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Di Sarro R, Varrucciu N, Di Santantonio A, Natali F, Kaleci S, Bianco A, Cappai M, Lucchi F, Bertelli MO. Appropriateness of psychopharmacological therapies to psychiatric diagnoses in persons with autism spectrum disorder with or without intellectual disabilities: a cross-sectional analytic study. Expert Opin Drug Saf 2023; 22:1271-1281. [PMID: 36681385 DOI: 10.1080/14740338.2023.2172396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Observational studies highlighted high rates of psychotropic medication in persons with autistic spectrum disorder (ASD) with or without intellectual disability, which seems to be associated with the management of problem behaviors more than co-occurrent psychiatric disorders. The purpose of the study is to investigate psychopharmacology use and diagnoses of co-occurrent psychiatric disorder (PD) in persons with ASD attending a public mental health service in Emilia Romagna, Italy. METHODS The present study is a multicenter, cross-sectional study. RESULTS 275 persons out of 486 (56.5%) resulted to receive at least one psychotropic drug, compared to 74 persons (15.2%) that were diagnosed with a PD. 63.6% were on poly-pharmacotherapy (2-10 compounds), with 37.8% receiving 3 or more medications. Antipsychotics were the most frequently prescribed class of psychotropic drugs (89%), followed by antiepileptics/mood stabilizers/lithium (42.1%) and anxiolytics (BDZ) (38.5%). Most common psychiatric disorders were psychotic disorders (29.7%), followed by anxiety disorders (17.5%), bipolar disorders (12.2%), and depressive disorders (9.4%). CONCLUSIONS Our findings support earlier research showing that many individuals with ASD receive pharmacotherapy without being diagnosed with a co-occurring psychiatric disorder, indicating that the main reasons for prescription and the type of compound frequently have little to no link with specific psychopathology.
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Affiliation(s)
- Rita Di Sarro
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Niccolò Varrucciu
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Anna Di Santantonio
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Francesca Natali
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annamaria Bianco
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy
| | - Michela Cappai
- Emilia-Romagna Region, Mental Health and Pathological Addictions, Italy
| | - F Lucchi
- Department of Mental Health and Pathological Addictions, Public Local Health Bologna, Italy
| | - Marco O Bertelli
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy
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Song M, Rubin BS, Ha JW, Ware RS, Doan TN, Harley D. Use of psychotropic medications in adults with intellectual disability: A systematic review and meta-analysis. Aust N Z J Psychiatry 2023; 57:661-674. [PMID: 36700564 DOI: 10.1177/00048674221149864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study presents the proportion of adults with intellectual disability using psychotropic medications including antipsychotics, antidepressants, anxiolytics, hypnotics and sedatives, and psychostimulants. METHODS A search was performed in PubMed, Embase, PsycINFO, Web of Science, and Scopus up to 31 December 2021. Articles were included if they reported the proportion of adults with intellectual disability using psychotropic medications. Frequency of use was estimated using a random effects meta-analysis. Meta-regression analysis was used to assess the association between study-level characteristics and variability in estimates, when heterogeneity was considerable. RESULTS Twenty-four articles were included in pooled analysis. The pooled prevalence of psychotropic medications was 41% (95% confidence interval: 35-46%). Pooled prevalences of subclasses were as follows: antipsychotics 31% (27-35%), antidepressants 14% (9-19%), anxiolytics 9% (4-15%), hypnotics/sedatives 5% (2-8%), and psychostimulants 1% (1-2%). Heterogeneity was considerable between studies, except for psychostimulants. There was no significant association between assessed characteristics and variability in prevalence estimates. CONCLUSION Two-fifths of adults with intellectual disability were prescribed psychotropic medications. Antipsychotics and antidepressants were used by one-third and one-seventh of adults, respectively. There was considerable variability between studies, and further investigation is required to determine the source of variability. More studies are needed to better characterise prescribed psychotropic medications, including effectiveness and adverse effects, to ensure appropriate use of these drugs.
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Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-University of Queensland (MRI-UQ), Mater Misericordiae Hospital, Brisbane, QLD, Australia
| | - Bryn S Rubin
- Ochsner Clinical School, University of Queensland, Brisbane, QLD, Australia
| | - Justin Wt Ha
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Robert S Ware
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-University of Queensland (MRI-UQ), Mater Misericordiae Hospital, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Tan N Doan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - David Harley
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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Ursumando L, Fucà E, Costanzo F, Vicari S. Delusion of Pregnancy in Down Syndrome: Two Case Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13339. [PMID: 36293918 PMCID: PMC9602499 DOI: 10.3390/ijerph192013339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Individuals with intellectual disability (ID) are more vulnerable to psychotic disorder and schizophrenia than the general population. However, psychotic symptoms have not been widely described in this population. Here, we deeply investigated the cases of two young women with ID and Down syndrome (DS) who developed a delusion of pregnancy, a rare condition defined as a fixed belief of being pregnant despite factual evidence to the contrary. The assessment included psychopathological and neuropsychological examination, as well as the evaluation of cognitive and adaptive functioning. In these cases, delusion manifested as a psychotic symptom of a cyclothymic disorder (case 1) or as an independent delusional disorder (case 2). However, some similarities emerged: both women exhibited good pre-morbid adaptive functioning and family history of psychiatric disorders; moreover, in both cases delusion emerged in association with an external trigger. Difficulties in verbally expressing one's thoughts and beliefs were found, as well as poor abstract reasoning skills that may have affected the ability to deeply conceptualize the delusional idea itself. These findings may provide crucial insights into the clinical manifestation of psychosis in individuals with DS and underscore the importance of a routine psychological and neuropsychological follow-up to provide prompt and adequate intervention.
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Affiliation(s)
- Luciana Ursumando
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
- Department of Life Sciences and Public Health, Catholic University, 00168 Rome, Italy
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Rawlings GH, Beail N. Long-COVID in people with intellectual disabilities: A call for research of a neglected area. BRITISH JOURNAL OF LEARNING DISABILITIES 2022; 51:BLD12499. [PMID: 36247098 PMCID: PMC9538317 DOI: 10.1111/bld.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Background Long-COVID (also known as post-coronavirus-19 syndrome) is a term used to describe symptoms that people experience following their recovery from the COVID-19 virus. The severity of long-COVID is well recognised, with healthcare providers commissioning services to diagnose and treat those affected, as well as funded research into the condition. Methods We performed a systematic search for relevant articles but were unable to find any research on long-COVID in people with intellectual disabilities. Due to the lack of data, we have only been able to make extrapolations from what is known about the condition within the general population. Findings We provide an overview of long-COVID and its potential relevance to people with an intellectual disability. We have focused specifically on symptoms or signs, prevalence, risk factors and treatments of the condition in this group, highlighting areas for clinical practice and future research from a psychosocial perspective. We raise serious questions about our current understanding and the availability of the evidence-based to inform treatments tailored towards this population. Conclusion This is the first report that we are aware of on the topic of long-COVID in people with an intellectual disability. The lack of research is preventing us from gaining a greater understanding of how the condition impacts people with an intellectual disability.
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Affiliation(s)
| | - Nigel Beail
- Clinical Psychology UnitUniversity of SheffieldSheffieldUK
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Costanzo F, Zanni G, Fucà E, Di Paola M, Barresi S, Travaglini L, Colafati GS, Gambardella A, Bellacchio E, Bertini E, Menghini D, Vicari S. Cerebellar Agenesis and Bilateral Polimicrogyria Associated with Rare Variants of CUB and Sushi Multiple Domains 1 Gene (CSMD1): A Longitudinal Neuropsychological and Neuroradiological Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031224. [PMID: 35162247 PMCID: PMC8835405 DOI: 10.3390/ijerph19031224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 12/04/2022]
Abstract
Cerebellar agenesis is an extremely rare condition characterized by a near complete absence of the cerebellum. The pathogenesis and molecular basis remain mostly unknown. We report the neuroradiological, molecular, neuropsychological and behavioral characterization of a 5-year-old girl, with cerebellar agenesis associated with parietal and peri-Sylvian polymicrogyria, followed-up for 10 years at four time points. Whole exome sequencing identified two rare variants in CSMD1, a gene associated with neurocognitive and psychiatric alterations. Mild intellectual impairment, cerebellar ataxia and deficits in language, memory and executive functions, with relatively preserved adaptive and psychopathological domains, were initially showed. Phonological awareness and verbal memory declined at 11 years of age, and social and anxiety problems emerged. Adaptive and psychopathological characteristics dramatically worsened at 15 years. In summary, the developmental clinical outcome showed impairment in multiple cognitive functions in childhood, with a progressive decline in cognitive and adaptive abilities and the emergence of psychopathological symptoms in adolescence. The observed phenotype could be the result of a complex interplay between cerebellar abnormality, brain malformation and the relations with CSMD1 variants. These findings may provide insights into the developmental clinical outcomes of a co-occurrence between rare brain malformation and rare genetic variants associated to neurodevelopmental disorders.
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Affiliation(s)
- Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital IRCCS, Via Ferdinando Baldelli 41, I-00146 Rome, Italy; (F.C.); (E.F.); (S.V.)
| | - Ginevra Zanni
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Viale di San Paolo 15, I-00146 Rome, Italy; (G.Z.); (L.T.); (E.B.)
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital IRCCS, Via Ferdinando Baldelli 41, I-00146 Rome, Italy; (F.C.); (E.F.); (S.V.)
| | - Margherita Di Paola
- Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, I-00179 Rome, Italy;
- Department of Mental Health, King Faisal Specialist Hospital & Research Center, Riyadh 12713, Saudi Arabia
| | - Sabina Barresi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, Viale di San Paolo 15, I-00146 Rome, Italy;
| | - Lorena Travaglini
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Viale di San Paolo 15, I-00146 Rome, Italy; (G.Z.); (L.T.); (E.B.)
