Risk factors for tardive dyskinesia in adults with intellectual disability, comorbid psychopathology, and long-term psychotropic use

Abstract

Psychotropic medications are commonly used as an adjunct treatment in large-scale residential care facilities for adults with developmental disabilities. While the benefits of medication are noted, there are very severe conditions that can result from long term medication use. Tardive dyskinesia (TD) manifests as a variety of involuntary, repetitive movements caused by a history of neuroleptic medication use. Due to the serious nature of this disorder, it is necessary to find predisposing factors for TD in a population of adults with intellectual and developmental disabilities. The current study seeks to expand the literature related to TD utilizing a measure of medication side effects, the Matson evaluation of drug side effects (MEDS). Results and implications for assessment and practice are discussed.

Introduction

Intellectual disability (ID) presents with a host of delays and deficits including health issues and adaptive behaviors, psychiatric disorders, and challenging behaviors (Dixon et al., 2008, Holden and Gitlesen, 2008, Lifshitz et al., 2008, Matson and Rivet, 2008, Matson and Smiroldo, 1997, Matson et al., 1997b, Matson et al., 2008b, McGillibray et al., 2008, Myrbakk and von Tetzchner, 2008, Paclawskyj et al., 1997). Psychological treatments have been proposed for these conditions (Kurtz et al., 2008, Paclawskyj et al., 2000, Ringdahl et al., 2008). Despite these efforts pharmacotherapy remains a widely used intervention for psychiatric conditions and challenging behaviors (Matson & Wilkins, 2008). These drugs, which are dominated by the antipsychotics are often prescribed continuously for many years, and for many individuals, often resulting in more serious and often chronic side effects (Advokat, Mayville, & Matson, 2000). Among the most problematic of these side effects is tardive dyskinesia.

Tardive dykinesia (TD) is a condition associated with long term neuroleptic drug use. This disorder is characterized by involuntary movements of the orofacial region and choreoathetoid movements in the limbs and trunk. TD typically manifests in individuals during or following the cessation of long term neuroleptic therapy (Casey & Gerlach, 1984). While the main risk factor for developing TD is neuroleptic drug use, it is important to investigate other possible predisposing factors that can contribute to the onset of TD. The most researched risk factors include: schizophrenia or anxiety diagnoses (Casey, 1984, Kane, 1999, Liddle et al., 1993, Van Os et al., 1997), age (Jeste and Caligiuri, 1993, Kane and Smith, 1982, Koshino et al., 1992, Van Os et al., 1997), and level of cognitive impairment (Brown and White, 1991, Sandyk et al., 1991).

This condition is an important consideration for adults with intellectual disabilities living in residential care facilities. In these settings, neuroleptic drugs are commonly used as an adjunct therapy to behavioral interventions. As such, the risk of developing TD is particularly high for this population. What is still unknown is whether the risk factors found in the literature for the general clinical population have applicability to the adult intellectually disabled (ID) population. This study seeks to ascertain relevant predisposing factors to developing TD in a population of adults with ID.