Some Monitoring and Treatment Suggestions for ID Patients
- Do metabolic monitoring (HgbA1c, fasting glucose, fasting lipids) at least twice annually and more often if there are multiple medical or neurological conditions. ID patients may not be able to exercise, so they are at higher risk of metabolic side effects with medications such as olanzapine, quetiapine, and clozapine.
- Consider expanded lab work, including a standard intake panel (CBC, electrolytes, liver function test) as well as annual rheumatoid factor, ANA, vitamin levels (including Vitamin D, B12, and folate), and H. pylori (patients with ID have higher rates of H. pylori than the general population).
- Do an AIMS scale (or your favorite standardized screen for EPS) at least twice yearly, or more often if the patient has a diagnosed EPS condition, a history of EPS, or a muscular disorder such as cerebral palsy.
- Patients with ID are more vulnerable to neuroleptic malignant syndrome (NMS), and the fatality rate is higher in ID patients.
- Use extra caution with any medications that affect the seizure threshold (clozapine, anticholinergics, antihistamines, phenothiazines, bupropion, etc).
- Take into account difficulty with pill swallowing, as dysphagia is common; consider alternate preparations (liquids, dissolvables, etc).
Table: Intellectual Disability Severity Levels
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