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, I-00100 Rome, Italy;
| | - Antonio Gambardella
- Institute of Neurology, University Magna Græcia, I-88100 Catanzaro, Italy;
- Institute of Molecular Bioimaging and Physiology, National Research Council, I-88100 Catanzaro, Italy
| | - Emanuele Bellacchio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, Viale di San Paolo 15, I-00146 Rome, Italy;
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Viale di San Paolo 15, I-00146 Rome, Italy; (G.Z.); (L.T.); (E.B.)
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital IRCCS, Via Ferdinando Baldelli 41, I-00146 Rome, Italy; (F.C.); (E.F.); (S.V.)
- Correspondence: ; Tel.: +39-0668597091
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital IRCCS, Via Ferdinando Baldelli 41, I-00146 Rome, Italy; (F.C.); (E.F.); (S.V.)
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, Largo Agostino Gemelli 1, I-00168 Rome, Italy
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What do we know about non-epileptic seizures in adults with intellectual disability: A narrative review. Seizure 2021; 91:437-446. [PMID: 34332255 DOI: 10.1016/j.seizure.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/05/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022] Open
Abstract
Psychogenic non-epileptic seizures (PNES) superficially resemble epileptic seizures, but are not associated with abnormal electrical activity in the brain. PNES are a heterogeneous entity and while there is increasing interest in the characterisation of PNES sub-groups, little is known about individuals with PNES who have an intellectual disability (ID). ID is a lifelong condition characterised by significant limitations in cognitive, social and practical skills. ID (commonly with comorbid epilepsy) has been identified as a risk factor for developing PNES. However, people with ID are often excluded from research in PNES. This has unfortunately resulted in a lack of evidence to help inform practice and policy for this population. This narrative review synthesises the currently available evidence in terms of the epidemiology, demographic and clinical profile of adults with PNES and ID. There is a particular focus on demographics, aetiological factors, PNES characteristics, diagnosis and treatment of the condition in this population. Throughout this article, we critique the existing evidence, discuss implications for clinical practice and highlight the need for further research and enquiry. What emerges from the evidence is that, even within the sub-group of those with ID, PNES are a heterogeneous condition. Individuals with ID and PNES are likely to present with diverse and complex needs requiring multidisciplinary care. This review is aimed at the broad range of healthcare professionals who may encounter this group. We hope that it will stimulate further discussion and research initiatives.
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McCausland D, Guerin S, Tyrrell J, Donohoe C, O'Donoghue I, Dodd P. A qualitative study of the needs of older adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1560-1568. [PMID: 34124818 DOI: 10.1111/jar.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research indicates that adults with intellectual disabilities are living longer. However, there is limited research on how this affects health and care needs. OBJECTIVE The present study aimed to examine the health and social care needs of older adults with intellectual disabilities in Ireland using multiple informants. METHODS Data were gathered from a sample of 20 adults aged 50 years or older (Mean = 59.1, SD = 5.9, range = 50-72; 11 female). The sample included individuals with mild (n = 7), moderate (n = 10) and severe/profound (n = 3) intellectual disabilities. Additional data from keyworkers (n = 19) and family carers (n = 15) provided a more complete understanding of needs. RESULTS Results revealed some areas of agreement and difference between adults with intellectual disability and their carers regarding the social care, employment, retirement, physical and mental health needs of this population. CONCLUSIONS The findings of this study have potential implications for the provision of high-quality services for older adults with intellectual disabilities.
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Affiliation(s)
| | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Dublin 4, Ireland
| | | | - Clare Donohoe
- St Michael's House Disability Services, Dublin 9, Ireland
| | | | - Philip Dodd
- St Michael's House Disability Services, Dublin 9, Ireland
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Smith E, Sumner P, Hedge C, Powell G. Smart speaker devices can improve speech intelligibility in adults with intellectual disability. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:583-593. [PMID: 33772998 DOI: 10.1111/1460-6984.12615] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Successful communication is vital to quality of life. One group commonly facing speech and communication difficulties is individuals with intellectual disability (ID). A novel route to encourage clear speech is offered by mainstream smart speakers (e.g., Amazon Alexa and Google Home). Smart speakers offer four factors important for learning: reward immediacy, spaced practice, autonomy/intrinsic motivation and reduced social barriers. Yet the potential of smart speakers to improve speech intelligibility has not been explored before. AIMS To determine whether providing individuals with intellectual disabilities with smart speaker devices improved ratings of speech intelligibility for (1) phrases related to device use and (2) unrelated words via a semi-randomized controlled trial. METHODS & PROCEDURES In a semi-randomized controlled trial, an intervention group of adults with ID (N = 21) received smart speakers, while a control group (N = 22) did not. Before and after about 12 weeks, participants were recorded saying smart speaker-related phrases and unrelated words. Naïve participants then rated the intelligibility of the speech recordings. OUTCOMES & RESULTS The group that received smart speakers made significantly larger intelligibility gains than the control group. Although the effect size was modest, this difference was found for both smart speaker-related phrases and unrelated words. CONCLUSIONS & IMPLICATIONS While the mechanism of action remains to be determined, the presence of smart speakers in the home had a demonstrable impact on ratings of speech intelligibility, and could provide cost-effective inclusive support for speech and communication improvement, improving the quality of life of vulnerable populations. What this paper adds What is already known on the subject Speech intelligibility is a key obstacle for social relationships and quality of life across several vulnerable populations (children with speech difficulties, older adults with dementia, individuals with ID). Anecdotal reports suggest mainstream smart speakers (e.g., Amazon Alexa, Google Home), could improve speech intelligibility. What this paper adds to existing knowledge We used a semi-randomized controlled trial to show that using a smart speaker for about 12 weeks could improve ratings of speech intelligibility in adults with ID for both smart speaker-related phrases and unrelated words. What are the potential or actual clinical implications of this work? These initial findings suggest that smart speaker technology could be a novel, and inclusive, route to improving speech intelligibility in vulnerable populations.
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Affiliation(s)
| | - Petroc Sumner
- School of Psychology, Cardiff University, Cardiff, UK
| | - Craig Hedge
- School of Psychology, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
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Fombonne E, Green Snyder L, Daniels A, Feliciano P, Chung W. Psychiatric and Medical Profiles of Autistic Adults in the SPARK Cohort. J Autism Dev Disord 2020; 50:3679-3698. [PMID: 32096123 DOI: 10.1007/s10803-020-04414-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study examined lifetime medical and psychiatric morbidity reported by caregivers of 2917 autistic adults participating in the US research cohort SPARK. Participants were 78.4% male, 47.3% had intellectual disability, and 32.1% had persistent language impairments. Childhood language disorders (59.7%), speech/articulation problems (32.8%), sleep (39.4%) and eating problems (29.4%), motor delays (22.8%) and history of seizure (15.5%) were the most frequently reported clinical features. Over two thirds (67.2%) had been diagnosed with at least one psychiatric disorder (anxiety disorders: 41.1%; ADHD: 38.7%). Compared to verbally fluent participants, those with language impairments had lower frequencies of almost all psychiatric disorders. Female sex and older age were associated with higher medical and psychiatric morbidity.
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Affiliation(s)
- Eric Fombonne
- Departments of Psychiatry, Pediatrics & Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | | | | | | | - Wendy Chung
- The Simons Foundation, New York, NY, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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Kattari SK. Ableist Microaggressions and the Mental Health of Disabled Adults. Community Ment Health J 2020; 56:1170-1179. [PMID: 32306130 DOI: 10.1007/s10597-020-00615-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
Microaggressions perpetuate inequalities and stereotypes against people from marginalized communities. Research demonstrates that ongoing experiences of identity-related microaggressions can negatively impact mental health outcomes, increase somatic symptoms, and increase negative affect. This study explores the relationship between experiences of ableist microaggressions and mental health outcomes among disabled adults by using a quantitative cross-sectional survey of 311 U.S. adults who identify as disabled/having a disability, to examine the correlation between ableist microaggressions (using the AMS-65) and mental health (assessed by the MHI-18). Findings indicate that increased experiences ableist microaggressions are negatively correlated with positive mental health outcomes, and that the visibility of disabilities/impairments are correlated with experiencing ableist microaggressions. These findings can inform the work of counselors, therapists, social workers, and other human service professionals when supporting disabled individuals, recognizing that their mental health may be related to these common and often unintentional oppressive interactions.
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12
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European Psychiatric Association (EPA) guidance on prevention of mental disorders. Eur Psychiatry 2020; 27:68-80. [DOI: 10.1016/j.eurpsy.2011.10.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 10/11/2011] [Accepted: 10/19/2011] [Indexed: 12/18/2022] Open
Abstract
AbstractThere is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions. Since a large proportion of lifetime mental illness starts before adulthood, such interventions are particularly important during childhood and adolescence. Prevention is important for the sustainable reduction of the burden of mental disorder since once it has arisen, treatment can only reduce a relatively small proportion of such burden. The challenge for clinicians is to incorporate such interventions into non-clinical and clinical practice as well as engaging with a range of other service providers including public health. Similar strategies can be employed in both the European and global contexts. Promotion of mental well-being can prevent mental disorder but is also important in the recovery from mental disorder. This guidance should be read in conjunction with the EPA Guidance on Mental Health Promotion. This guidance draws on preparatory work for the development of England policy on prevention of mental disorder which used a wide range of sources.
