Psychiatric disorders in children with intellectual disability

We investigated psychiatric disorders in intellectually disabled children; the prevalence rate and types of psychiatric disorders, and the association of psychiatric disorders with sex, residence type, level of disability, and epilepsy were examined. The population comprised 155 intellectually disabled children. Medical information was obtained from case files, which indicated that a psychiatric disorder had previously been diagnosed for 11% of patients. A careful re-examination of the case files revealed a psychiatric disorder for 33%. The criteria of a psychiatric ICD-10 diagnosis were fulfilled by 23%, and a further 10% had an unspecified mental disorder. The most common diagnoses were pervasive developmental disorders and hyperkinetic disorders. The former were less common among children with mild intellectual disability. In conclusion, about one-third of children with intellectual disability have a psychiatric disorder which needs to be taken into account in treatment.     

Psychiatric disorders in children with intellectual disability

We investigated psychiatric disorders in intellectually disabled children; the prevalence rate and types of psychiatric disorders, and the association of psychiatric disorders with sex, residence type, level of disability, and epilepsy were examined. The population comprised 155 intellectually disabled children. Medical information was obtained from case files, which indicated that a psychiatric disorder had previously been diagnosed for 11% of patients. A careful re-examination of the case files revealed a psychiatric disorder for 33%. The criteria of a psychiatric ICD-10 diagnosis were fulfilled by 23%, and a further 10% had an unspecified mental disorder. The most common diagnoses were pervasive developmental disorders and hyperkinetic disorders. The former were less common among children with mild intellectual disability. In conclusion, about one-third of children with intellectual disability have a psychiatric disorder which needs to be taken into account in treatment.     

Ageing and mental health problems in people with intellectual disability

PURPOSE OF REVIEW: Increasing numbers of people with intellectual disability are now living well into old age. This paper will review the recent literature pertaining to the mental health of older people with intellectual disability. RECENT FINDINGS: Overall, the prevalence of mental health problems is high in adults of all ages with intellectual disability. A major epidemiological study did not report sufficient detail to examine the effect of ageing on specific disorders or the differential effects of ageing and early mortality in people with Down's syndrome. At least a third of people with Down's syndrome can expect to develop Alzheimer's disease in middle age whilst for other people with intellectual disability, Alzheimer's disease is probably no more common than in the general population. Diagnosis and management of dementia is complicated by the high rates of comorbid physical and mental health problems. SUMMARY: Overall, mental health problems in older people with intellectual disability are similar to younger people with intellectual disability, however there are more cases of dementia and physical health problems. Further research is needed to improve our understanding of the effects of ageing on the mental health and care needs of older people with intellectual disability.     

Prevalence and incidence of health problems in people with intellectual disability

The objective of this study was to determine the prevalence and incidence of the most frequent chronic health problems in relation to age in people with intellectual disabilities living in residential facilities in the Netherlands. A prospective cohort study was done with four data collections, each with an interval of one year. Data were collected by means of questionnaires which were completed by each person's physician. Striking results included the reported high prevalence and incidence of visual and hearing impairment, which was even more pronounced in people with Down's syndrome than in people with intellectual disability resulting from other causes. Gastrointestinal problems also appeared to have high incidence rates. Dementia was frequently reported in people with Down's syndrome aged 40 years and older. The results reflect the need for a more predictive policy which can anticipate health problems in people with intellectual disability.     

A classification of behaviour problems exhibited by people with intellectual disability

Data collected on problem behaviours exhibited by 405 adults and adolescents with intellectual disability using a Behaviour Disorder Scale were analysed to assess relations between problem behaviours. Clients exhibited a number of problem behaviours. Factor analyses showed that the behaviours occurred in syndromes. One factor analysis produced two sets of behaviours which are hypothesised to represent conduct and emotional syndromes. No other checklist of behaviours prepared for use with people with intellectual disability identifies a list of behaviours which represent an emotional syndrome.     

Psychiatric health needs and services before and after complete deinstitutionalization of people with intellectual disability

Before total deinstitutionalization in Norway, many believed that the ordinary health care system could give people with intellectual disability the same or even better health care than that which they received in institutions. It was said that institutions created psychiatric problems, and that these would diminish or even disappear with the closing of these establishments. The present study is a prospective cohort study without a control group. It examines the frequency of mental health problems and the psychiatric health services which 109 subjects aged between 16 and 65 years received before (1987) and after (1995) deinstitutionalization. Mental health problems were defined as behavioural disturbances, and psychiatric disorders and symptoms. Psychiatric disorders were identified with the Psychopathology Instruments for Mentally Retarded Adults (PIMRA), which were filled in by the carers. Behaviour disturbances were identified as having occurred or not during the previous year. Psychiatric problems remained frequent, and there was a significant increase in behavioural problems in spite of total deinstitutionalization and improved physical living conditions. Access to qualified help, such as psychologists and psychiatrists, had been substantially reduced. Most mental health problems among people with intellectual disability are not solved by reorganization or deinstitutionalization, and such measures are no substitution for professional assistance.     

