Diagnosis: A Project Overview Morag Budiselik](https://reader035.fdocuments.in/reader035/viewer/2022062722/568139c0550346895da16442/html5/thumbnails/26.jpg)
ReferencesBailey N. M. (2007) Prevalence of psychiatric disorders in adults with
moderate to profound learning disabilities. Advances in Mental Health and Learning Disabilities, 1 (2), 36-44
Chaplin R. (2004) General psychiatric services for people with intellectual disability and mental illness. Journal of Intellectual Disability Research, 48, 1-10
Clarke D. J., Kelley S., Thinn K. & Corbett J. A. (1990) Psychotropic drugs and mental retardation: Disabilities and the prescription of drugs for behaviour and for epilepsy in 3 residential settings. Journal of Mental Deficiency Research, 28 (3) 229-233
Deb S. (2007) The role of medication in the management of behaviour problems in people with learning disabilities. Advances in Mental Health and Learning Disabilities, 1 (2), 26-31
Deb S., Clarke D. & Unwin G. (2006) Using Medication to Manage Behaviour Problems Among Adults with a Learning Disability: Quick Reference Guide. Birmingham and London: University of Birmingham, Royal College of Psychiatrists and Mencap. Available from: www.ld-medication.bham.ac.uk
Deb S. & Fraser W. I. (1994) The use of psychotropic medication in people with learning disability: towards rational prescribing. Human Psychopharmacology 9 259-272
Sturmey P., Lindsay W. R. & Didden R. (2007) Editorial special issues: dual diagnosis. Journal of Applied Research in Intellectual Disabilities, 20, 379-383