Among individuals with developmental disabilities (DDs) and mental retardation (MR), 50–60% will have at least mild psychological dysfunction and 10–15% will have severe psychiatric disorders.2 This rate may be up to seven times higher than the rate in the general population.3 The frequency of psychiatric disease is correlated with the severity of cognitive compromise.2 The common DDs with prominent psychiatric presentations include:4
- Prader-Willi syndrome
- fragile X syndrome
- Down syndrome
- Angelman's syndrome
- fetal alcohol syndrome
These disorders frequently coexist with symptoms of epilepsy, since the prevalence of epilepsy is much higher in people with DDs and MR than in the general population.2
The following pages focus on the use of psychotropic agents in patients with DDs, epilepsy, and a comorbid psychiatric disorder. Diagnostic issues are reviewed in an attempt to establish a treatment focus with clear target symptoms. Factors to be considered prior to the use of psychotropic agents in patients with developmental disabilities and epilepsy are outlined.
The major classes of psychotropic agents useful in this population include the antidepressants and antipsychotic drugs. Other agents (buspirone, beta-blockers, amphetamines, and mood stabilizers) are useful for controlling problems such as aggression and impulsivity. Side effects of these drugs, particularly those affecting the seizure threshold, are reviewed.
It is hoped that these pages will provide a template for the diagnosis and effective psychotropic treatment of this very specialized population. Although side effects are many, effective use of these medications can significantly ameliorate the considerable difficulties associated with psychiatric illness.
Adapted from: Barry JJ and Huynh N. Psychotropic drug use in patients with epilepsy and developmental disabilities. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;205–217. With permission from Elsevier (www.elsevier.com).