Bullying and people with severe intellectual disability

Although bullying has been shown to reduce quality of life in many spheres, anti‐bullying strategies have yet to be incorporated into services for adults with severe intellectual disability (ID). The present study employed a survey of staff and parent concerns about 54 previously surveyed students who had left a school for pupils with severe ID. A content analysis of follow‐up interviews was performed in 10 cases. Staff identified 19% of the survey sample as bullying others and 11% as being picked on. Neither gender nor communication ability had an impact. There was no significant change in bully or victim status over time, although some people did change. Parents or staff raised bully/victim problems in more than half of the interviews. There is sufficient evidence of bullying behaviour to warrant the adoption of anti‐bullying strategies.     

Psychiatric diagnosis in persons with intellectual disability in India

BACKGROUND: This study examines the rate of psychiatric diagnosis as per ICD-10 and Reiss Screen for Maladaptive Behaviours (RSMB), and distribution of psychiatric diagnosis with regard to the severity of intellectual disability (ID). It also explores the degree of agreement between Reiss screen and clinical diagnosis (ICD-10) in relation to dual diagnosis. METHODS: In this study Intelligence (IQ) and Social Quotient (SQ) were estimated on Indian adaptation of Binet's scale and Vineland Social Maturity Scales, respectively, in 60 consecutive persons with ID. Both ICD-10 and RSMB were used independently to determine the presence of psychiatric diagnosis. RESULTS: Clinically, according to ICD-10, about 60% of the sample was found to have dual diagnosis as compared to 48% on RSMB. Agreement between ICD-10 and RSMB about psychiatric comorbidity was 82%. Commonest psychiatric diagnosis was unspecified psychosis followed by bipolar affective disorders. CONCLUSION: Persons with ID do suffer from various psychiatric disorders. RSMB is a useful tool for differentiating between psychiatric problems and maladaptive behaviours. Hence RSMB can be used in the Indian context.     

Eating disorders in adults with intellectual disability

There is an increasing focus on the nutrition of people with intellectual disability (ID), but less interest in the range of eating disorders (EDs) that they may exhibit and the bio‐psycho‐social impact of these conditions. Despite diagnostic and methodological difficulties, psychopathology and ED research studies suggest that 3–42% of institutionalized adults with ID and 1–19% of adults with ID in the community have diagnosable EDs. Weight surveys indicate that 2–35% of adults with ID are obese and 5–43% are significantly underweight, but the contribution of diagnosable EDs is unknown. Such data and case reports suggest that EDs are associated with considerable physical, behavioural, psychiatric and social comorbidity. Review papers have focused on the aetiology and treatment of pica, rumination, regurgitation, psychogenic vomiting and food faddiness/refusal. Emerging clinical issues are the development of appropriate diagnostic criteria, multimodal assessment and clinically effective treatment approaches. Key service issues include staff training to improve awareness, addressing comorbidity and access issues, and maintaining support for adults with ID and EDs, and their carers. Research should confirm the multifaceted aetiology and comorbidity of EDs. Then multicomponent assessment and treatment models for EDs can be developed and evaluated.     

Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders

We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N = 124) as compared to adults with ID only (N = 562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD.     

Mood disorders in intellectual disability

PURPOSE OF REVIEW: This article examines reviews and research on the diagnosis and treatment of mood disorders in people with intellectual disability published from September 2004 to December 2005. RECENT FINDINGS: Patients with intellectual disability have limitations in verbal ability, and with increasing levels of disability may have an atypical clinical presentation. Thus, methods to diagnose mood disorders were a major research focus. Informant-rating scales and two self-report instruments provided data on thought patterns, aberrant behavior, appetite, and suicidality. Behavioral symptoms such as aggression were frequently associated with mood disorders. Pharmacotherapy and electroconvulsive therapy were found to be effective treatments. Mood disorders were frequently identified in people with intellectual disability, although suicide was still quite rare. SUMMARY: Patients with milder levels of disability can use self-report measures and can be diagnosed using standard criteria with little modification. For those with more severe disability, diagnosis is challenging and often requires the use of residual categories. Atypical clinical presentation, including maladaptive behaviors, lent support for 'behavioral equivalent' substitutes of standard criteria. Typical pharmacological agents were effective for depression and electroconvulsive therapy for treatment-resistant bipolar disorder.     

Psychiatric co-morbidity and gender differences in intellectual disability

Background Although gender differences in psychopathology among the general psychiatric population appear to be well documented, such differences have been either ignored or inconsistently investigated among people with intellectual disability (ID). Methods The study examined psychiatric co‐ morbidity in 295 men and 295 women with ID and significant social impairments living in community settings. The sample was drawn from consecutive clinical referrals to a specialist mental heath service of South‐East London. Psychiatric diagnoses were based on ICD‐10 criteria. Results Personality disorder was more common among men, although dementia and adjustment reaction were more common among women. There were also gender differences in marital status, with a larger percentage of women being either married or in a stable relationship. Gender differences in the source of referral were also observed, with more women being referred through primary care and more men being referred through generic mental health services. Conclusions Female patients seem to have at some extent different mental health needs from male patients. Such differences should be taken into account in the design and delivery of clinical service for people with ID.     

Mental disorders and problematic behaviours in people with intellectual disability: future directions for research

In recent years there has been a nriajor growth of interest in the field of mental health and intellectual disability. This article outlines some of the issues that will be important to address in the coming years. The issues discussed include: the interaction of biological and environmental factors in the aetiology of behavioural and psychiatric disorders; diagnosis and classification; epidemiology; dementia; recognition of mental illness in the community; treatment; service provision; and training.