Matson Evaluation Of Drug Side Effects Research Articles

Movement Disorders in Adults With Intellectual Disability and Behavioral Problems Associated With Use of Antipsychotics?

__To the Editors:__ We read with great interest the article by Scheifes and colleagues about movement disorders in adults with intellectual disability (ID) and behavioral problems associated with the use of antipsychotics. The authors examined movement disorders in this population. The study shows that 44% of the study populationwith ID and behavioral problems had at least 1 movement disorder (parkinsonism, dyskinesia, akathisia, and dystonia). These results are in line with research in other populations. High prevalence of movement disorders among psychiatric patients using antipsychotics is already known. The conclusion of this study is that the prevalence of movement disorders in people with ID and behavioral problems is high, especially in ID patients using antipsychotics. Current use of antipsychotic drug and a dose in target range seems significantly associated with the risk of having thesemovement disorders. However, in our opinion, there are limitations in the validity of the instruments and the design of the study that compromise the validity of the conclusions. The best available instruments are used despite the limited number of standardized assessments for this population. Unfortunately, the validity of these instruments is unknown for people with ID. In addition, there are avoidable omissions in other measurements that may have biased the results. Information about the medical history of the participants is missing; it is essential to know if the participants had the movement disorder at the moment of their admission in the centers. Other medication use is not included in the analysis, although it was reported. This information is important because it is also known that other medications, such as dopamine receptor blockers, antidepressants, and antiepileptics, can cause these movement disorders. Several cross-sectional studies about movement disorders in ID patients have been performed in the past few years (Table 1). None of these studies are generalizable. In the study population of Scheifes et al, the intelligence quotient (IQ) is much higher compared with the general ID population. It could be that the level of ID influences the prevalence of movement disorders. Because of a lack of valid measurements, several tools are used in different studies. Therefore, the comparison of the study results is difficult. This highlights the need for uniform instruments that are valid, reliable, practical, and feasible in the ID population. There are only 3 instruments developed and validated in people with ID, these are as follows: Akathisia Ratings of Movement Scale for akathisia (ARMS), Dyskinesia Identification System Condensed User Scale (DISCUS) for dyskinesia, and Matson Evaluation of Drug Side Effects (MEDS) for overall adverse effects of psychotropic drugs. In the case of other movement disorders, there are no instruments that are validated for the ID population. More research is needed to acquire valid instruments and subsequently reach consensus on recommended instruments. In the study population of Scheifes et al, most patients have a Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) classification, and antipsychotics are used on-label, comparable with the studies of Matson et al and Fodstad et al. In the conclusion of Scheifes et al, the results are compared with the study of de Kuijper et al, but these participants use the antipsychotics off-label as shown in Table 1. Therefore, these populations are not comparable. It is still unclear if antipsychotics cause movement disorders in the ID population. It could be a result of the ID itself, an adverse effect of the antipsychotics, or a result of the psychiatric disease. Studies done in this field are all cross-sectional (Table 1), and none of them examined the presence of movement disorders before the start of antipsychotics. Only Fodstad et al compared the use of antipsychotics in patients with or without a psychiatric disorder; the limitation of the study was a small number of participants. A long-term prospective follow-up study with different ID patient groups (eg, adults with ID with on-label use, off-label use, and without antipsychotics use) is needed. That study would be composed of an assessment of movement disorders before the start of antipsychotics, during follow-up, and after the discontinuation of antipsychotic use. In addition, there could be a control group with ID and behavioral problems but without antipsychotic use. In this way, a causal relationship could be demonstrated. In conclusion, further research is needed to develop instruments that diagnose movement disorders that are valid, reliable, practical, and feasible in the ID population.With these instruments, a prospective follow-up study can be done. This subject should no longer be on the sidelines of evidence-based medicine, because it has a great impact on the quality of life of patients with ID.

Current status of the Matson Evaluation of Drug Side Effects (MEDS)

The Matson Evaluation of Drug Side Effects (MEDS) is currently the best established and most researched measure of drug side effects in the intellectual disability (ID) literature. Initial research was conducted on its psychometric properties such as reliability and validity. More recent research studies have used the measure to determine the interactive effects of severity of drug side effects on adaptive and social behaviors as well as symptoms of commonly medicated psychiatric conditions among persons with ID. Most recently the MEDS has been used to study potential risk factors of psychotropic drugs. The present study was written to review the current status of MEDS research in the broader context of psychotropic drug side effect research in general.

An Examination of Psychotropic Medication Side Effects: Does taking a greater number of psychotropic medications from different classes affect presentation of side effects in adults with ID?