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Gormez A, Kurtulmus A, Ince Z, Torun P, Uysal O, Cıtak S. Psychiatric symptoms, challenging behaviour and utilization of psychiatric services among adults with intellectual disabilities in Turkey. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1038-1048. [PMID: 32207206 DOI: 10.1111/jar.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prevalence of and the factors associated with psychiatric symptoms (PS) and challenging behaviour (CB) in adults with intellectual disabilities, and the utilization of psychiatric services in Turkey. METHOD Psychiatric Assessment Schedule for Adults with Developmental Disorders Checklist-Revised was used for PS and a structured form for other variables in 771 participants. RESULTS Of the participants, 50.1% had PS and 36.4% presented with CB. Multivariate analysis revealed that a higher level of needs, better verbal ability, residential living, incontinence and CB, and lifetime suicidal ideation/attempt were independently associated with PS. For CB, it emerged as male carer, PS, lifetime suicidal attempt/ideation, lower level of verbal ability and autism spectrum disorder. Barriers were experienced by 64.7% of participants within the previous year. CONCLUSIONS Psychiatric symptoms and CB seem to be problems for a significant proportion of adults with intellectual disabilities in Turkey, and there are certain barriers to psychiatric services.
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Affiliation(s)
- Aynur Gormez
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Kurtulmus
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeynep Ince
- Bagcilar Basak Special Education and Rehabilitation Centre, Istanbul, Turkey
| | - Perihan Torun
- Department of Public Health, Bezmialem Vakif University, Istanbul, Turkey
| | - Omer Uysal
- Department of Statistics, Bezmialem Vakif University, Istanbul, Turkey
| | - Serhat Cıtak
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
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Sutton P, Gates B. Giving voice to adults with intellectual disabilities and experience of mental ill-health: validity of a psychosocial approach. Nurse Res 2019; 26:19-26. [PMID: 30211488 DOI: 10.7748/nr.2018.e1520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mental ill-health is more prevalent among adults with intellectual disabilities (ID) than in the wider population. An interest in the mental health needs of people with ID has developed in recent decades, which corresponds with implementation of the health and social policy of deinstitutionalisation. Much clinical and research activity has focused on how such mental health needs may be addressed. The literature indicates that the views of people with ID concerning their mental health care have received limited attention. AIM To describe the adaption of a psychosocial research approach ( Hollway and Jefferson 2000 , 2013 ), and discuss the methodological challenges encountered in enabling adults with intellectual disabilities (ID) to express their views and be actively involved in producing knowledge about their experiences of care and support as service users with diagnosed mental health needs. DISCUSSION A considerable advantage of the interview format of this psychosocial approach was the opportunities it afforded participants to recount their personal stories. This is contrary to the question-and-answer technique of interviewing, which can suppress the stories of interviewees. In such structured approaches, the interviewer establishes the boundaries and usually maintains control over the production of data. CONCLUSION Undertaking two research interviews with participants, analysis of the entire material regarding individual participants, and undertaking comparative analysis of data relating to all participants provided a system for checking consistency. This approach therefore provides a valid method for enabling the participation of people with ID. IMPLICATIONS FOR PRACTICE The approach used is congruent with the requirement for the subjectivities of researchers - and those being researched - to be acknowledged, which is central to disability research. It is also compatible with person-centred planning and coproduction, which are central to contemporary ID nursing practice.
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Affiliation(s)
- Paul Sutton
- Learning disabilities, College of Nursing and Midwifery, University of West London, London, England
| | - Bob Gates
- College of Nursing and Midwifery, University of West London, London, England
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Mazza MG, Rossetti A, Crespi G, Clerici M. Prevalence of co-occurring psychiatric disorders in adults and adolescents with intellectual disability: A systematic review and meta-analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:126-138. [PMID: 31430018 DOI: 10.1111/jar.12654] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 07/23/2019] [Accepted: 07/31/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Subjects with intellectual disability (ID) are vulnerable to experience psychiatric disorders. The present authors performed a systematic review and meta-analysis to estimate the prevalence of co-occurring psychiatric disorders, excluding co-occurring autism spectrum disorders, in subjects with intellectual disability. METHOD The present authors performed a random-effects meta-analysis of the prevalence of psychiatric disorders in adults and adolescents with intellectual disability. RESULTS Twenty-two studies were included. The pooled prevalence of any co-occurring psychiatric disorders in intellectual disability was 33.6% (95% CI: 25.2%-43.1%) with high heterogeneity but no publication bias. Prevalence was lower in population-based studies, in studies that used ICD criteria for the psychopathology and in studies with low risk of bias. The prevalence was higher in mild, moderate and severe intellectual disability than in profound intellectual disability. CONCLUSIONS Psychiatric disorders are common in subjects with intellectual disability, and the present authors found that clinical and methodological moderators affect the pooled prevalence.
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Affiliation(s)
- Mario G Mazza
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Aurora Rossetti
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | | | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Tassé MJ, Balboni G, Navas P, Luckasson R, Nygren MA, Belacchi C, Bonichini S, Reed GM, Kogan CS. Developing behavioural indicators for intellectual functioning and adaptive behaviour for ICD-11 disorders of intellectual development. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:386-407. [PMID: 30628126 DOI: 10.1111/jir.12582] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/31/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND We present the work conducted to arrive at deriving behavioural indicators that could be used to guide clinical judgement in determining the presence and severity of deficits in intellectual functioning and adaptive behaviour for the purpose of making a diagnosis of disorders of intellectual development. METHODS An interdisciplinary expert panel provided guidance in developing behavioural indicators for intellectual functioning. A national dataset of adaptive behaviour on a sample of individuals with a diagnosis of intellectual disability was used to develop the behavioural indicators for the adaptive behaviour. The adaptive behaviour data were analysed using a cluster analysis procedure to define the different severity groupings by chronological age groups. RESULTS We present a series of tables containing behavioural indicators across the lifespan for intellectual functioning and adaptive behaviour, including conceptual, social and practical skills. These tables of behavioural indicators have been proposed for use in the clinical version of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) to be published by the World Health Organization. CONCLUSIONS The proposed behavioural indicators for disorders of ID described in the present article and to be included in the ICD-11 Clinical Descriptions and Diagnostic Guidelines are put forth to assist professionals in making an informed clinical decision regarding an individual's level of intellectual functioning and adaptive behaviour for the purpose of making a determination about the presence and severity of disorders of ID.
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Affiliation(s)
- M J Tassé
- Nisonger Center & Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - G Balboni
- Department of Philosophy, Social and Human Sciences and Education, University of Perugia, Perugia, Italy
| | - P Navas
- INICO & Department of Personality, Assessment and Psychological Treatment, University of Salamanca, Salamanca, Spain
| | - R Luckasson
- Department of Special Education, University of New Mexico, Albuquerque, NM, USA
| | - M A Nygren
- American Association on Intellectual and Developmental Disabilities, Washington, DC, USA
| | - C Belacchi
- Department of Communication, Sciences Humanities and International Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - S Bonichini
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - G M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - C S Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
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Hamers PCM, van Ool JS, Festen DAM, Hendriksen JGM, Bindels PJE, Hermans H. Reliability and validity of the Dutch Anxiety, Depression And Mood Scale in adults aged <50 years with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:568-574. [PMID: 30460756 PMCID: PMC7379946 DOI: 10.1111/jar.12550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/03/2018] [Accepted: 10/28/2018] [Indexed: 11/29/2022]
Abstract
Background Reliable and valid screening instruments for depression and anxiety are needed for adults with intellectual disabilities. Methods Internal consistency (n = 198), inter‐rater reliability (n = 41), test–retest reliability (n = 37) and criterion validity (n = 43) were studied in adults aged between 18 and 49 years. Internal consistency was also studied in a sample with epilepsy (n = 98). Results Internal consistencies of the Dutch ADAMS total scale and subscales were satisfactory to good (α = 0.76–0.92), as well as in the subgroup with epilepsy (α = 0.74–0.88). Inter‐rater reliability and test–retest reliability were fair to excellent for the total scale (ICC’s: 0.57–0.84) and subscales (ICC’s: 0.43–0.86). The criterion validity of the Dutch ADAMS Depressive Mood subscale was good with a sensitivity of 88% (95% CI: 53%–98%) and a specificity of 80% (95% CI: 64%–90%). Conclusions Our study shows that the Dutch ADAMS is a reliable and valid instrument for adults aged between 18 and 49 years with intellectual disabilities (and comorbid epilepsy).
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Affiliation(s)
- Pauline C M Hamers
- Department of General Practice, Intellectual Disability Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
| | - Jans S van Ool
- Department of Residential Care, Kempenhaeghe Epilepsy Center, Heeze, The Netherlands
| | - Dederieke A M Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jos G M Hendriksen
- Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, Heeze, The Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurological Learning Disabilities, Kempenhaeghe Epilepsy Center, Heeze, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Heidi Hermans
- Department of General Practice, Intellectual Disability Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
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Surley L, Dagnan D. A review of the frequency and nature of adaptations to cognitive behavioural therapy for adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:219-237. [PMID: 30353630 DOI: 10.1111/jar.12534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 06/28/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is increasing evidence that cognitive behavioural therapy (CBT) can be effective for people with intellectual disabilities. The aim of this review was to report the nature and frequency of adaptations reported in studies of CBT for people with intellectual disabilities. METHOD This review updated and extended a previous review by (Whitehouse et al. 2006, J Appl Res Intellect Disabil, 19, 55), which used a framework of adaptations developed by (Hurley et al., 1998, J Dev Phys Disabil, 10, 365). Adaptations included simplification, language, activities, developmental level, use of directive style, flexible methods, involve caregivers, transference/countertransference and disability/rehabilitation approaches. A search identified peer-reviewed papers that reported individual CBT informed psychological interventions for people with an Intellectual Disability. RESULTS The search identified 23 studies which met the inclusion criteria for review. Studies reported the majority of the categories of adaptation described by (Hurley et al., 1998, J Dev Phys Disabil, 10, 365). CONCLUSIONS The results suggest that the framework of adaptations needs further development to increase sensitivity in identifying and categorizing adaptations of CBT. Increased, systematic reporting of adaptations to studies of CBT with people with intellectual disabilities is recommended.
