Antipsychotic medication for behaviors that challenge in individuals with intellectual disabilities: a clinically informed review

Article Article scientifique Revue de la littérature Antipsychotic medication for behaviors that challenge in individuals with intellectual disabilities: a clinically informed review eng 2025-07-28 author Pascucci Alessandro 419411 SYNAPSY Centre de recherche translationnelle en neurosciences psychiatriques (CTNP) (SYNAPM) author Gerber Fabienne author Besson Marie 87576 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Kosel Markus Mathaus 668114 Département de psychiatrie (PSYAT) 1609408 10.3389/fpsyt.2025.1609408 40791204 1664-0640 PMC12336111 https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1609408/full <p>Individuals with intellectual disabilities (ID) frequently exhibit behaviors that challenge (BC), such as aggression and self-injury, which significantly impact their quality of life. Pharmacological interventions, particularly antipsychotics, are regularly employed to manage these behaviors. However, these medications are frequently prescribed off-label, increasing the risks of polypharmacy, drug-drug interactions, and potential adverse effects. We conducted a comprehensive literature search to identify studies on antipsychotic interventions for BC in individuals with ID. Eligible studies included observational (cross-sectional and longitudinal) studies and randomized controlled trials (RCTs). Findings from RCTs were mixed: while some trials reported reductions in aggression and irritability with antipsychotics such as risperidone and olanzapine, others showed no advantage over placebo or supported deprescription strategies. Observational studies generally supported the short-term effectiveness of risperidone, olanzapine, and zuclopenthixol in reducing aggressive behaviors, although evidence for their impact on self-injurious behaviors (SIBs) was inconsistent. Across both study types, the use of antipsychotics was consistently associated with adverse effects, including sedation, weight gain, and metabolic changes. Preliminary open-label evidence suggested that aripiprazole may reduce BC in individuals with Fragile X Syndrome (FXS), while causing fewer metabolic side effects. These findings highlight key limitations of the current literature, including the scarcity of studies focusing specifically on ID populations, small sample sizes, the limited number of RCTs, and often controversial or inconsistent results. Despite these limitations, the review indicates potential benefits from reducing dosages and discontinuing long-term antipsychotic use, particularly when guided by personalized treatment plans and regular reassessment. Overall, the results support cautious and individualized prescribing, with close monitoring of adverse effects and attention to deprescribing when appropriate. Further longitudinal and naturalistic studies are warranted, along with the development of structured tools to assist clinicians in optimizing pharmacological care for this vulnerable population.</p> Intellectual disabilities Pharmacological interventions Antipsychotics Risperidone Olanzapine Aripiprazole Zuclopenthixol Challenging behaviors Dewey 616.89 Dewey 617 60 Département de psychiatrie 225 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 573 Troubles du développement intellectuel et du spectre de l'autisme chez l'adulte 916 Frontiers in psychiatry 16 307cf53f-1656-4b54-a2ab-585b2a8abeaf Article (Published version) Public Article_scientifique_from_unpaywall.pdf 867840 application/pdf CC BY-4.0 f6a366126d7c1ce824121f0bc0c8818278c9093b66e17dd3ce2fc0f04c1a5f87 d3bf8cee-9cb7-4f32-8e94-9ecc96e4068b Supplemental data Public Table_1.docx 16149 application/vnd.openxmlformats-officedocument.wordprocessingml.document 3e3c649b6fa4b74fdaca0f6d4fb0ef13a9f993a571b8dd7bc28e539e04ba5df9 fdcf823c-4dc1-4084-a055-fe9ad477c3a8 Supplemental data Public Table_2.docx 39479 application/vnd.openxmlformats-officedocument.wordprocessingml.document b2acf5dbef2d7a91c2b04209a67db8dd0e10e498930833a45a68c1678062c015 a3e34c75-2542-417b-bdbb-88596d6b5914 Supplemental data Public Table_3.xlsx 6677 application/vnd.openxmlformats-officedocument.spreadsheetml.sheet b7716b2fe9e1eb123a482007df1c7d35b30b95c0ef23cdf4235f20450c81b99a 6289a920-23b7-41e1-bb7d-c722da0be9e0 Supplemental data Public Table_4.xlsx 6772 application/vnd.openxmlformats-officedocument.spreadsheetml.sheet 22a155cd891043489f84c4f57ca072edf177db97949bec900c6f1b019dbc903c openAccess Faculté de médecine / Section de médecine clinique / Département de psychiatrie Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Antipsychotic medication for behaviors that challenge in individuals with intellectual disabilities: a clinically informed review	Frontiers in psychiatry			2025	34	1,116

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Pascucci, Alessandro

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