This study examined whether the number of psychotropic medications an individual is taking across classes influences side effects among adults with Intellectual Disability (ID). Participants were 80 adults diagnosed with ID. Dependent variables were the composite score and domain scores of the Matson Evaluation of Drug Side-effects (MEDS), which is an instrument used to assess side effects. There were three levels of the independent variable: Group 1 – those taking zero psychotropic medications, Group 2 – those taking one psychotropic medication, and Group 3 – those taking two psychotropic medications across different medication classes. There was a significant main effect regarding number of psychotropic medication classes prescribed. Further analysis revealed that four of the nine MEDS domains had significantly different mean scores for number of psychotropic medication classes. For the majority of MEDS domains, such as Central Nervous System-General, Parkinsonism/Dyskinesia, and Behavioral/Akathesia domains, participants in the no psychotropic medication group had significantly lower mean scores than those in the one and two psychotropic medication groups. Only two MEDS domains, Cardiovascular and Hematologic Effects as well as Skin, Allergies, and Temperature, were significantly different between participants taking one psychotropic medication as compared with two psychotropic medications from different classes. Implications of these findings and recommendations for future research are discussed.

Tardive Dyskinesia and intellectual disability: An examination of demographics and topography in adults with dual diagnosis and atypical antipsychotic use

Atypical antipsychotic medications are commonly used in large-scale residential care facilities for adults with developmental disabilities. While the benefits of this class of psychotropics are noted, debate exists whether the side effect profile of these medications outweigh their therapeutic benefit, especially in those who use them long-term. Tardive Dyskinesia (TD) is a movement disorder often caused by a history of neuroleptic use which can cause deleterious effects. Due to the seriousness of TD and the impact on an individual's quality of life, it is necessary to identify predisposing factors for this condition in a population of adults with intellectual and developmental disabilities. The current study seeks to expand the literature related to TD and atypical antipsychotic medication utilizing a measure of medication side effects, the Matson Evaluation of Drug Side Effects (MEDS). Results and implications for assessment and practice are discussed.

Atypical Antipsychotic Adjustments and Side-Effects over Time in Adults with Intellectual Disability, Tardive Dyskinesia, and Akathisia

Atypical antipsychotic use is prevalent in ID, and can result in serious side effects, particularly long-term. The purpose of this paper was to examine side effects over time and adjustments in atypicals in ID, tardive dyskinesia (TD), and akathisia. Side effects of 84 ID adults were assessed across four administrations of the Matson Evaluation of Drug Side-Effects (MEDS). Persons with TD or akathisia who experienced changes in atypicals were more likely to evince side effects. These trends were evident across total MEDS scores and subscales for cardiovascular and hematology, CNS for parkinsonism/dyskinesia and behavioral/akathisia. Atypical antipsychotic use poses a risk for side effects in individuals with ID, particularly in relation to medication adjustments over time and the presence of neuroleptic-induced movement disorders.

Risk factors for tardive dyskinesia in adults with intellectual disability, comorbid psychopathology, and long-term psychotropic use

Psychotropic medications are commonly used as an adjunct treatment in large-scale residential care facilities for adults with developmental disabilities. While the benefits of medication are noted, there are very severe conditions that can result from long term medication use. Tardive dyskinesia (TD) manifests as a variety of involuntary, repetitive movements caused by a history of neuroleptic medication use. Due to the serious nature of this disorder, it is necessary to find predisposing factors for TD in a population of adults with intellectual and developmental disabilities. The current study seeks to expand the literature related to TD utilizing a measure of medication side effects, the Matson evaluation of drug side effects (MEDS). Results and implications for assessment and practice are discussed.

The convergent and divergent validity of the Matson Evaluation of Drug Side-effects (MEDS) and the Dyskinesia Identification System: Condensed User Scale (DISCUS)

Background Medication side-effects such as tardive dyskinesia (TD) are known to occur in individuals with a history of psychotropic drug use. This study aimed to contribute to the development of measures for assessing TD by examining the validity of the Matson Evaluation of Drug Side-effects (MEDS) with the Dyskinesia Identification System: Condensed User Scale (DISCUS) in 163 adults with intellectual disability (ID).Method To establish convergent validity, the relationship between the MEDS and the DISCUS in identifying TD was examined. To establish divergent validity, the ability of the MEDS to differentiate between TD and other side-effects was investigated.Results The MEDS demonstrated convergent validity with the DISCUS on the Central Nervous System – Parkinsonism/Dyskinesia (CNS-PD) Subscale. The MEDS showed divergent validity with the DISCUS in cardiovascular and gastrointestinal side-effects, Parkinsonism symptoms (i.e., tremor, mask-like face), dystonia, and akathisia.Discussion The MEDS appears to have significant clinical utility in measuring tardive dyskinesia and other medication side-effects in individuals with ID.

Matson Evaluation of Drug Side-Effects (MEDS) Profiles of Selective Serotonin Reuptake Inhibitors (SSRI) in Adults with Intellectual Disability

Selective serotonin reuptake inhibitors (SSRI) are generally considered the drug class of first resort for persons with intellectual disability (ID) and mood disorders. This trend is consistent with the general population. While efficacy has been established, little has been done to look at side effect risk factors of SSRIs for persons with ID. In this study we describe data from the Matson Evaluation of Drug Side-Effects (MEDS) for 49 adults with mild to profound ID who were prescribed SSRIs (n = 13), SSRIs plus other psychotropic drugs (n = 15), or no psychotropics (n = 21). From these data we conclude that higher doses of SSRIs and prescription of additional psychotropic medications increase the possibility that undesirable side effects would emerge compared to controls.