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Affiliation(s)
- Laura Surley
- Northumberland, Tyne and Wear NHS Foundation Trust, Northumberland, UK
| | - Dave Dagnan
- Cumbria Partnership NHS Foundation Trust, Workington, UK
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Hamers PCM, Festen DAM, Hermans H. Non-pharmacological interventions for adults with intellectual disabilities and depression: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:684-700. [PMID: 29797730 DOI: 10.1111/jir.12502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Although high rates of depression symptoms are reported in adults with intellectual disabilities (IDs), there is a lack of knowledge about non-pharmacological treatment options for depression in this population. The first research question of this paper is: Which non-pharmacological interventions have been studied in adults with ID and depression? The second research question is: What were the results of these non-pharmacological interventions? METHOD Systematic review of the literature with an electronic search in six databases has been completed with hand searches. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines have been followed. Selected studies met predefined inclusion criteria. RESULTS Literature search resulted in 4267 papers of which 15 met the inclusion criteria. Five different types of non-pharmacological interventions have been studied: cognitive behavioural therapy, behavioural therapy, exercise intervention, social problem-solving skills programme and bright light therapy. CONCLUSION There are only a few studies of good quality evaluating non-pharmacological interventions for adults with ID and depression. Some of these studies, especially studies on cognitive behavioural therapy, show good results in decreasing depressive symptoms. High-quality randomised controlled trials evaluating non-pharmacological interventions with follow-up are needed.
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Affiliation(s)
- P C M Hamers
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
| | - D A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Hermans
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
- Amarant Group, Healthcare Organization for People with Intellectual Disabilities, Tilburg, The Netherlands
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Wallace RA. National Disability Insurance Scheme, health, hospitals and adults with intellectual disability. Intern Med J 2018; 48:351-359. [PMID: 29512328 DOI: 10.1111/imj.13671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/08/2017] [Accepted: 10/08/2017] [Indexed: 11/28/2022]
Abstract
Preventable poor health outcomes for adults with intellectual disability in health settings have been known about for years. Subsequent analysis and the sorts of reasonable adjustments required in health and disability support settings to address these health gaps are well described, but have not really been embedded in practice in any significant way in either setting. As far as health is concerned, implementation of the National Disability Insurance Scheme (NDIS, the Scheme) affords an opportunity to recognise individual needs of people with intellectual disability to provide reasonable and necessary functional support for access to mainstream health services, to build capacity of mainstream health providers to supply services and to increase individual capacity to access services. Together these strands have potential to transform health outcomes. Success of the Scheme, however, rests on as yet incompletely defined operational interaction between NDIS and mainstream health services and inherently involves the disability sector. This interaction is especially relevant for adults with intellectual disability, known high users of hospitals and for whom hospital outcomes are particularly poor and preventable. Keys to better hospital outcomes are first, the receiving of quality person-centred healthcare from physicians and hospitals taking into account significance of intellectual disability and second, formulation of organised quality functional supports during hospitalisation. Achieving these require sophisticated engagement between consumers, the National Disability Insurance Agency, Commonwealth, State and Territory government leaders, senior hospital and disability administrators, NDIS service providers and clinicians and involves cross fertilisation of values, sharing of operational policies and procedures, determination of boundaries of fiscal responsibility for functional supports in hospital.
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Affiliation(s)
- Robyn A Wallace
- Calvary Health Care Tasmania, Hobart, Tasmania, Australia.,St Helen's Private Hospital, Hobart, Tasmania, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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A case series to examine whether people with learning disabilities can learn prerequisite skills for cognitive behavioural therapy. COGNITIVE BEHAVIOUR THERAPIST 2018. [DOI: 10.1017/s1754470x1700023x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAlthough cognitive behavioural therapy (CBT) is recommended for the treatment of a number of mental disorders among the general population, the ability of individuals with learning disabilities (LD) to understand CBT concepts and engage in CBT has been questioned. Aims: To examine whether specific prerequisite skills for CBT can be taught to people with LD using a newly developed training intervention and to investigate the acceptability of the intervention. Method: The study adopted a within-subjects case series research design. Quantitative assessment methods were used to evaluate the CBT skills of six adults with mild to moderate LD pre-intervention, following intervention and at 1-week follow-up. Participants were also asked to provide some qualitative feedback about how they had experienced the intervention. Results: The cognitive mediation skills and the ability of most participants to link activating events to emotions increased following intervention training and this improvement was maintained for four of them at follow-up. The feedback of participants regarding the process and content of the task demands was positive. Conclusions: The findings suggest that people with LD can learn some of the skills considered necessary to participate in CBT, such as cognitive mediation. However, further and more robust research is required to substantiate these findings.
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22
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Pawar DG, Akuffo EO. Comparative survey of comorbidities in people with learning disability with and without epilepsy. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.018234] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo ascertain the prevalence of epilepsy and understand the differences in the comorbidities of non-epileptic and epileptic patients with learning disabilities. A simple comparative survey was undertaken between the two main groups of patients: non-epileptic and epileptic.ResultsThe prevalence of epilepsy in the study group was 30%. A total of 70% of patients with any type of challenging behaviour were in the non-epileptic group compared with 59% in the epileptic group. Depression was the most common diagnosis in both groups, being slightly more in the non-epileptic group.Clinical ImplicationsOur study suggests that there is no association between epilepsy and the prevalence of challenging behaviour of psychiatric conditions within the learning disabilities population.
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Sajith SG, Goh YL, Wee JM. General Practitioners' Perceptions on Clinical Management and Training Needs regarding the Healthcare of Community-Dwelling People with Intellectual Disability: A Preliminary Survey in Singapore. Korean J Fam Med 2017; 38:327-332. [PMID: 29209471 PMCID: PMC5711650 DOI: 10.4082/kjfm.2017.38.6.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 11/05/2022] Open
Abstract
Background Studies worldwide indicate that people with intellectual disability have high risks of physical and mental morbidities, and poor quality of health care. This study was aimed at determining general practitioners' perceptions on barriers in clinical assessment and training needs with regard to the healthcare of community-dwelling people with intellectual disability. Methods A survey questionnaire was developed specifically for the study through focus group discussions and a literature review. The study was conducted as a cross-sectional anonymous survey of private general practitioners practicing in Singapore. The survey contained questions on their experience and training needs in assessing and treating patients with intellectual disability. Results Forty-nine of the 272 questionnaires sent out were returned. The respondents were predominantly male general practitioners working in “solo” practices. For most general practitioners, the proportion of patients with intellectual disability ranged from 1% to 5%. Nearly 90% of general practitioners identified problems in communicating with such patients as an important barrier that affected the quality of assessment of their health conditions. Other barriers identified were behavioral issues and sensory impairments. Only one-third of the general practitioners were confident that they had sufficient knowledge of physical and mental health conditions related to patients with intellectual disability. Three-fourths of the general practitioners believed that further training in this area would be beneficial. Conclusion Appropriate interventions to address barriers in assessment and management of patients with intellectual disability with further training for general practitioners may improve the standard of healthcare provided to this population group.
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Affiliation(s)
| | - Yen-Li Goh
- Department of General Psychiatry, Institute of Mental Health, Singapore
| | - Joshua Marcus Wee
- Department of General Psychiatry, Institute of Mental Health, Singapore
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Kelly M. The implementation of the Care Programme Approach for service users with a learning disability. Building Bridges to the same Old Horizons? J Psychiatr Ment Health Nurs 2017; 24:396-402. [PMID: 28493301 DOI: 10.1111/jpm.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: People with mental health problems and learning disabilities often do not receive the care they require. The Care Programme Approach (CPA) is meant to help with this. However, there have been many problems in the past with the introduction of the CPA into mental health services. There is no literature which explores what factors help or hinder the introduction of the CPA for service users with a mental health and learning disability, especially from the perspective of those responsible for overseeing this process. WHAT DOES THIS ARTICLE ADD TO EXISTING KNOWLEDGE?: The implementation of the CPA for this service user group is fragmented, and services are not working together in partnership. The CPA is being effectively implemented for people who are deemed to present with a risk to themselves or others. If a service user does not present with a high risk, they are not provided care through the CPA. Service users were not involved in the development or introduction of the policy in practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Services need to work better at engaging service users when they are developing and introducing new policies. Rather than applying the CPA for all service users, across all services, it should only be considered for those deemed to present with a high risk. It is effectively implemented for these people. For those not deemed to present with a high risk, services should consider using alternative service user led care planning frameworks. ABSTRACT Introduction The Care Programme Approach was introduced in England to ensure services met the needs of people with mental health problems and a concurrent learning disability (dual diagnosis). The CPA implementation was patchy and services failed to work in partnership. Aim This study aimed to explore the factors shaping the recent implementation of the CPA for service users with a dual diagnosis. Method A single case study approach was undertaken. Data were collected through interview (n = 26), documentary analysis (n = 64), steering group observation (n = 3) and the Partnership Assessment Tool (n = 26). Data were analysed using the Framework Approach. Results The CPA was only effectively implemented for people who were deemed to present with a high level of risk. Discussion The problems associated with implementation in the 1990s continue more recently for those with a dual diagnosis. The CPA has become more aligned with risk management protocols than supporting individual service user's recovery. Implications for practice Service users should be involved in the implementation of policies which have an impact on their recovery. The CPA should only be applied for those who present with high-risk issues, whilst alternative user-led initiatives should be considered for other service users.
