To study the usage, efficacy, and side effects patterns of atypical neuroleptics (atypicals) in adolescents and young adults with developmental disabilities (DDs) (mental retardation).
Method:
We undertook a chart review of adolescents and young adults (under age 25 years) seen by our specialized mental health team.
Results:
Risperidone and olanzapine were by far the most frequently prescribed atypicals. Robust clinical effects were noted for both psychotic and nonpsychotic disorders. Most patients tolerated atypicals well, although a significant minority did experience neuroleptic induced movement disorders (NIMDs), particularly dystonias and dyskinesias. Female patients with DDs appear to be at particular risk of NIMDs.
Conclusions:
Atypicals are useful in treating various conditions associated with DDs. This population, however, seems particularly sensitive to NIMDs, hence caution and close monitoring are required.
CrabbHF. Pharmacotherapy in mental retardation. In: BourasN, editor. Mental health in mental retardation. Cambridge: Cambridge University Press; 1994. p 187–204.
2.
HillBKBalowEABruininksRH. A national study of prescribed drugs in institutions and community residential facilities for mentally retarded people. Psychopharmacol Bull1985;21:279–84.
3.
GualtieriC.TMS: A system for prevention and control. In: RateyJ, editor. Mental retardation: Developing pharmacotherapies. American Psychiatric Press; 1991. p 35–49.
4.
CampbellMRapoportJSimpsonG.Antipsychotics in children and adolescents. J Am Acad Child Adolesc Psychiatry1999;38:537–45.
5.
BregmanJD. Pharmacologic interventions. In: VolkmarF, editor. Child and adolescent clinics of North America: Mental retardation. Philadelphia: WB Saunders Co; 1996. p 853–80.
6.
SinghNNAmanMG. Effects of thioridazine dosage on the behavior of severely retarded persons. American Journal of Mental Deficiency1981;85:580–7.
7.
CampbellMArmenterosJMaloneRAdamsPEisenbergZOverallJ.Neuroleptic related dyskinesias in autistic children: A prospective, longitudinal study. J Am Acad Child Adolesc Psychiatry1997;3:835–43.
8.
BruunR.Subtle and unrecognized side effects of neuroleptic treatment in children with Tourette disorder. Am J Psychiatry1989;4:722–30.
9.
MaloneRErnstMGodfreyKLocascioJCampbellM.Repeated episodes of neuroleptic related dyskinesias in autistic children. J Clin Psychopharmacol1989;9:207–9.
10.
CampbellMAdamsP.PerryRSpencerEKOverallJE. Tardive and withdrawal dyskinesias in autistic children: A prospective study. Psychopharmacol Bull1988;24:251–5.
11.
GualtieriTCBreuningSESchroederSRQuadeD.Tardive dyskinesia in mentally retarded children, adolescents and young adults: North Carolina and Michigan studies. Psychopharmacol Bull1982;18:62–5.
12.
WerryJAmanM.Methylphenidate and haloperidol in children: Effects on attention, memory and activity. Arch Gen Psychiatry1995;32:790–5.
13.
ShapiroEShapiroAFulopGHubbardMMandelJNordlieJ, and others. Controlled study of haloperidol, pimozide and placebo for the treatment of Gilles de la Tourette syndrome. Arch Gen Psychiatry1989;46:722–30.
14.
SpencerECampbellM.Children with schizophrenia: Diagnosis, phenomenology and pharmacotherapy. Schizophr Bull1994;20:713–25.
15.
CampbellMSmallAGreenWJenningsSPerryRBennettW, and others. Behavioral efficacy of haloperidol and lithium carbonate: A comparison in hospitalized aggressive children with conduct disorder. Arch General Psychiatry1984;41:650–6.
16.
CunninghamMPillaiVBlachford RogersW.Haloperidol in the treatment of children with severe behaviour disorders. Br J Psychiatry1968;114:848–54.
17.
Gutierrez-EsteinouRGrebbJ.Risperidone: An analysis of the first three years of general use. Int Clin Psychopharmacol1997;12:503–10.
18.
McDougleCJHolmesJPCarlsonDCPeltonGHCohenDJPriceLH. A double blind placebo controlled trial of risperidone in adults with autistic disorder and other pervasive developmental disorders. Arch Gen Psychiatry1988;55:633–41.
19.
ConnorDFPoseverTA. A brief review of atypical neuroleptics in individuals with developmental disability. Mental Health Aspects of Developmental Disabilities1998;4:93–102.
20.
TollefsonGBeasleyMTamuraRTranPPotvinJ.Blind controlled long term study of the comparative incidence of treatment emergent tardive dyskinesia with olanzapine or haloperidol. Am J Psychiatry1997;154:1248–53.
21.
KhanBU. Brief report: Risperidone for severely disturbed behaviour and tardive dyskinesia in developmentally disabled adults. J Autism Dev Disord1997;27:479–89.
22.
MandokiM.Risperidone treatment of children and adolescents: Increased risk of extrapyramidal side effects. J Child Adolesc Psychopharmacol1995;5:49–67.
HerskowitzJ.Developmental toxicology. In: PopperC, editor. Psychiatric pharmacosciences of children and adolescents. Washington (DC): American Psychiatric Press; 1987.
25.
VitielloBBeharD.Mental retardation and psychiatric illness. Hospital and Community Psychiatry. 1992;43:494–9.
