Predicting Antipsychotic Withdrawal Outcome in People with Intellectual Disabilities: An Exploration of Practitioner Predictions and Factors Influencing it

Abstract

Abstract – Objective: The aim of this study was to examine the predictive value(s) of different practitioners (i.e., intellectual disability physicians, caregivers, and behavioral scientists) in determining the success of antipsychotic withdrawal in individuals with intellectual disabilities who are prescribed antipsychotic medications for the treatment of challenging behaviors. Additionally, this study sought to identify the association of (patient) characteristics and (environmental) factors with the predictions made by intellectual disability physicians. Method: This study was conducted using data from a double-blind randomized control trial of 88 participants. At baseline, practitioners predicted the success of withdrawal from antipsychotic medication, and these predictions were compared to the outcome of the withdrawal at week 22 to calculate positive and negative predictive values. A binary logistic regression was used to calculate the effect of nine factors on the expectation of the ID-Physician. Results: ID-physicians, caregivers, and behavioral scientists exhibited positive and negative predictive values of 63.6/27.3%, 71.0/44.4%, and 69/-%, respectively. The presence of autism spectrum disorder and movement disorder(s) decreased the odds of the ID-Physician predicting a successful outcome of the withdrawal, with odds ratios of .167 and .025, respectively. No other factors or characteristics were found to significantly influence their prediction. Conclusions: The findings of this study indicate that clinicians' predictions were not reliable enough to be used for decisions about withdrawing antipsychotics. Only autism and movement disorders showed a significant correlation with predictions made by ID-physicians. Other patient factors, environmental and pharmacological factors had limited to no effect. The development of a predictive model could help clinicians make decisions when considering antipsychotics withdrawal.