Cognitive variables and depressed mood in adults with intellectual disability

Background Cognitive theory forms the foundation for cognitive therapy. There has been little research on cognitive theories and cognitive variables associated with depression in individuals with intellectual disability (ID). The current study examined cognitive variables of automatic thoughts, cognitive triad, hopelessness, attributions and self-esteem associated with two cognitive theories of depression: Beck's Cognitive Triad theory and the Hopelessness theory of depression. Methods Seventy-three adults with ID screened for adequate receptive vocabulary were interviewed as part of a larger study. They reported on cognitive constructs relating to depressed mood. In addition, comparisons were made between 12 adults with ID and diagnosed major depression and a matched group of 12 adults with ID and no psychiatric diagnoses in order to determine if these groups differed on the cognitive constructs associated with the two cognitive theories of depression. Results The cognitive variables examined were all significantly correlated with depressed mood in the direction predicted by their respective cognitive theory. Internal consistencies were good or excellent for most instruments, with the exception of those measuring hopelessness and attributions. In addition, significant differences were obtained between groups of individuals with and without co-morbid major depression on all variables except for hopelessness. Conclusions The results indicate that adults with ID screened for adequate receptive vocabulary are capable of reporting on subjective feelings of depressed mood and associated cognition constructs. The instruments used may be suitable for this population as they generally possessed sound internal consistencies. The results support the further examination of cognitive theories of depression among individuals with ID in order to assess the appropriateness of cognitive therapies for this population. Discrepant findings regarding hopelessness are discussed.     

Effectiveness of treatment programmes for depression among adults with mild/moderate intellectual disability

Background The current study describes the development and evaluation of group treatment programme for people with mild/moderate intellectual disability (ID). Methods A total of 34 participants (16 males, 18 females) completed the treatment programme and 15 participants (six males, nine females) comprised a control group. Results Compared to the control group, the intervention group showed an improvement in levels of depression, positive feelings about the self, and lower levels of automatic negative thoughts after the intervention. These changes were maintained at 3‐month follow‐up. Conclusions These results demonstrate that intervention programmes are effective for the treatment of depression among people with ID.     

A prospective analysis of life events, problem behaviours and depression in adults with intellectual disability

Background Life events have consistently been found to be associated with behaviour problems and depression among individuals with intellectual disability (ID). However, prior findings have typically been based on correlational or retrospective analyses of case files. The current study attempted to replicate prior findings from life events with concurrent data and extend them to the prospective prediction of behaviour problems and depression. The influence of impact ratings of life events was also explored. Methods Seventy‐four informants rated 104 adults with ID on measures of life events, behaviour problems and depressive symptoms. Life events were rated as having either a positive, negative or no impact on the life of the individual with ID. Measures were completed twice, at a 4‐month interval. Results Behaviour problems were both correlated with and predicted by frequency counts of life events and life events perceived as negative. However, the predictive ability depended on which measure of problem behaviour was selected. Positive life events were not associated with concurrent behaviour problems. Depressive symptoms were correlated with all life changes, but only predicted by frequency counts of life events and life events perceived as negative. Again, the predictive ability depended on which measure of depression was selected. Findings were corroborated with a group of individuals with clinical diagnoses of major depression. Conclusions Frequency counts of all life events and life events perceived as negative play a role in the development of behaviour problems and depressive symptoms among adults with ID. The results have implications for interventions for behaviour problems following a life event, and for reducing depressive symptoms for adults with mild ID.     

The use of clozapine in adults with intellectual disability

Background There are not many studies on the use of clozapine in patients with intellectual disability (ID). The authors describe a case series of patients treated with clozapine, drawn from a medium secure unit, a low secure assessment and treatment service and a community team in the London region. Method A retrospective file‐review of patients treated in these three settings during the time period March–June 2002 was performed (n = 24). Information was collected using a semistructured proforma. Results Of the 24 patients, 67% had schizophrenia, 17% had schizoaffective disorder and 8% had bipolar disorder. Patients had been unwell for a mean of 6 years and had been tried on a mean of four antipsychotics. The mean maximum dose of clozapine was 488 mg. The outcomes on the clinical global impression (CGI) scale showed 29% very much improved, 42% much improved, 21% minimally improved and 8% no change. 54% of the whole sample and 53% of those from the medium secure unit were discharged to homes in the community. The drug had to be stopped in four patients, of which three were because of neutropaenia. Conclusion Clozapine appears to be safe and efficacious in many people with ID. Careful monitoring of side‐effects is needed during therapy.     

