The long-term objectives of this proposal are to identify the following: (1) the necessary components of an effective review and monitoring system for achieving reductions in high utilization rates and dosages of psychotropic medication in residential facilities for the developmentally disabled (DD); (2) the minimum utilization rate of psychotropic medication based on the increase of withdrawal-emergent target symptoms (e.g., aggressive and self-injurious); and (3) quantitative characteristics of withdrawal-emergent side affects tardive dyskinesia or TD) by computerized analysis of movement patterns identified as symptoms of TD by clinical ratings. Reductions in high utilization rates can be accomplished by Minimal Effective Dose (MED) procedures which withdraw medication or decrease dosages in those cases in which management of behavior is not adversely affected. In 75% of the cases, withdrawal TD is not adversely affected. In 75% of the cases, withdrawal TD is expected to occur and then dissipate over a one-year period Significant increases in target symptoms are not expected in 2/3 of the cases. The investigators will be able to establish a no-medication control group, a baseline control group, and two withdrawal-review groups (policy alone vs, policy plus monitoring). Specific target symptoms and specific side effects will be measured. The study will fill gaps in the literature, and will provide an empirical basis for documenting TD in the DD population, and for establishing the MED-type review as a clinically acceptable alternative to judicial or administrative directives for achieving significant reductions in utilization rates of psychotropic medications in the DD population.
