Relapse of Aggressive and Disruptive Behavior in Mentally Retarded Adults Following Antipsychotic Drug Withdrawal Predicts Psychotropic Drug Use a Decade Later
J Clin Psychiatry 2006;67(8):1272-1277
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Background: Mental retardation is frequently
associated with aggression toward self and others. Antipsychotic
medications are frequently used as a major treatment of such
aggression. However, national and state policies and guidelines
are weighted toward stopping or decreasing the doses of these
medications whenever possible, although exceptions are permitted.
The purpose of this study was to determine if relapse during or
after antipsychotic drug withdrawal in mentally retarded adults
predicts continuing antipsychotic drug use an average of a decade
Method: We report here on a 6- to 13-year
(average 10-year) follow-up of 151 institutionalized mentally
retarded adults. During the period 1990-1997, the subjects had
been prescribed antipsychotic medications to treat maladaptive
behaviors, primarily consisting of aggression,
disruptive/destructive behaviors, or a combination of these. We
compared subjects' psychotropic medication profiles in 2003 as
they related to outcome during the earlier period. Our goal was
to determine if rapid relapse (a clinically significant increase
in maladaptive target symptoms, beginning 3 months or less after
antipsychotic drug termination or dosage reduction, that was
reversed by antipsychotic drug reinstitution or dosage increases)
during or after routine withdrawal of an antipsychotic predicted
psychotropic drug use in 2003.
Results: For those individuals successfully
withdrawn from antipsychotic medications, 66.3% (55/83) were
still psychotropic drug free in 2003. For those who rapidly
relapsed during the period 1990-1997 following antipsychotic drug
withdrawal or dosage decreases, only 9.0% (5/55) were
psychotropic medication free in 2003.
Conclusion: These observations support policies
and guidelines indicating that attempts to stop treatment with
antipsychotic medications in mentally retarded individuals are
worthwhile. However, the results also indicate that eventual
discontinuation of antipsychotic medications in institutionalized
mentally retarded adults who have previously relapsed upon such
withdrawal is unlikely to be successful. Rigid adherence to drug
withdrawal policies and guidelines in such individuals should be