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The purpose of this paper is to establish and evaluate a psychotropic medication education group for men with intellectual disability on a secure psychiatric ward.

A multi-disciplinary team was convened to oversee the project. A curriculum was developed that covered major classes of psychotropic drugs as well as broader themes related to taking medication and general wellbeing. Each group session incorporated a range of teaching methods supported by accessible materials. Evaluation was by qualitative and quantitative methods.

There was interest and enthusiasm for the group. Participant feedback was generally positive and most of those who completed the group reported achieving their personal learning goals. There was no significant difference in results of a medication knowledge test at baseline and at the end of the course. Feedback from group members and reflections of the course facilitators are discussed.

The results of this small-scale study may not be applicable to other groups or settings. Evaluation measures seemed unable to capture some elements of the group processes and outcomes.

Establishing and running a psychoeducational group on a low-secure ward for men with intellectual disabilities is possible and potentially valuable. Learning from this project will be useful for others considering group-based interventions for people with intellectual disability.

This paper adds to the limited literature describing interventions to improve medication knowledge in people with intellectual disability.

We report the case of a man with Asperger's syndrome and borderline intelligence, atypical eating disorder (food faddiness/refusal due to fear of choking) and XYY syndrome. We consider multi‐modal management and inter‐agency service provision issues in meeting his complex mental health and social needs.

This paper introduces service changes impacting on adults with learning disabilities, defines the concepts of learning disability, needs and need assessments, dual diagnosis and mental health needs and considers their service implications. Between 25% and 50% of adults with learning disabilities have mental health needs, and the main clinical types are outlined. The findings from a national multi‐professional survey of services for adults with learning disabilities and mental health needs are summarised and the difficulties of meeting the complex needs of these adults are demonstrated. Recent developments in clinical diagnostic assessment, needs assessment, care planning, outcome monitoring, staff training and service evaluation are discussed, including the possible advantages of the care programme approach (CPA). Recommendations are given for services for adults with learning disabilities and mental health needs and points for discussion with service users and carers are suggested.

People with schizophrenia and related psychoses may be more likely to be ‘treatment‐resistant’ when dually diagnosed with intellectual disabilities. This case study highlights many of the difficulties which can occur in their assessment and management. Clozapine is currently the best available intervention for treatment‐resistant schizophrenia, and its use has increased in people with intellectual disabilities. However, it is not always effective, and a wide range of adjunctive strategies have been suggestive and tried. The evidence base for the specific use of these additional strategies in people with intellectual disabilities needs to be increased.

The ‘Outlands Pilot’ was a joint project set up in 1992 by Devon Social Services Department and the Health Authority. It offered an intermediate setting between hospital and home. Elderly people who had been assessed as needing residential care after discharge from hospital were admitted instead to the Outlands Unit for a six‐week period of rehabilitation. The explicit aim was to rebuild people's confidence and physical independence, so that they could manage at home again. This paper reports on the success of the model and barriers to its wider use.

The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The International Classification of Diseases (ICD) underpinning principle of clinical utility is currently poor for persons with Disorders of Intellectual Development (DID) and mental disorders. This impedes access to healthcare resources; services and social inclusion thereby further aggravating their vulnerability. The purpose of this paper is to present a critical overview and evidence informed recommendations within the context of an international collaborative programme, undertaken by the Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists, UK with support from the World Health Organisation (WHO).

The authors carried out: first, a systematic review (SR) of literature, using PRISMA guidelines regarding the reliability, validity and utility of the ICD-10/Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria in people with DID (PWDID); second, a national and international consultation exercise with partners, stakeholders and experts; third, a multicentric survey of problem behaviours in PWDID; and finally, information dissemination/dialogues including presentations and workshops at key scientific events, consultation networking, data gathering and consensus building.

The SR revealed a dearth of robust studies – most consisting of weak research methodologies. Significant difficulties were highlighted regarding the application of diagnostic criteria in the current classificatory systems – particularly in people with severe/moderate DID. Recommendations supported the introduction WHERE APPROPRIATE of modifications based on observed phenomena (signs) in PWDID in lieu of reported symptoms to facilitate DIAGNOSIS AND better access to healthcare and the community. Heterogeneity precluded quantitative pooling and meta-analysis. The consensus building exercise globally revealed that problem behaviours were the commonest reasons for referral to healthcare services with significant numbers without a diagnosed mental disorder being prescribed psychoactive medication.

The consensus gathering exercise WAS SELECTIVE AND did not cover all of the 194 member states of WHO due to resource and time constraints and this constitutes the main limitation of our study. Based on the SR and expert consensus, the authors submitted evidence informed pragmatic proposals to the WHO aimed at addressing the shortcomings of the ICD-10. The key recommendations focused on improving clinical utility within the context of epistemic iteration which would consolidate and strengthen the future evidence base. It was also recommended that self-injurious behaviour should form a standalone sub category in view of its relevance for healthcare services and resources which underpin clinical utility.

The ICD-11 is a global, multidisciplinary and multilingual development for public health benefit with 70 per cent of the world's health expenditures assigned using this system for resource allocation. Currently mental disorders in PWDID can be misinterpreted, unrecognised and under reported resulting in barriers to access to treatment and healthcare resources. Conversely disorders may be over diagnosed when the inherent discrepancies between the chronological age and the developmental level of functioning are not considered. Conclusions and recommendations from this study will result in better diagnosis of mental disorders and healthcare resources in this population.

PWDID are a vulnerable sector of the population with an increased prevalence of mental health problems who are marginalised and discriminated by society. Early detection, treatment and management of these conditions will prevent further decompensation and stigmatisation.

To the best of the authors knowledge this is the first comprehensive, large-scale study which evaluates the ICD classificatory system within the context of clinical utility for PWDID, including experts and stakeholders from both lower/middle- and high-income countries. The international consultation/consensus building process culminating in the formulation of evidence informed recommendations, aimed at improving the clinical utility of the ICD-11 for this population, has the potential to improve access to appropriate healthcare and treatment and consequent enhancement of their quality of life.