Background Physical distress resulting from medical problems has been found to cause increased behavior problems in with Intellectual Disabilities (ID). Despite this fact, little has been documented on the medical problems of individuals with ID admitted for inpatient psychiatric care. We conducted an exploratory investigation based on a retrospective chart review of the medical problems and medications for 198 people with ID who had been admitted to a specialized inpatient psychiatric unit. Most patients were referred for admission because of aggressive, disruptive and self-injurious behaviors. The average length of stay was 17.6 days. Method We tallied the total number of medical problems and medications listed in the patients’ discharge summaries. Because longer stays are disruptive, costly and associated with greater overall impairment, we examined the relationship between length of stay and frequency of discharge medical diagnoses. We also assessed whether or not the number of psychoactive medications correlated with the number of medical diagnoses. The effects of other demographic and diagnostic variables on rates of medical diagnoses and medications were also evaluated, including gender, age group (16–25, 26–45, 46–60, > 60), level of ID (Mild, moderate or severe ID), and diagnosis of an Autism Spectrum Disorder (ASD) or Down syndrome (DS). Results Inpatients with a higher number of medical diagnoses had longer lengths of stay (Spearman r = +.32, p < 0.0001). There was a significant correlation between number of psychoactive medications and number of medical problems (Spearman r = + .32, p < 0.0001). The most frequent medical comorbidity was constipation, reported in 60% of the inpatients (n = 118), while Gastro- Esophageal Reflux Disease (GERD) was identified in 38% (n = 75). Older inpatients had an increased number of medical problems, as might be expected, but a diagnosis of an ASD, gender, and level of ID had no detectible effect on rates of either medical diagnoses or medications. There were only 13 inpatients with DS; in this modest sample, it was found that they had higher rates of osteoarthritis, cardiac problems, hearing loss, hypothyroidism, and sleep apnea than peers without DS, as is consistent with previous findings on overrepresented conditions in this trisomy. Conclusions In the present study, individuals with ID admitted for inpatient psychiatric care exhibited high rates of medical problems, and these were associated with duration of inpatient stay. Based on these findings, further investigation of the effects of medical problems on behavior among individuals with ID admitted for inpatient psychiatric care is warranted.

Obsessional slowness may be a severe variant of OCD. Although it appears to occur infrequently, there may be an elevated rate in people with DS. The current report is severely limited in scope since the case descriptions were based on a retrospective review. However, because of the paucity of published information about this clinical phenomena, it was felt that the case series might serve to establish the need for further, more systematic, prospective evaluation of individuals with DS and clinically significant slowness.

Recent reports suggest that individuals with autism spectrum disorders (ASD) may experience depression at a high frequency, yet few published studies address this issue, especially among adults. In the current investigation, we reviewed features of depression and comorbid traits among depressed inpatients with intellectual disabilities (ID) as a function of ASD. A retrospective chart review was performed for 53 inpatients meeting criteria for depression (13 individuals with ASD and ID and 40 matched individuals with ID but without ASD), all of whom had received a diagnosis of depression at the time of discharge from a specialty psychiatric unit for adults with ID. The depression diagnoses were based on a comprehensive clinical assessment; specific mood and anxiety symptoms were reported by informants at the time of intake using the Mood and Anxiety Semi-Structured (MASS) Interview for Patients with Intellectual Disabilities (Charlot, Deutsch, Hunt, Fletcher, & McIlvane, 2007). Overall, few qualitative differences were detected between the 2 groups. Both depressed inpatient groups had high rates of comorbid anxiety disorders as well as externalizing behaviors. Inpatients with ASD had a total of 2 more symptoms (out of 29 possible symptom items) than their depressed peers without an ASD diagnosis (mean scores of 12.23 and 9.85, respectively). Anxiety disorders were reported in 62% of individuals with ASD and 38% of those without ASD. Antipsychotic medication was prevalent among the patients with ASD and depression. Over 80% of the inpatients with ASD and depression, compared with 49% of the non-ASD group, were treated with these medications.

The MASS Interview, a semi-structured interview containing behavioural descriptions of DSM-IV symptom criteria, shows promise as a potentially helpful tool in the psychiatric diagnostic evaluation of persons with ID and limited expressive language skills, in the detection of mood and anxiety disorders. The tool also yields a wide breadth of clinical information and is easy for mental health clinicians to use.

In the United States, research directed specifically at improving our understanding of the psychiatric assessment and treatment of individuals with intellectual disabilities (ID) has grown, yet lags far behind efforts for typically developing children and adults. In the United States, a lack of a national approach to the mental health problems of people with ID has likely contributed to a lack of a clear and cohesive national research agenda for "dual diagnosis" of intellectual disabilities and mental health disorders. Despite these concerns, much has been learned and important progress has been made. This article provides an overview of the latest developments in research and social policy on behalf of persons with ID and mental health needs in the United States.