Relapse of Aggressive and Disruptive Behavior in Mentally Retarded Adults Following Antipsychotic Drug Withdrawal Predicts Psychotropic Drug Use a Decade Later

Background: Mental retardation is frequentlyassociated with aggression toward self and others. Antipsychoticmedications are frequently used as a major treatment of suchaggression. However, national and state policies and guidelinesare weighted toward stopping or decreasing the doses of thesemedications whenever possible, although exceptions are permitted.The purpose of this study was to determine if relapse during orafter antipsychotic drug withdrawal in mentally retarded adultspredicts continuing antipsychotic drug use an average of a decadelater.

Method: We report here on a 6- to 13-year(average 10-year) follow-up of 151 institutionalized mentallyretarded adults. During the period 1990–1997, the subjects hadbeen prescribed antipsychotic medications to treat maladaptivebehaviors, primarily consisting of aggression,disruptive/destructive behaviors, or a combination of these. Wecompared subjects’ psychotropic medication profiles in 2003 asthey related to outcome during the earlier period. Our goal wasto determine if rapid relapse (a clinically significant increasein maladaptive target symptoms, beginning 3 months or less afterantipsychotic drug termination or dosage reduction, that wasreversed by antipsychotic drug reinstitution or dosage increases)during or after routine withdrawal of an antipsychotic predictedpsychotropic drug use in 2003.

Results: For those individuals successfullywithdrawn from antipsychotic medications, 66.3% (55/83) werestill psychotropic drug free in 2003. For those who rapidlyrelapsed during the period 1990–1997 following antipsychotic drugwithdrawal or dosage decreases, only 9.0% (5/55) werepsychotropic medication free in 2003.

Conclusion: These observations support policiesand guidelines indicating that attempts to stop treatment withantipsychotic medications in mentally retarded individuals areworthwhile. However, the results also indicate that eventualdiscontinuation of antipsychotic medications in institutionalizedmentally retarded adults who have previously relapsed upon suchwithdrawal is unlikely to be successful. Rigid adherence to drugwithdrawal policies and guidelines in such individuals should bereconsidered.