Social comparison, self-esteem and depression in people with intellectual disability

The present study explores the relationship between social comparison processes, self-esteem and depression in people with intellectual disability. Forty-three people with mild and moderate intellectual disability completed adapted measures of self-esteem and social comparison. The social comparison scale offers subscale scores on achievement, social attractiveness and group belonging dimensions. The self-esteem scale offers subscale scores for positive and negative self-esteem. A significant positive correlation was found between positive self-esteem and social comparison on the achievement dimension. Depression was significantly negatively correlated with social comparison on the social attractiveness and group belonging dimensions, and with positive self-esteem. Regression analysis showed that depression was significantly and independently predicted only by social comparison on the social attractiveness dimension. The present authors conclude that social comparison is associated with self-esteem and depression in people with intellectual disability in the same way as it is for people without intellectual disability. Further exploration of social comparison process in people with intellectual disability may inform cognitive behavioural interventions for this group of people.     

Prevalence of hypertension in adults with intellectual disability in the Netherlands

Background   Literature on the prevalence of hypertension in people with intellectual disability (ID) is mostly based on file studies or on measurements limited to the age group below 50 years. We measured and calculated the prevalence of hypertension in adults with ID and studied the distribution of hypertension in relation to age, gender, diagnosis of Down's syndrome and level of ID.
Methods   In an observational cross-sectional study, standardized blood pressure measurements were obtained from 258 randomly selected adult clients of three Dutch care providers for people with ID. Hypertension was defined as a mean systolic blood pressure above 140 mm Hg on repeated measurements.
Results   The overall prevalence rate of hypertension was 17.4% (95% CI 12.28–22.46). This was comparable to the prevalence in the general Dutch population. No accurate blood pressure measurement could be performed in 28.4% of people with severe and profound ID owing to repetitive physical activity or resistance. Hypertension was significantly related to older age and absence of Down's syndrome; no correlation with gender or level of ID could be shown.
Recommendation   The risk factor hypertension should be detected and treated in the same manner as in the general population following national guidelines.     

Lifestyle and health behaviours of adults with an intellectual disability

Background There is currently no published research in Ireland on the health behaviours of adults with an intellectual disability (ID). With an increasing age profile and similar patterns of morbidity to the general population, the ID population would benefit from baseline data from which to establish risk factors. Methods A questionnaire survey was carried out with 157 carers of people with an ID in the west of Ireland. Results The results of this survey were compared with results of a health survey for the general population in the same region. The present survey found that 68% of the ID sample was overweight or obese. Levels of smoking (2.6%) and regular alcohol consumption (10.3%) were relatively low in comparison with the general population. However, participation in exercise and adherence to a healthy diet were poor. The level of resident choice and decision‐making did not have any relationship to health behaviours nor did residential setting. Finally, there were no gender differences in health and lifestyle profiles. Conclusion The results of this study have important implications for health promotion interventions for people with an ID.     

The experience of sexuality in adults with intellectual disability

Background

People with intellectual disability have the same sexual needs as those without any disability, yet their sexuality is often restricted by reluctant attitudes and/or fears based on irrational beliefs. The aim of this study is to describe and analyse different areas of sexuality in adults with mild or moderate intellectual disability.

Method

The sample consisted of 180 men and 180 women attending occupational centres. All the participants were administered a questionnaire about sexuality adapted to their characteristics.

Results

Results show that 84.2% have had sexual relationships with another person, this percentage being higher in females and in people aged between 38 and 55 years old. Condoms are used by 41.4%. The most frequently used contraceptive methods are the pill (39.6%), transdermal patch (30.2%) and intrauterine device (6.7%). 9.4% of the women and 2.8% of the men has experienced sexual abuse.

Conclusion

In conclusion, there is a need to draw up educational programmes, differentiated according to gender and adapted to their reality, which include contents related with sexual health, sexual abuse and condom use.     

Social support and intellectual disabilities: a comparison between social networks of adults with intellectual disability and those with physical disability

Background   Social support has been identified as a major protective factor in preventing mental health problems and also as a major contributor to quality of life. People with intellectual disabilities (ID) have been identified as having limited social support structures. Interventions have been focused on promoting their social presence and integration. However, previous studies have shown that this does not always lead to the formation of social relationships. To date few studies have looked at how having an ID leads to impoverished social networks. This study aimed to do this by contrasting the social relationships of people with physical disabilities (PD) and people with ID.
Methods   Two groups of participants were recruited; 30 people with mild ID and 17 people with PD. Social and functional support networks were assessed, in addition to life experiences. Between and within group differences were then explored statistically.
Results   Adults with ID had more restricted social networks than PD, despite being involved in more activities. Social support for adults with ID was mainly provided by family and carers and few relationships with non-disabled people were identified. In contrast adults with PD had larger social networks than had been reported in the mainstream literature and had a balance of relationships with disabled and non-disabled people.
Conclusions   The results suggest that there are additional processes attached to having an ID, which lead to continued impoverished lifestyles. The findings also endorse other work that suggests being physically integrated and engaged in a wide range of activities does not guarantee good social and emotional support.     

