1. UCI-RCOC NEURODEVELOPMENTAL PROGRAM AND CLINIC A 14 Year Review February 2, 2012

2. UCI Professional Personnel Ira T. Lott, MD - Pediatric Neurologist and Director Paul Touchette, EdD – Psychologist Gail Fernandez, MD – Psychiatrist Anne Tournay, MD – Neurologist Larry Plon, Pharm D. - Research Pharmacist Christy Hom, PhD - Neuropsychologist and Coordinator

3. Objectives 1) To determine the extent of polypharmacy for psychoactive drugs in the RCOC consumer population 2) Interdisciplinary Team Clinic for RCOC consumers with medication and behavioral issues

4. Psychoactive Drug Survey 30 months consecutive data CalOptima Pharmacy Billing Records Accessed Cross-linked to RCOC consumers

5. 30 month Medication Survey 30 month Medication Survey 7,419 psychoactive drug prescriptions for RCOC population ( 26.8% of all prescriptions written) 62% had more than one psychoactive drug prescription and 32% had 3 or more First study of its kind in the DD population, published J Intellect Disability Research

7. 30 Month Survey of Psychoactive Medications 2,229,970 prescriptions surveyed 92,162 patients 25% were for psychoactive drugs Is it possible to determine medication adherence from the pharmacy billing records?

8. Calculation of Medication Adherence Ratio = # of days of drug supply # of days from first to last refill Adherence “yes” if ratio is ≥0.75 to 1.1 Adherence “no” if ratio<0.75

9. Adherence by Residence Type Cross linked adherence calculations with residence type from CDER

10. Number of Clients by Residence ResidenceFrequency Valid Percent Cumulative Percent Own Home/ Parent/Guardian 74932.532.6 Own Home/ Independent Living 1406.138.7 Supported Living 1134.943.6 CCF (RCFE) 11.544.5 CCF (1-3) 4.244.7 CCF (4-6) 72531.576.2 CCF (7-15) 401.777.9 CCF (16-49) 793.481.3 CCF (50+) 4.281.5 Total = 1865 RCOC Consumers

11. Psychoactive vs. Other Drug Types Drug TypeFrequency Percent of all fills Psychoactive54604624.5 Cardiac1356916.1 Antihypertensive678723.0 Antilipemic617182.8 Antidiabetic351191.6

12. Clients in Own Home Significantly Less Adherent for All 5 Medication Classes Own Home vs. CCF Chi-Square Odds Ratio (95% conf. interval) Valuep-value Antidiabetic4.040.04 6.58 (0.80-53.37) Antilipemic18.31<0.00 7.29 (2.64-20.27) Cardiac5.510.02 2.98 (1.16- 7.62) Blood pressure18.69<0.0014.38 (3.19-65.31) Psychoactive Medications 116.5<0.00 2.07 (1.81- 2.38)

13. Factors Affecting Medication Adherence Residence Group home residents are twice as likely to adhere to their psychoactive prescriptions than consumers who live in their own home or family home Medication form Divalproex ER is 2.01 times more likely to be adhered to than regular Divalproex Polypharmacy, gender, and age did not affect adherence.

14. Conclusions from Adherence Study Medication adherence is problematic for clients living in their own home This is very similar to the general population Public health efforts towards medication adherence indicated

15. INTERDISCIPLINARY CLINIC

16. Introduction to Interdisciplinary Clinic Team consists of neurologist, psychiatrist, educational, research and neuropsychologists All clients referred by RCOC (1837 consumers evaluated since 1998) Interdisciplinary team review of diagnostic, medication, and treatment options for each client

17. Primary Referral Reasons Polypharmacy Medication side effects Increasing behavioral problems Need for diagnostic services

18. Mean Age of 1500 Consumers Mean ages of consumers in years 2007-2011 less than in years 2001-2006; p<.001

19. Age Distribution of Clinic Population

20. Gender Distribution Distribution from 2001-2004 significantly different than that from 2007-2011 Distribution in 2005 significantly different than that in 2006, but not from that in 2004 Distribution from 2010-2011 significantly different from 2007

21. Level of Intellectual Disability

22. Distribution of Intellectual Disability *Prior to 2008, consumers with No Intellectual Disability had their ID Level coded as missing % of Consumers with ID, Severity Unspecified has sharply increased since 2008

23. Number of Psychoactive Medications Pre- Clinic

24. Average # of Psychoactive Medications Pre-Clinic Average # of medications from 2001-2007 greater than average # of medications from 2008-2011; p<.001

25. Top 25 Medications Pre-Clinic

26. Major Psychiatric Diagnostic Categories

27. Diagnostic Trends by Year Significant increase in consumers with an Anxiety Disorder or Autistic Disorder

28. Diagnostic Trends by Year Significant decrease in consumers with Bipolar Disorder, OCD, or Impulse Control Disorder

29. DIFFERENCES BETWEEN DISORDERS

30. Associations with # of Psychoactive Medications Schizophrenia, Bipolar Disorder, and Impulse Control Disorder associated with more medications Autistic Disorder associated with fewer medications (possibly because younger in age)

31. Associations with Schizophrenia Significantly older than patients not diagnosed with Schizophrenia Significantly higher intellectual functioning Taking significantly more psychoactive medications than those without Schizophrenia Significantly better personal, community, and social skills than rest of clinic population

32. Associations with Bipolar Disorder Taking significantly more psychoactive medications than those without Bipolar Disorder Caregivers less compliant in following clinic recommendations Significantly more irritable than consumers without Bipolar Disorder Significantly better personal, community, and social skills than rest of clinic population

33. Associations with Autistic Disorder Significantly younger than consumers without Autism Taking fewer psychoactive medications Significantly less personal, community, and social skills Significantly more maladaptive behaviors (both internalizing and externalizing behaviors)