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Affiliation(s)
- M Kelly
- Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, London, UK
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McCorkindale S, Fleming MP, Martin CR. Perceptions of learning disability nurses and support staff towards people with a diagnosis of schizophrenia. J Psychiatr Ment Health Nurs 2017; 24:282-292. [PMID: 28248434 DOI: 10.1111/jpm.12381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ABOUT THE SUBJECT?: People with learning disability are more likely than the general population to develop schizophrenia. Personal recovery philosophies are based on positive attitudes and an optimism that recognizes and values people and their strengths and capacity to achieve goals. Little is known from previous studies about the illness perceptions of learning disability practitioners who work with people that experience both a learning disability and schizophrenia. The illness beliefs of learning disability practitioners about schizophrenia may mediate the potential for social exclusion and limit recovery outcomes. WHAT THIS STUDY/PAPER ADDS TO EXISTING KNOWLEDGE?: The findings show that the illness beliefs of learning disability practitioners and support workers regarding schizophrenia are pessimistic in terms of the consequences for people with schizophrenia and learning disability and their relatives as well as the chronic course of the illness. WHAT ARE THE IMPLICATIONS FOR CLINICAL PRACTICE?: This study identifies the nature of LD practitioner perceptions about schizophrenia and provides guidance about how personal recovery philosophies can be applied to the management of LD and schizophrenia. The beliefs of learning disability practitioners and support workers regarding schizophrenia need to be reframed to support better recovery outcomes and social inclusion for this group. The findings from this study can inform the development of training in bio-psycho-social models of schizophrenia, recovery approaches, family/carer interventions, clinical supervision, mentorship and reflection on clinical practice, which could be potentially useful strategies to help facilitate a reframing of beliefs. ABSTRACT Background and purpose of study The prevalence of schizophrenia in people with learning disability is 3-4%. This is the first study to investigate the illness perceptions of learning disability (LD) practitioners towards people with schizophrenia. Methods Learning disability practitioners (n = 210) that work with people with LD and schizophrenia completed a modified version of the Illness Perception Questionnaire Schizophrenia Carers Version (IPQ-SCV). Descriptive and correlational analyses were conducted for all of the IPQ-SCV subscales. Results A significant positive correlation was found between consequences relative and consequences patient (0.495, P < 0.001), and a negative correlation was found between timeline episodic and timeline chronic (-0.243, P < 0.001) subscales. Discussion Consistent with previous evidence found regarding negative staff attitudes to schizophrenia recovery outcomes, course and chronicity, the current investigation has extended and confirmed these observations to staff working with individuals with comorbid schizophrenia and learning disability. Implications for practice This study identifies the nature of LD practitioner perceptions about schizophrenia and contributes to the development of the recovery philosophy in relation to the management of LD and schizophrenia. The findings inform the design of training modules in bio-psycho-social models of schizophrenia, recovery approaches, family intervention, clinical supervision and reflection. These can help LD practitioners to reframe their schizophrenia/LD illness beliefs.
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Affiliation(s)
- S McCorkindale
- Inverclyde Community Learning Disabilities Team, Cathcart Centre, Greenock, UK
| | - M P Fleming
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - C R Martin
- Faculty of Society and Health, Buckinghamshire New University, Uxbridge, Middlesex, UK
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Aguilar C, Karyadi KA, Kinney DI, Nitch SR. The Use of RBANS among Inpatient Forensic Monolingual Spanish Speakers. Arch Clin Neuropsychol 2017; 32:437-449. [DOI: 10.1093/arclin/acx006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/19/2017] [Indexed: 11/14/2022] Open
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Lovell A, Bailey J. Nurses' perceptions of personal attributes required when working with people with a learning disability and an offending background: a qualitative study. J Psychiatr Ment Health Nurs 2017; 24:4-14. [PMID: 27439391 DOI: 10.1111/jpm.12326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Learning disability nursing in the area of people with a learning disability and an offending background has developed considerably over recent years, particularly since the publication of the Bradley (). There has been limited work into the competencies nurses require to work in this area, and even less about the personal attributes of learning disability nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Learning disability nursing's specific contribution to the care of this population lies in their knowledge of the interaction between the learning disability, an individual's, sometimes abusive, personal history and an understanding of the subsequent offending behaviour. The knowledge base of nurses working with people with learning disabilities and an offending background needs to reflect the changing service user group. This is particularly in relation to substance misuse, borderline personality disorder, and mental health and the way such factors inter-relate with the learning disability. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further research is required into the relationship among decision making, risk taking or reluctance to do this, and the personal attributes required by nurses to work in secure learning disability care. Learning disability secure services are likely to continue to undergo change as circumstances alter and the offending population demonstrate greater complexity; nursing competencies and personal attributes need similarly to adapt to such changes. Mental health nursing has a great deal to contribute to effective working with this population, specifically with regard to developing strong relationships when concerns around borderline personality disorder or substance misuse are particularly in evidence. ABSTRACT Aim To identify and discuss the personal attributes required by learning disability nurses to work effectively with people with an offending background in secure and community settings. Background This study was part of a larger research investigation into the nursing competencies required to work with people with an offending background. There are few existing studies examining the personal attributes necessary for working with this group. Design A qualitative study addressing the perceptions of nurses around the personal attributes required to work with people with learning disabilities and an offending background. Methods A semi-structured interview schedule was devised and constructed, and 39 individual interviews were subsequently undertaken with learning disability nurses working in high, medium, low secure and community settings. Data were collected over 1 year in 2010/11 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings The thematic analysis produced three categories of personal attributes, named as looking deeper, achieving balance and connecting, each of which contained a further three sub-categories. Conclusion Nursing of those with a learning disability and an offending background continues to develop. The interplay among personal history, additional background factors, nurses' personal attributes and learning disability is critical for effective relationship building.
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Affiliation(s)
- A Lovell
- Department of Mental Health & Learning Disabilities, Faculty of Health & Social Care, University of Chester, Chester, UK
| | - J Bailey
- Faculty of Health & Social Care, University of Chester, Chester, UK
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Bouvet C, Coulet A. Relaxation therapy and anxiety, self-esteem, and emotional regulation among adults with intellectual disabilities: A randomized controlled trial. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2016; 20:228-40. [PMID: 26420821 DOI: 10.1177/1744629515605942] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 05/20/2023]
Abstract
This pilot study is a randomized controlled trial on the effects of relaxation on anxiety, self-esteem, and emotional regulation in adults with intellectual disabilities (ID) working in a center of supported employment in France. We studied 30 adults with mild or moderate ID who were split at random into a relaxation group (RG, 15 subjects), who completed 10 sessions of relaxation therapy, and a control group (CG, 15 subjects), who were on a waiting list. The method used is the pretest and posttest. Variables were assessed by the State-Trait Anxiety Inventory form Y scale, the Rosenberg Self-Esteem scale, and the Emotion Regulation Questionnaire. We found that in the RG, relaxation significantly reduced state anxiety, t(14, 15) = 17.8***, d = -0.72, and improved self-esteem, t(14, 15) = -7.7***, d = 1.03, and cognitive reappraisal, t(14, 15) = -6.3***, d = 1.3, while the CG showed no change for these variables. We conclude that relaxation seems to be an interesting therapeutic option for reducing anxiety in people with ID in a supported employment setting.
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Osugo M, Cooper SA. Interventions for adults with mild intellectual disabilities and mental ill-health: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:615-622. [PMID: 27109143 DOI: 10.1111/jir.12285] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND People with intellectual disabilities have very high rates of mental ill health. Standard psychosocial interventions designed for the general population may not be accessible for people with mild intellectual disabilities, and drug usage tends to be modified - 'start low and go slow'. This systematic review aims to synthesise the evidence on psychological, pharmacological and electroconvulsive therapy (ECT) interventions for adults with mild intellectual disabilities and mental ill health. METHOD PRISMA guidelines were followed. Medline, Embase, PsycINFO and CINAHL were searched, as was grey literature and reference lists of selected papers. Papers were selected based on pre-defined inclusion and exclusion criteria. A proportion of papers were double reviewed. Data was extracted using a structured table. STUDY REGISTRATION PROSPERO 2015:CRD42015015218. RESULTS Initially, 18 949 records were identified. Sixteen studies were finally selected for inclusion; seven on psychological therapies, two on group exercise, five on antipsychotics and two on antidepressants. They do not provide definitive evidence for effectiveness of psychosocial interventions, nor address whether starting low and going slow is wise, or causes sub-optimum therapy. CONCLUSIONS There are few evidence-based interventions for people with mild intellectual disabilities and mental ill-health; existing literature is limited in quantity and quality. Group cognitive-behavioural therapies have some supporting evidence - however, further randomised control trials are required, with longer-term follow-up, and larger sample sizes.
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Affiliation(s)
- M Osugo
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Unwin G, Tsimopoulou I, Kroese BS, Azmi S. Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: A review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 51-52:60-75. [PMID: 26803286 DOI: 10.1016/j.ridd.2015.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/08/2015] [Accepted: 12/14/2015] [Indexed: 05/20/2023]
Abstract
Relatively little is known about the application of cognitive behavioural therapy (CBT) to people with intellectual disabilities (ID). This review sought to synthesise available evidence on the effectiveness of CBT for anxiety or depression to assess the current level of evidence and make recommendations for future research. A comprehensive systematic literature search was conducted to identify qualitative and quantitative studies. Robust criteria were applied to select papers that were relevant to the review. Included papers were subject to quality appraisal. Eleven out of the 223 studies considered met our inclusion criteria and were included in the review in which CBT was used with participants with ID and anxiety (n=3), depression (n=4) or a mixed clinical presentation (n=4). There remains a paucity of evidence of effectiveness, however, the studies indicate that CBT is feasible and well-tolerated and may be effective in reducing symptoms of depression among adults with mild ID. Qualitative data reflect a positive perception of CBT amongst clients and carers. Further research is required to investigate the components of CBT, suitability for CBT, and requisite skills for CBT, which uses valid, sensitive and more holistic outcome measures.
