Evidence map›Paper›PMID 40908653›Full record

ArticleJournal of intellectual disability research : JIDR2025

Off-Label Antipsychotic Withdrawal in People With Intellectual Disabilities: Development and Internal Validation of a Prediction Model.

Joëlle Weijgertze-Lanser, Maureen B G Wissing, Roy G Elbers, Josien Jonker, Gerda M de Kuijper, Dederieke A M Maes-Festen

Erratum issuedAbstract readValidation Study
In one paragraph

Article in Journal of intellectual disability research : JIDR, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Joëlle Weijgertze-LanserDepartment of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.ORCID 0009-0002-0314-2197
Maureen B G WissingDepartment of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Roy G ElbersDepartment of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Josien JonkerDepartment of Centre for Intellectual Disabilities and Mental Health/GGZ Drenthe, the Netherlands.ORCID 0000-0002-7913-2967
Gerda M de KuijperDepartment of Centre for Intellectual Disabilities and Mental Health/GGZ Drenthe, the Netherlands.
Dederieke A M Maes-FestenDepartment of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.ORCID 0000-0002-7613-0720

Funding

Academic Collaborative Research Center Healthy Ageing and Intellectual DisabilitiesZonMw 848016008
6 · The paper itself

Abstract

backgroundOff-label antipsychotic use in people with intellectual disabilities and challenging behaviour is high. Antipsychotic withdrawal is recommended, but attempts are often unsuccessful. This study aimed to develop and internally validate a prediction model that provides insight into predicting factors for unsuccessful (i.e. incomplete) off-label antipsychotic withdrawal attempts in people with intellectual disabilities.

methodsData collected in two previous studies examining the withdrawal of off-label antipsychotics in people with intellectual disabilities and challenging behaviour living mostly in 24/7 care settings (98.6%) in the Netherlands were analysed. The dataset included 141 participants (64.5% male, median age 52). We selected candidate predictors (age, level of intellectual disability, defined daily dose, autism spectrum disorder and three subscales of the Aberrant Behavior Checklist [ABC], namely stereotypy, hyperactivity and lethargy) based on previous research and clinical relevance. A multivariable logistic regression analysis with backward selection procedures was conducted to identify significant predictors. The model was internally validated using bootstrapping procedures.

resultsThe analysis revealed the level of intellectual disability (p = 0.030, OR = 2.374), defined daily dose (p = 0.063, OR = 2.833), and ABC stereotypy (p = 0.007, OR = 1.106) as key predictors for unsuccessful withdrawals. The variables explained 20% of the variance (Nagelkerke's R-square, R

conclusionsThe odds of unsuccessful withdrawal increase with a more severe level of intellectual disability, a higher antipsychotic defined daily dose and higher stereotypy scores. The results inform healthcare providers about the predictive factors enabling them to better anticipate and support future withdrawal attempts.

Indexed as

Antipsychotic AgentsIntellectual DisabilityOff-Label UseProblem BehaviorAdolescentAdultAgedFemaleHumansMaleMiddle AgedNetherlandsYoung AdultAntipsychotic Agentsantipsychoticschallenging behaviourintellectual disabilitiesoff‐labelwithdrawal

Identifiers

PMID40908653
PMCPMC12576382

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.