Akathisia in adults with severe and profound intellectual disability: A psychometric study of the MEDS and ARMS

Background This study assessed the psychometrics of two measures – the Matson Evaluation of Drug Side‐effects (MEDS) and the Akathisia Ratings of Movement Scale (ARMS) – and examined the symptom profile of akathisia in a sample of people with intellectual disability (ID).Method Sixty‐six participants formed three groups of 22 individuals, matched on age, race, sex, and level of ID. The sample comprised Group 1: individuals with no antipsychotic drug use and no diagnosis of akathisia (control group); Group 2: individuals taking antipsychotics and with no diagnosis of akathisia (no akathisia group); and Group 3: individuals taking antipsychotics and with a diagnosis of akathisia (akathisia group).Results Both measures indicated the presence of akathisia in those individuals with a diagnosis of akathisia, while the two groups without a diagnosis of akathisia did not qualify for a diagnosis of akathisia on either scale. Interestingly, item analysis of the MEDS and ARMS tended to identify different symptoms of akathisia and were moderately correlated.Conclusions The data appear to suggest that both measures have merit, that they are complementary, and that they should be used together when assessing akathisia in individuals with ID.

Matson Evaluation of Drug Side-effects (MEDS) Profiles in Adults with Intellectual Disability, Tardive Dyskinesia, and Akathisia

Drug side effect profiles of 161 intellectually disabled inpatient adults were assessed with the Matson Evaluation of Drug Side Effects (MEDS). Based on diagnoses made by a board certified psychiatrist and a neurologist specializing in movement disorders, participants were divided into three groups: controls (no movement disorder), tardive dyskinesia (TD), and a group with tardive dyskinesia/akathisia (TD Akathisia). Significant differences in side effects were noted between all three groups with the most severe side effects occurring in the TD Akathisia group. Group differences between the TD and TD Akathisia groups were most pronounced on CNS-Parkinsonism/Dyskinesia, CNS-Behavioral Akathisia, and CNS-Dystonia subscales, with the latter side effect group experiencing the greatest side effects. Implications of these data are discussed and future research is suggested.

Psychometric Properties and Participant Characteristics for Persons with Intellectual Disability using the Matson Evaluation of Drug Side-effects (MEDS)

In study one, 163 adults with intellectual disabilities (ID) who chronically received psychotropic medications were evaluated to further establish psychometric properties of the Matson Evaluation of Drug Side-effects (MEDS). Test–retest reliability was also examined for 76 adults. Cutoff scores for total and subfactors are reported as well as the implications of the present data for evaluating antipsychotic medications. In study two of our paper, we explored drug prescription practices for the same 163 participants. While most participants had been switched to atypical antipsychotic drugs, akathisia and tardive dyskinesia were still typical and frequent side effects. The implication of the data in these studies is discussed with respect to using the MEDS as a means of assessing side effects resulting from chronic antipsychotic drug use.

An analysis of side-effect profiles of anti-seizure medications in persons with intellectual disability using the Matson Evaluation of Drug Side Effects (MEDS)

We investigated the side-effect profiles of anti-seizure medications in persons diagnosed with a seizure disorder and intellectual disability. The majority of the 124 participants receiving anti-epileptic medication were white female, and were receiving only one anti-epileptic medication. The side-effect profiles of these participants were contrasted with a matched group of 124 individuals not taking any anti-epileptic or psychotropic medications. Using the Matson Evaluation of Drug Side Effects (MEDS), significant differences were found among the two groups on the central nervous system—general and endocrine/genitourinary subscales. Overall, participants taking anti-epileptic medications were experiencing relatively few side-effects as measured by the MEDS; between-group differences for side-effects were found on the general central nervous system effects and endocrine/genitourinary subscales. Implications of the present findings are discussed.

Side effect profiles of atypical antipsychotics, typical antipsychotics, or no psychotropic medications in persons with mental retardation

Antipsychotic medications have been used to treat a variety of behavioral and psychiatric disturbances in persons with mental retardation. Given the well-documented side effects of traditional antipsychotics, newer “atypical” antipsychotics have been well received in this population due to initial reports of a more favorable side effect profile. We compared the side effect profiles of both the typical and atypical antipsychotics using a comprehensive instrument, the Matson Evaluation of Drug Side Effects (MEDS) scale. Participants taking atypical antipsychotics did not differ in overall side effects from a matched control group taking no psychotropic medication, and both groups showed significantly fewer overall side effects than participants taking typical antipsychotics. Subscales designed to measure involuntary movements (e.g., akathisia, tardive dyskinesia) detected differences between participants taking either atypical or typical antipsychotics with respect to akathisia only. Implications of these findings and directions for future research are discussed.