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Affiliation(s)
- Gemma Unwin
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Ioanna Tsimopoulou
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Biza Stenfert Kroese
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sabiha Azmi
- North East London NHS Foundation Trust, Good Mayes Hospital, Barley Lane, London, UK
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Thomas S, Jenkins R, Burch T, Calamos Nasir L, Fisher B, Giotaki G, Gnani S, Hertel L, Marks M, Mathers N, Millington-Sanders C, Morris D, Ruprah-Shah B, Stange K, Thomas P, White R, Wright F. Promoting Mental Health and Preventing Mental Illness in General Practice. LONDON JOURNAL OF PRIMARY CARE 2016; 8:3-9. [PMID: 28250821 PMCID: PMC5330334 DOI: 10.1080/17571472.2015.1135659] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert 'Think Tank' convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your 'cluster' of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.
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Affiliation(s)
- Steve Thomas
- Mental Health/Learning Disabilities/Dementia Portfolio, NHS Sheffield Clinical Commissioning Group
| | - Rachel Jenkins
- ETHICS Board of Trustees, Epidemiology and Mental Health Policy, Kings College London
| | - Tony Burch
- Primary Care Advisor, Health Education , NW London
| | | | | | - Gina Giotaki
- Laboratory for Geocultural Analyses (GEOLAB), Ionian University
| | | | - Lise Hertel
- Strategic Clinical Network for Mental Health , London
| | - Marina Marks
- Educational Trust for Health Improvement through Cognitive Strategies (ETHICS)
| | | | | | - David Morris
- Mental Health, Inclusion and Community, University of Central Lancashire
| | | | - Kurt Stange
- Family Medicine and Community Health, Epidemiology and Biostatistics, Oncology and Sociology, Case Western Reserve University , Cleveland , OH , USA
| | | | - Robert White
- Ealing Primary Care Mental Health Service, West London Mental Health Trust
| | - Fiona Wright
- Public Health Barking and Dagenham Council and Greater London Authority
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32
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Pruijssers A, van Meijel B, Maaskant M, Teerenstra S, van Achterberg T. The Diagnostic Guideline for Anxiety and Challenging Behaviour for Persons with Intellectual Disabilities: Preliminary Outcomes on Internalizing Problems, Challenging Behaviours, Quality of Life and Clients' Satisfaction. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:242-254. [PMID: 26810713 DOI: 10.1111/jar.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with intellectual disabilities are vulnerable to develop psychopathology (in particular anxiety) and related challenging behaviour. A diagnostic guideline was developed to support professionals to better diagnose and thus treat psychopathology and related CB. This study examined preliminary outcomes from the application of this guideline. METHOD A comparative multiple case study with an experimental and a control condition. RESULTS The application of the guideline showed a trend of decreases of internalizing problems (P = 0.07) and anxiety/depressed problems (P = 0.09). We found no statistically significant decreases of externalizing problems and no increases in perceived quality of life as compared with care as usual. Clients were not more satisfied with the support they received for coping with their emotional and behaviour problems. CONCLUSION The application of the Diagnostic Guideline for Anxiety and Challenging Behaviour did not show statistically significant changes in externalizing problems and Quality of Life. Despite the small sample size of n = 59, we did find a trend in decreasing internalizing problems and anxiety/depressed problems. Further research into either or not confirming these trends is recommended.
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Affiliation(s)
- Addy Pruijssers
- Research Group Mental Health Nursing, Department of Health, Sports & Welfare/Cluster Nursing, Inholland University for Applied Sciences, Amsterdam, The Netherlands.,Esdégé-Reigersdaal (a service provider for people with (intellectual) disabilities), Broek op Langedijk, The Netherlands.,Inholland University, Alkmaar, The Netherlands
| | - Berno van Meijel
- Research Group Mental Health Nursing, Department of Health, Sports & Welfare/Cluster Nursing, Inholland University for Applied Sciences, Amsterdam, The Netherlands.,Inholland University, Alkmaar, The Netherlands.,Department of Psychiatry, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.,Parnassia Academy, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Marian Maaskant
- Department of Health Services Research, Maastricht University, The Netherlands.,Stichting Pergamijn (service provider for people with intellectual disabilities), Echt, The Netherlands
| | - Steven Teerenstra
- Section Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theo van Achterberg
- Quality of Care, Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium.,Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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33
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Crawford C, Burns J, Fernie BA. Psychosocial impact of involvement in the Special Olympics. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 45-46:93-102. [PMID: 26275609 DOI: 10.1016/j.ridd.2015.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 05/13/2015] [Accepted: 07/13/2015] [Indexed: 06/04/2023]
Abstract
Existing evidence suggests that people with intellectual disabilities are vulnerable to low self-esteem leading to additional psychosocial issues such as social exclusion and stress. Previous research into the involvement of Special Olympics (SO) of people with intellectual disabilities has indicted positive psychosocial outcomes. Involvement in sport is known generally to have psychological and social benefits. This study aimed to compare the psychosocial impact of involvement in sport through the SO to no or limited sports involvement, for a sample of people with intellectual disabilities. A cross sectional design was employed comparing three groups, SO, Mencap Sports, and Mencap No Sports on the variables: Self-esteem, quality of life, stress levels and social networks. One hundred and one participants were recruited either through the SO or Mencap. Data were collected through the completion of validated questionnaires by one to one interviews with the participants. Analysis revealed that self-esteem, quality of life, and stress were all significantly associated with SO involvement. Logistic regression analysis was used to explore whether scores on these variables were able to predict group membership. Self-esteem was found to be a significant predictor of group membership, those in the SO having the highest self-esteem. The findings provide further evidence of a positive association between sport involvement and increased psychological wellbeing, especially for those involved in the SO. The implications of these findings for practice and future research into the relationship between sport and psychological wellbeing within the learning disabled population are considered.
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Affiliation(s)
- Clare Crawford
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Salomons Campus at Tunbridge Wells, Broomhill Road, Southborough, Tunbridge Wells, Kent TN3 0TF, UK
| | - Jan Burns
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Salomons Campus at Tunbridge Wells, Broomhill Road, Southborough, Tunbridge Wells, Kent TN3 0TF, UK.
| | - Bruce A Fernie
- King's College London, Institute of Psychiatry, Department of Psychology, London, UK; CASCAID, South London & Maudsley NHS Foundation Trust, London, UK
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Pruijssers A, van Meijel B, Maaskant M, Keeman N, van Achterberg T. Quality of Diagnosis and Treatment Plans After Using the 'Diagnostic Guideline for Anxiety and Challenging Behaviours' in People with Intellectual Disabilities: A Comparative Multiple Case Study Design. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:305-16. [PMID: 25727744 DOI: 10.1111/jar.12180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. MATERIALS AND METHODS A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. RESULTS The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. CONCLUSIONS Working with the 'Diagnostic Guideline for Anxiety and CB' leads to improved diagnoses and treatment plans compared with care as usual.
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Affiliation(s)
- Addy Pruijssers
- Esdégé-Reigersdaal, Broek op Langedijk, The Netherlands.,Inholland University, Department of Health, Sports & Welfare / Cluster Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Berno van Meijel
- Inholland University, Department of Health, Sports & Welfare / Cluster Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,VU University Medical Center, Department of Psychiatry, EGO Institute for Health and Care Research Amsterdam, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands
| | - Marian Maaskant
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Stichting Pergamijn, Echt, The Netherlands
| | | | - Theo van Achterberg
- Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium.,Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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35
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Idusohan-Moizer H, Sawicka A, Dendle J, Albany M. Mindfulness-based cognitive therapy for adults with intellectual disabilities: an evaluation of the effectiveness of mindfulness in reducing symptoms of depression and anxiety. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:93-104. [PMID: 24020487 DOI: 10.1111/jir.12082] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 05/07/2023]
Abstract
BACKGROUND Mindfulness-based interventions have been shown to be effective in the treatment of a range of health and psychological disorders in adults and young people without intellectual disabilities (ID). Clinical studies are emerging reporting on the efficacy of mindfulness-based interventions as a stand-alone treatment for common clinical disorders in adults with ID. METHOD This paper aims to evaluate the efficacy of an innovative structured mindfulness-based cognitive therapy (MBCT) group programme adapted for adults with ID with a diagnosis of either recurrent depression, anxiety or both clinical conditions and a history of deliberate self-harm behaviour. Two groups ran consecutively consisting of a total of fifteen participants and seven carers. All participants were recorded as having either a borderline, mild, or moderate ID. The group programme ran over a period of 9 weeks with a follow-up session at 6 weeks post group intervention. Outcome measures included the Hospital Anxiety and Depression Scale and two sub-scales from the Self-Compassion Scale administered at baseline, post therapy and at 6-week follow-up. RESULTS The evaluation showed that participants reported an improvement in their experience of depression, anxiety, self-compassion and compassion for others. The most significant impact was in the reduced levels of anxiety reported. Improvements across all outcomes were maintained at 6-week follow-up. CONCLUSION The results of the evaluation suggest that people with intellectual disabilities benefit from a structured MBCT group intervention and the results are maintained at 6-week follow-up.
