|
The Rational Use of Psychotropic Medication for Individuals with
Intellectual Disabilities
|
 |
Edwin J. Mikkelsen, M.D.
Description:
The central premise far this book Is the thesis that a psychiatric
diagnosis Is a necessary, but not a sufficient, basis to justify the
use of psychotropic medication in individuals with intellectual
disabilities (ID). For example, the diagnosis of a depressive
disorder does not legitimize the use of three antidepressants (or
even one), if efficacy cannot be demonstrated. A corollary thesis is
that in those situations where a psychiatric diagnosis has been
established, there still needs to be a rigorous risk-benefit analysis
with regard to the utilization of the proposed medication.
Historically, psychotropic medications were indiscriminately used to
address behavioral problems that presented in individuals with ID. In
this era, the first-generation antipsychotic agents, such as
Chiorpromazine and Thioridazine (also referred to as “major
tranquilizers”), were often prescribed for their sedative
effects. The publications of pioneering psychiatrists, such as Frank
Menolascino (1970) and Ludwig Szymanski (1977), alerted the
profession to the inappropriateness of the indiscrirninant use of
antipsychotic medication for this population. This early work also
suggested that a valid psychiatric diagnosis could be established in
mmiv individuals with ID, which could then be used to develop
psychopharmacological treatment plans that were effective for the
underlying condition. One of the most significant publications in
this regard was the classic article by Sovner and Hurley, which
appeared in the prestigious Archives of General Psychiatry in 1.983.
This article demonstrated the existence of affective disorders in
individuals with ID. Unfortunately, these efforts were not entirely
sufficient to end the indiscriminate use of psychotropic medication.
Thus, many individuals with ID continue to receive multiple
psychotropic medications, with very little empirical documentation of efficacy.
My own experience in this regard derives from consultations on
individuals with problematic presentations from several states
throughout the country, over many years. It is not uncommon to find
large numbers of individuals who are receiving five to six (and
occasionally as many as eight) psychotropic medications. All of these
individuals have one or more psychiatric diagnoses on record, which
has been used to justify the psychotropic medication regimen. Thus,
the indiscriminate use of psychotropic medication continues. In my
opinion, the only difference between the major tranquilizer era and
now is the indiscriminate use of multiple classes of psychotropic
medications for varied psychiatric diagnoses that have questionable
validity and reliability. This book illustrates empirical methods for
ensuring that psychotropic
medications are utilized in a manner that: 1) can be justified by the
severity of the symptoms related to the underlying psychiatric
diagnosis; 2) clearly establishes their efficacy; and, 3) ensures
that the potential side effects of the medication do not exceed its
therapeutic benefit.
In order to accomplish this goal, the following chapters review the
importance of:
-
Risk-benefit considerations in the use of psychotropic medications;
-
Neutral data collection methods that present a balanced perspective;
-
Establishing the efficacy of medications;
-
Ruling out medical and/or behavioral contributions to the disorder; and,
-
The formulation(s) of psychopharnrncological algorithms that take
into account the risk-benefit equation.
Some of the chapters are followed by a Notes section, which
elaborates on specific points in the text and/or discusses references
relating to that particular chapter. The final chapter is dedicated
to a discussion of the factors that contribute to unnecessary
polypharnrncy and techniques to help prevent it. The Appendices that
follow are intended to provide a template for the clinical use of
psychopharmacological agents in individuals with ID that incorporates
the principles outlined in the text. |
|
|
 |
|
 |
Click
here to order
ISBN: 1-57256-057-6 Pages: 122
Table of contents
Acknowledgements
Introduction
Chapter I - Risk-Benefit Considerations in the Use of PsychotTopic
Medications in Individuals with Intellectual Disabilities
Chapter II - Neutral Data Collection Methods
Chapter III -Establishing the Efficacy of a Psychotropic Medication
Chapter IV - Differential Diagnosis of Medical Issues and Behavioral
I)isorders Occurring in Individuals with Intellectual Disabilities
Chapter V - Formulation of Psychopharmacologic Algorithms for Adults
with Intellectual Disabilities and Psychiatric Disorders
Chapter VI - Pathways to and from Polypharmacy
Appendix I - Brief Symptom-Based Checklists to Aid in the
Identification of Possible Psychiatric Contributions to
Self-Injurious and/or Aggressive Behavior
Appendix II - The Comprehensive Clinic Consult: Individuals with
Intellectual Disabilities Who Engage in Aggressive and/or Self
Injurious Behavior
Appendix III - The Comprehensive Clinic Consult: A Hypothetical
Example of an Individual with Intellectual Disabilities Who Engages
in Aggressive and/or Self-Injurious Behavior
|
Upcoming Conferences:
New Educational Products:
|
Human Needs and Intellectual Disabilities: Applications for Person
Centered Planning, Dual Diagnosis, and Crisis Intervention
Steven Reiss, Ph.D.