An audit of investigations into allegations of abuse involving adults with intellectual disability

Background The present paper describes the results of an audit of referrals to a psychology service requesting specialist assistance in the investigation of allegations of abuse. Methods The referrals were over a 2-year period and case notes and records were reviewed to analyse the nature of the allegation, the characteristics of the victims or perpetrators, and the process of the investigation and its outcome. Results Twenty-six people were referred for investigation into allegations of sexual or physical abuse. The referrals were for assistance with an investigative interview (n = 12), capacity to give consent to a sexual relationship (n = 8) and competence to give evidence in court (n = 6). The referrals were all in relation to adults, covering a range of ages and degrees of intellectual disability. Conclusions The process of the investigations suggested that a number of barriers still exist which can make decision-making in relation to the alleged abuse extremely difficult. Resolution of the allegations through the criminal justice system was also problematic.     

Incidence of and risk factors for falls among adults with an intellectual disability

Background Falls among people with intellectual disability (ID) occur at a younger age than the general population and are a significant cause of injury and hospitalisation. There is very limited research investigating risk factors for falls among people with ID and none with people living outside of formal care arrangements, either independently or with their family. We used a medical chart audit to identify the incidence and risk factors for falls among people with ID living in a variety of settings. Methods We retrospectively identified 114 consecutive patients, aged 18 years and over who attended a clinic for people with developmental disabilities within a 15‐month period. Fall information was measured by carer recall of falls in the past 12 months. Potential risk factors were extracted from medical reports and a patient information questionnaire. Potential predictors were identified using univariate analysis and entered into a multiple logistic regression. Results Of 114 participants, 39 (34%) reported a fall in the previous 12 months. The number of reported falls was similar for formal care and non‐formal care arrangements. The vast majority of fallers (84%) reported sustaining an injury from a fall and many potential risk factors were identified. Multivariate analysis revealed having seizures in the past 5 years, a history of fracture and increasing age were risk factors for falls. Conclusions Falls are a significant health concern for adults with ID of all ages as a result of their incidence and the resulting injuries. Falls appear to be equally an issue for people residing in formal and non‐formal care accommodation. Further research is needed to develop screening tools and interventions for this population.     

Consensus guidelines into the management of epilepsy in adults with an intellectual disability

Background   Epilepsy has a pervasive impact on the lives of people with intellectual disability and their carers. The delivery of high-quality care is impacted on by the complexity and diversity of epilepsy in this population. This article presents the results of a consensus clinical guideline process.
Results   A Delphi process identified a list of priority areas for the development of evidence-based guidelines. All guidelines were graded and consensus on scoring was achieved across the guideline group.
Conclusion   There is a dearth of high-quality evidence from well-constructed studies on which to base guidance. However, the development of internationally derived consensus guidelines may further support the management of epilepsy in adults with an intellectual disability.     

Paroxetine in depressed adolescents with intellectual disability: an open label study

The aim of this study was to evaluate the efficacy and side-effects of paroxetine treatment in adolescents with mild intellectual disability and major depressive disorder (MDD). Seven adolescents (14.7–18.4 years of age) were treated with paroxetine (dosage 20–40 mg day^?1). Clinical changes were assessed at the beginning of the pharmacological treatment and after 9 weeks utilizing the DSM-IV diagnostic criteria and the Montgomery-Asberg Depression Rating Scale (MADRS). Four out of the seven subjects did not fulfil the DSM-IV diagnostic criteria after the 9-week treatment. The mean decrease in the total score on the MADRS was significant (41%). Some items of the MADRS showed significant improvement: inner tension (66%); lassitude (55%); apparent sadness (53%); inability to feel (44%); and reported sadness (43%). Three subjects showed sedation, two subjects gastrointestinal complaints and one subject insomnia; all these symptoms were transitory and not severe. No behavioural activation was evident. This preliminary, uncontrolled study of a few cases suggests that adolescents with intellectual disability and MDD may respond to paroxetine, and that adverse side-effects are mild.     

Queensland psychiatrists' attitudes and perceptions of adults with intellectual disability

Background Quality mental health care for adults with an intellectual disability (ID) depends upon the availability of appropriately trained and experienced psychiatrists. There have been few surveys of psychiatrists working with this population. Method This Australian study obtained psychiatrists’ attitudes to and perceptions of the mental health needs of adults with an ID. Training needs were also sought. The survey instrument used was a purposely designed, 28‐item self‐administered questionnaire featuring multiple‐choice and open‐ended questions. Results The majority of psychiatrists expressed concerns about treatment of this group, describing unmet needs. A total of 75% considered that antipsychotics were overused to control aggression, and 34% of psychiatrists were reluctant to treat adults with an ID. In total, 85% agreed that mental health in ID should be offered as a training option for psychiatric registrars, and that specialized mental health services would provide a high standard of care for this population. Conclusion Broad concerns are raised regarding pathways to mental health care for adults with an ID in Australia. An Australia‐wide training strategy needs to be developed. Partnerships between mental health, disability and community services that serve the mental health needs of this population, should actively seek to engage psychiatrists.