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36
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Belva BC, Matson JL. Examining the psychometrics of the Psychopathology Inventory for Mentally Retarded Adults-II for individuals with mild and moderate intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:291-302. [PMID: 25462489 DOI: 10.1016/j.ridd.2014.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/05/2014] [Accepted: 10/13/2014] [Indexed: 06/04/2023]
Abstract
With growing recognition of the occurrence of psychological disorders in individuals with intellectual disability (ID), researchers and clinicians alike have placed emphasis on developing measures to assess for psychopathologies in this population. Despite an increased interest in the topic, there is still a dearth of psychometrically robust measures available to assess for psychopathology in adults with mild and moderate ID. The purpose of this study was to examine the psychometric properties of a revised measure for psychopathology in individuals with mild and moderate ID, the Psychopathology Inventory for Mentally Retarded Adults - second edition (PIMRA-II). Internal consistency, inter-rater reliability, and test-retest reliability were investigated. Validity was studied via convergent validity by comparing the PIMRA-II to the Assessment of Dual Diagnosis (ADD) and via discriminate validity by comparing the PIMRA-II to the Social Performance Survey Schedule (SPSS) prosocial scores. Lastly, an exploratory factor analysis was conducted to determine the factor structure of the scale.
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Affiliation(s)
- Brian C Belva
- Louisiana State University, 2124 Cheshire Bridge Road NE, Atlanta, GA 30324, United States.
| | - Johnny L Matson
- Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, United States.
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37
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Roy M, Balaratnasingam S. Intellectual disability and indigenous Australians: an overview. Asia Pac Psychiatry 2014; 6:363-72. [PMID: 25339537 DOI: 10.1111/appy.12157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 09/09/2014] [Indexed: 11/29/2022]
Abstract
The review summarizes important literature in the emerging field of intellectual disability (ID) in indigenous Australians. Search of various electronic databases revealed 19 papers that provide information regarding prevalence, sociodemographic factors, and issues in assessment and management. Overall, there is limited information regarding ID in indigenous Australians, which is reported to be more prevalent compared with nonindigenous Australians. Sociocultural constructs affect what is considered to be ID in indigenous communities and this may be at odds with western notions. Other difficulties include lack of validated psychometric instruments to effectively measure cognitive functioning in indigenous Australians. Prenatal, perinatal, and postnatal factors are significant factors that impair brain development and contribute to ID in indigenous communities. Comorbid physical and psychiatric disorders need to be assessed and managed. This paper provides an overview of current knowledge regarding this important area that requires further research, appropriate training, and resourcing.
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Affiliation(s)
- Meera Roy
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
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38
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Foley KR, Jacoby P, Einfeld S, Girdler S, Bourke J, Riches V, Leonard H. Day occupation is associated with psychopathology for adolescents and young adults with Down syndrome. BMC Psychiatry 2014; 14:266. [PMID: 25274152 PMCID: PMC4190345 DOI: 10.1186/s12888-014-0266-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 09/10/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Young adults with Down syndrome experience increased rates of emotional and behavioural problems compared with the general population. Most adolescents with Down syndrome living in Western Australia participate in sheltered employment as their main day occupation. Relationship between day occupation and changes in behaviour has not been examined. Therefore, the aim of this research was to explore any relationship between post school day occupations and changes in the young person's behaviour. METHODS The Down syndrome Needs Opinion Wishes database was used for case ascertainment of young adults aged 15 to 32 years with Down syndrome. Families of 118 young people in this population-based database completed questionnaires in 2004, 2009 and 2011. The questionnaires addressed both young person characteristics such as age, gender, presence of impairments, behaviour, functioning in activities of daily living, and family characteristics such as income and family functioning. Post-school day occupations in which the young people were participating included open and sheltered employment, training and day recreation programs. Change in behaviour of young adults who remained in the same post-school day occupation from 2009 to 2011 (n = 103) were examined in a linear regression model adjusting for confounding variables including age, gender, prior functioning and behaviour in 2004 and family income. RESULTS In comparison to those young adults attending open employment from 2009 to 2011, those attending day recreation programs were reported to experience worsening in behaviour both in the unadjusted (effect size -0.14, 95% CI -0.24, -0.05) and adjusted models (effect size -0.15, 95% CI -0.29, -0.01). CONCLUSIONS We found that the behaviour of those participating in open employment improved compared to those attending other day occupations. Further examination of the direction of this association is required.
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Affiliation(s)
- Kitty-Rose Foley
- Telethon Kids Institute, University of Western Australia, Perth, Australia ,School of Exercise and Health Sciences, Edith Cowan University, Perth, Australia ,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, The University of New South Wales, Sydney, Australia
| | - Peter Jacoby
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Stewart Einfeld
- Faculty of Health Sciences, University of Sydney, Sydney, Australia ,Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Sonya Girdler
- Telethon Kids Institute, University of Western Australia, Perth, Australia ,School of Exercise and Health Sciences, Edith Cowan University, Perth, Australia ,School of Occupational Therapy and Social Work, Centre for Research into Disability and Society, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia Australia
| | - Jenny Bourke
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Vivienne Riches
- Centre for Disability Studies, The University of Sydney, Sydney, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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Bennett C. Understanding systemic problems in providing mental health services to people with an intellectual disability and co-morbid mental disorders in Victoria. Australas Psychiatry 2014; 22:48-51. [PMID: 24215972 DOI: 10.1177/1039856213510574] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This paper explores the difficulties the services system in Victoria has in responding to people with intellectual disability (ID) and mental health problems and identifies the underlying assumptions that have led to these. These issues are discussed and where possible put into a Victorian context with the intention of informing service development in the area of Dual Disability (co-morbid mental disorders in people with intellectual disability). CONCLUSIONS People with ID have high levels of mental health need. Generic services have difficulty responding to these needs due to a range of patient, professional and service system factors as well as some of the conceptual issues underpinning policy and legislation.
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Affiliation(s)
- Chad Bennett
- Clinical Director, The Victorian Dual Disability Service, St Vincent's Hospital, Melbourne, VIC, Australia
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40
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Hulbert-Williams L, Hastings R, Owen DM, Burns L, Day J, Mulligan J, Noone SJ. Exposure to life events as a risk factor for psychological problems in adults with intellectual disabilities: a longitudinal design. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:48-60. [PMID: 23627774 DOI: 10.1111/jir.12050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 05/07/2023]
Abstract
BACKGROUND Several cross-sectional studies have shown an association between exposure to life events and psychological problems in adults with intellectual disability (ID). To establish life events as a risk factor, prospective designs are needed. METHODS Support staff informants provided data on the psychological problems of 68 adults with ID and their recent exposure to life events. Using data collected on the same sample 3.5 to 4 years earlier, prospective analysis of the relationships between life events exposure and psychological problems over time was explored. RESULTS Hierarchical linear regression analyses demonstrated a contribution of life events to the prediction of later psychological problems after controlling for earlier psychological problems. Exploratory analyses showed that the relationship between life events and psychological problems might be unidirectional, and non-spurious; remaining present once the impact of other correlates of psychological problems was controlled. CONCLUSIONS These data offer support for the status of life events (with a negative valence) as a risk factor for psychological problems in adults with ID. To establish life events as a causal risk factor, research is needed to examine the mechanisms via which life events have their impact on psychological well-being.
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Affiliation(s)
- L Hulbert-Williams
- School of Applied Sciences, University of Wolverhampton, Wolverhampton, UK
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41
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Rose N, Kent S, Rose J. Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:854-864. [PMID: 21917050 DOI: 10.1111/j.1365-2788.2011.01476.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Mainstream mental health services are providing more care for individuals with an intellectual disability (ID); this has implications for staff and service users. Attitudes of staff towards people with ID in mental health services may be negative and negative staff attitudes may have a detrimental impact on service provision. DESIGN A cross-sectional design was used. METHODS A questionnaire designed to investigate the attitudes and emotions of staff towards delivering mental health care to adults with ID was completed by 84 staff from mainstream and specialist ID services. RESULTS Staff in both services experienced more positive emotions when working with clients whom they are currently employed to work with. When the frequency of contact with adults with ID, the number of individuals worked with and the amount of formal ID training received were considered, there was no significant difference between the attitudes of staff in both services. Positive correlations were found between attitude scores and positive emotional experiences in both services. CONCLUSIONS The research suggests that numerous factors, including the role of emotional experience and a number of environmental aspects, need to be considered in the context of providing mental health services to adults with ID to ensure the highest quality. Research limitations and clinical implications of the study are also considered.
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Affiliation(s)
- N Rose
- Psychological Heath Service, Black Country Partnership NHS Foundation Trust, Stourbridge, UK.
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42
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Wieland J, Wardenaar KJ, Fontein E, Zitman FG. Utility of the Brief Symptom Inventory (BSI) in psychiatric outpatients with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:843-853. [PMID: 21726320 DOI: 10.1111/j.1365-2788.2011.01440.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Diagnostics and care for people with intellectual disabilities (ID) and psychiatric disorders need to be improved. This can be done by using assessment instruments to routinely measure the nature and severity of psychiatric symptoms. Up until now, in the Netherlands, assessment measures are seldom used in the psychiatric care for this population. The objective of the present paper is to evaluate the use of the Brief Symptom Inventory (BSI), a widely used standardised questionnaire in general psychiatry, in a well-defined sample of people with borderline intellectual functioning or mild ID diagnosed with one or more psychiatric disorders. METHODS A total of 224 psychiatric outpatients with either borderline intellectual functioning or mild ID participated in this study. All participants were new patients of Kristal, Centre for Psychiatry and Intellectual Disability in the Netherlands, in the period between 1 April 2008 and 1 October 2009. All participants were assessed by a multidisciplinary team, including a certified psychiatrist. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria were applied. The mean total intelligence quotient was measured with the Wechsler Adult Intelligence Scale (WAIS-III). The BSI was administered in an assisted fashion. Utility and psychometric properties of the BSI were investigated. Internal consistency coefficients (Cronbach's alphas) were computed. Bivariate correlations between the sub-scales were computed to assess differentiation between the scales. Mean sub-scale scores were compared between different DSM-IV-TR subgroups to investigate the discriminant abilities of the scales. A confirmatory factor analysis was conducted. RESULTS The results suggest that the BSI is practically useful. Internal consistencies ranged from 0.70 to 0.96 and thus are considered good to adequate. Sub-scale inter-correlations showed there is a degree of differentiation between the sub-scales. Discriminant validity was shown for the sub-scales depression, anxiety and phobic anxiety. Confirmatory factor analysis showed that the underlying structure of the BSI could be described by the same nine-factor model as reported in previous studies. CONCLUSIONS As a result of the psychometric properties illustrated, this study supports the use of the BSI as a screener for psychopathology and a general outcome measure in people with ID.