Human Needs and Intellectual Disabilities identifies the 12 human
needs most relevant to the lives of people with intellectual
disabilities, autism and related developmental disabilities. It
includes detailed, practical suggestions for caregivers or parents
interested in the happiness, quality of life, and self-determintion
of their loved ones or consumers. The book includes detailed,
practical suggestions for reducing episodes of challenging behavior
and psychiatric symptoms in people with a dual diagnosis
(intellectual disabilities and mental illness). It shows how to
substitute the language of individuality (e.g., "friendly
person") for the language of disability (e.g., "person with
disability"). It also reduces the tendency of planners to
confuse their own value system for that of the consumer. The
book includes scholarly reviews of dual diagnosis literature on
mental illness, prevalence, and assessment.
NADD # DA10-048B Details
|
Positive Identity Development
Author: Karyn Harvey, PhD
Positive Identity Development is an exciting new approach to
treatment for individuals with intellectual disabilities. This
book provides a new theoretical perspective on treatment along with a
variety of innovative tools. It rejects reducing adults with
intellectual disabilities to a mere compilation of their behaviors
and promotes the use of a positive, therapeutic approach to each
unique individual. Psychologists, social workers and therapists
should be able to use the tools presented in this book to directly
enhance the effectiveness of the treatment they provide to adults
with intellectual disabilities. This book promotes well-being on
every level and explores a broad range of issues relevant to the life
and mental health of adults with intellectual disabilities
Mbr Price: $34.95
Non-Mbr: $39.95
NADD #CT09-047B Details |
 Down
Syndrome: When to Worry about Mental Health and What to Do About It
Robin Friedlander, M.D. & Peter Johnson, Ph.D.
NADD # FI09-044B Details |
 Working
with People who have Intellectual Disability and Behavioral
Problems: A Self-Study Guide for Interdisciplinary Team Members
Ann R. Poindexter, M.D. & Paul D. Kolstoe, Ph.D.
NADD # ST09-045B Details |
Multi-Media CDs of NADD 25th Annual Conference Presentations
Presentations recorded at NADD 25th Annual Conference are available
as multi-media CDs. These CDs contain the video and Power Point
from conference presentations and are a great tool for training
yourself and your staff. To order, or for additional
information, click here.
Community Networks of Specialized Care: Building Community
Capacity through Training and Education Lisa Holmes, Liz
Froese, MSW, Rosanne Stein, LLB, BSc, Sandi Bricker
NADD Competency-Based Dual Diagnosis Certification Program Robert
Fletcher, DSW, ACSW, FAAIDD; Donna McNelis, PhD; John McGonigle,
PhD; Kathleen Olson, PhD; Jarrett Barnhill, MD
Autism Spectrum Disorders: Separating the Data from the
Myths Ann R. Poindexter, MD
Diagnostic Systems for Use with People with ID Luis
Salvador-Carulla, MD, PhD, Robert J. Fletcher, DSW, ACSW, FAAIDD,
Sally-Ann Cooper, MD
The price for the above multimedia is: Member:
$49.95 Non-member: $59.95
To order, or for additional information, click
here.
|
|
