The overlooked burden: anti-seizure medications, laxatives, and antipsychotics prescribed in primary care for people with intellectual disability

Objectives: People with intellectual disabilities (PwID) have higher prevalences of epilepsy and constipation than the general population. Constipation is having fewer than three bowel movements or requiring laxatives three or more times weekly. Both epilepsy and constipation contribute significantly to premature mortality. To manage constipation, many individuals are prescribed long-term laxatives, which serve as a surrogate indicator of constipation. PwID and epilepsy also have a high prevalence of multimorbidity and polypharmacy, particularly involving antiseizure medications (ASMs) and antipsychotics. This study aimed to explore associations between ASM use, antipsychotics, and laxative prescribing.Method: The primary care dataset in Cornwall, England (population 572,000), was used to examine patient prescribing records for laxatives, ASMs, and antipsychotics using SNOMED diagnosis codes for PwID. Age and sex were recorded. Results are reported as the prevalence of study cohorts.Results: Of 3,189 PwID in Cornwall’s GP registers, 2,799 (88%) were over 18, and 1,881 (59%) were men. Among them, 725 (23%) were prescribed laxatives and 467 (15%) ASMs. Of these, 209 were on both laxatives and ASMs (28.8% of all laxative users, 44.8% of all ASM users). Older PwID (> 40 years) were more likely to be on both ASMs and laxatives. Among the 209, 72 (34.4%) were on antipsychotics, with overrepresentation in those over 40.Conclusion: Nearly half of PwID on ASMs are prescribed laxatives, and over a third of them were also found to be taking antipsychotics. Given the significant links among epilepsy, constipation, and antipsychotic use to premature mortality in PwID, it is imperative to consider these factors collectively rather than individually.