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Affiliation(s)
- J Wieland
- Kristal, Centre for Psychiatry and Intellectual Disability, Leiden, The Netherlands.
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Bertelli M, Scuticchio D, Ferrandi A, Lassi S, Mango F, Ciavatta C, Porcelli C, Bianco A, Monchieri S. Reliability and validity of the SPAID-G checklist for detecting psychiatric disorders in adults with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:382-90. [PMID: 22119685 DOI: 10.1016/j.ridd.2011.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 08/24/2011] [Accepted: 08/24/2011] [Indexed: 05/08/2023]
Abstract
SPAID (Psychiatric Instrument for the Intellectually Disabled Adult) is the first Italian tool-package for carrying out psychiatric diagnosis in adults with Intellectual Disabilities (ID). It includes the "G" form, for general diagnostic orientation, and specific checklists for all groups of syndromes stated by the available classification systems. SPAID was established to provide an easy and quick tool for daily practice of the personnel working with ID. The present study was aimed at evaluating psychometric and psychodiagnostic characteristics of the SPAID-G and at supplying new data on the prevalence rate of psychiatric disorders in a multicentric Italian sample of people with ID living in different settings. The SPAID-G was randomly applied to 304 participants with ID attending residential facilities or assessment services across Italy. A part of the sample was also consecutively assessed through the use of DASH, PDD-MRS and by the clinical application of the DSM-IV TR criteria. The correlation between SPAID-G scores and those provided by other evaluation tools was over 60%. Additionally, the internal consistency and inter-rater reliability resulted to be good. Psychopathological symptoms were detected in approximately 40% of the sample. Respectively, autistic spectrum disorders, impulse control disorders, mood disorders, and dramatic personality disorders were the diagnostic orientations providing the most prevalent over-threshold scores. SPAID-G seems to be a valid diagnostic tool, quick and easy to use in psychiatric disorders assessment within the Italian population with ID.
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Affiliation(s)
- Marco Bertelli
- CREA, AMG Research and Evolution Centre, Florence, Italy.
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Spendelow JS. Assessment of Behavioral and Psychiatric Problems in People With Prader–Willi Syndrome: A Review of the Literature. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00296.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Townsend CE. Developing a Comprehensive Research Agenda for People With Intellectual Disability to Inform Policy Development and Reform. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00297.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Einfeld SL, Ellis LA, Emerson E. Comorbidity of intellectual disability and mental disorder in children and adolescents: a systematic review. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2011; 36:137-143. [PMID: 21609299 DOI: 10.1080/13668250.2011.572548] [Citation(s) in RCA: 233] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Mental disorder and intellectual disability each accounts for substantial burden of disease. However, the extent of this co-occurrence varies substantially between reports. We sought to determine whether studies in children and/or adolescents with acceptably rigorous methods can be distinguished from existing reports, and whether key risk factors could be ascertained. METHOD Published studies investigating the prevalence of mental disorders in children and/or adolescents with intellectual disability were reviewed. RESULTS Nine studies with acceptable methods were identified, 4 which compared the prevalence of mental disorder in populations of those with and without intellectual disability, and a further 5 studies that estimated the rates of mental disorder in those with intellectual disability were identified. Collectively, these studies demonstrate rates of comorbidity for children and adolescents between 30 and 50% with a relative risk of mental disorder associated with intellectual disability ranging from 2.8-4.5. The risks for this comorbidity associated with age, gender, severity of intellectual disability, and socioeconomic status remain uncertain. CONCLUSIONS Appreciation of this comorbidity needs to be a fundamental component of both mental health and intellectual disability services.
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Affiliation(s)
- Stewart L Einfeld
- Faculty of Health Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
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Hassiotis A, Serfaty M, Azam K, Strydom A, Martin S, Parkes C, Blizard R, King M. Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised controlled trial. Trials 2011; 12:95. [PMID: 21492437 PMCID: PMC3102627 DOI: 10.1186/1745-6215-12-95] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/14/2011] [Indexed: 11/12/2022] Open
Abstract
Background Several studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID. Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID. However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID. The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial. Methods Thirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months. TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory & Beck Depression Inventory) will be administered at baseline; end of treatment (4 months) and at six months to evaluate the changes in depression and anxiety. Client satisfaction, quality of life and the health economics will be secondary outcomes. Discussion The broad outcome of the study will be to produce clear guidance for therapists to apply an established psychological intervention and identify how and whether it works with people with intellectual disabilities. Trial registration ISRCTN: ISRCTN38099525
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Affiliation(s)
- Angela Hassiotis
- Department of Mental Health Sciences, University College Medical School, Charles Bell House, 67-73 Riding House Street, London W1W 7EY, UK.
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Amore M, Bertelli M, Villani D, Tamborini S, Rossi M. Olanzapine vs. risperidone in treating aggressive behaviours in adults with intellectual disability: a single blind study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:210-218. [PMID: 21129058 DOI: 10.1111/j.1365-2788.2010.01352.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Aggressive behaviour represents a frequent symptom in people with intellectual disability (PWID). Despite uncertain evidence of effectiveness, the use of antipsychotics (APs) drugs to treat aggressive behaviour is very common. Antipsychotic medication of aggressivity in PWID has recently become one of the most debated issues in mental health and the need of further research is persistently stressed by most researchers. AIM The present study was firstly aimed at evaluating the effectiveness (efficacy on target behaviour, safety and persistence on treatment) of new generation APs, in particular, olanzapine and risperidone in treating aggressive behaviour in PWID for who previous medication with first generation APs (FGAs) were not effective. METHODS 62 subjects with intellectual disability underwent to a 2-arm, parallel group pragmatic trial of olanzapine and risperidone with balanced randomisation and blind assessment of outcome at 4, 8, 12, 16, 20 and 24 weeks after a switch (cross-tapering) from a 24-week treatment with FGAs. Aggressive behaviours were assessed by Overt Aggression Scale (OAS) and clinical outcome by Clinical Global Impression Scale. Side effects were assessed with Dosage Record and Treatment Emergent Symptoms Scale, other symptom-specific scales, laboratory and instrumental tests. RESULTS Both risperidone and olanzapine resulted to be more effective than FGAs in reducing aggressive behaviour. Repeated-measures analysis of covariance revealed that treatment groups differed for cumulative number of aggressive episodes during the FGAs treatment, which was higher for olanzapine. CONCLUSION Our findings seem to confirm that olanzapine and risperidone can be effective in reducing aggressive behaviour in PWID. Both compounds resulted to be well tolerated, with side effects similar to those encountered in other patient populations.
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Affiliation(s)
- M Amore
- Division of Psychiatry, Department of Neurosciences, University of Parma, Parma, Italy
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Stinton C, Elison S, Howlin P. Mental health problems in adults with Williams syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 115:3-18. [PMID: 20025356 DOI: 10.1352/1944-7558-115.1.3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 06/23/2009] [Indexed: 05/28/2023]
Abstract
Although many researchers have investigated emotional and behavioral difficulties in individuals with Williams syndrome, few have used standardized diagnostic assessments. We examined mental health problems in 92 adults with Williams syndrome using the Psychiatric Assessment Schedule for Adults with Developmental Disabilities-PAS-ADD (Moss, Goldberg, et al., 1996). Factors potentially associated with mental health problems were also explored. The PAS-ADD identified mental health problems in 24% of the sample. The most common were anxiety (16.5%) and specific phobias (12%). Other diagnoses included depression, agoraphobia, and social phobia. No association was found between the presence of mental health problems and either individual (e.g., age, IQ, language level) or external (life events) variables.
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Affiliation(s)
- Chris Stinton
- University of Warwick, Warwick Medical School, Coventry, UK.
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Perspectives of intellectual disability in Asia: epidemiology, policy, and services for children and adults. Curr Opin Psychiatry 2009; 22:462-8. [PMID: 19625968 DOI: 10.1097/yco.0b013e32832ec056] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Given the scarcity of Asian literature on intellectual disability, the aim of this review article is to shed light on the epidemiology, policy, and services for children and adults with intellectual disability in Asia. RECENT FINDINGS The prevalence of intellectual disability across Asia appears to be consistent with western estimates at 0.06-1.3%, with the exception being China at 6.68%. In the only two studies of mental health conducted in Asia, the prevalence ranged from 4.4 to 48.3%. Some of the common physical health problems among Singaporean adults with intellectual disability are obesity, high blood pressure, and high blood cholesterol. All Asian countries/territories have at least one law or policy that promotes the well being of persons with disabilities, with Japan being the only country that has a law specifically enacted for persons with intellectual disability. Although there is an array of services being offered for children and adults with intellectual disability across south-east Asia, there is also a variation in the proportion of countries that offer these services. SUMMARY Overall, the challenge for Asia will be to develop a localized base of knowledge by conducting epidemiological studies, modeling after evidence-based practices, and evaluating its effectiveness. By adopting a scientific approach and formal publication of data, intellectual disability standards can be evaluated, managed, and improved in a systematic manner.
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