Are we training psychiatrists to develop skills in intellectual disability psychiatry? Current European context and future directions

Dias, Marisa Casanova; Perera, Bhathika; Riese, Florian; Picker, Livia De; Costa, Mariana Pinto da; Petricean, Alina; Kanellopoulos, A.; Krysta, K.; Baessler, Franziska

doi:10.1192/j.eurpsy.2020.102

Cited by 8 publications

(5 citation statements)

References 7 publications

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“…Although the risk of mental disorders among Polish PwID is up to three times higher than in the general population, they lack adequate diagnostic tools and specialists (Rękosiewicz, 2018). No special category for ID Psychiatry exists in Polish psychiatric training, and no inpatient or outpatient psychiatric services are provided typically for PwIDs (Casanova Dias et al, 2020; Krysta et al, 2019). However, the current reform underway in the pediatric mental health system, together with changes in the mode of training specialists, should improve the quality of care.…”

Section: Discussionmentioning

confidence: 99%

Perspectives on healthcare for people with intellectual disabilities in Poland

Wrzesińska,

Wrona,

Prysak

et al. 2024

Policy Practice Intel Disabi

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This paper presents current information on policy developments, service design, best practices, and approaches to empower the users of health and medical care services for people with intellectual disabilities in Poland. Polish regulations allow systemic support to be provided for all people with disabilities. However, Polish patients with intellectual disabilitiy (PwID) and their caregivers face many barriers. Although a key obstacle is the lack of a standard definition that approaches disability in an interdisciplinary way, PwID are also more likely to experience difficulties in personal communication in medical settings and less likely to encounter specialists prepared to work with this group. There is also a need to pay greater attention to the expectations of PwID. To facilitate a holistic approach to diagnosis and therapy, there needs to be coordination between different specialists, including medical staff, paramedics, psychologists, and teachers. Providing personal communication training for medical personnel, as well as developing dedicated procedures for PwID in primary health care, clinics and hospitals, will improve equal access to health and health literacy for all in Poland. Even so, it is important to respect the autonomy of PwID and the commitment of caregivers.

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Section: Discussionmentioning

confidence: 99%

Perspectives on healthcare for people with intellectual disabilities in Poland

Wrzesińska,

Wrona,

Prysak

et al. 2024

Policy Practice Intel Disabi

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“…More published research and improvements in clinical training to serve individuals who are MV and others with severe developmental disabilities are urgently needed. The present undertraining of psychiatrists for this challenging task requires attention globally, including in the USA [27].…”

Section: Discussionmentioning

confidence: 99%

Minimally Verbal Individuals with Autism Spectrum Disorders/Intellectual Disability and Challenging Behaviors: Can Strategic Psychiatric Treatment Help?

Hellings,

Singh,

Singh

et al. 2024

Disabilities

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(1) Background: Psychiatrists are increasingly required to treat minimally verbal (MV) individuals with autism spectrum disorder (ASD), intellectual disability (ID) and behavior problems without much published guidance. (2) Methods: We reviewed 80 charts of MV patients managed strategically for challenging behaviors, following IRB approval. Data extracted included demographics, ASD/ID level, diagnoses, epilepsy and medications. In this descriptive study, we examined the course of assessment and treatment and made recommendations for a strategic, person-centered approach. (3) Results: Of 53 males and 27 females, mean age 34 years (range 7–76), all had ID; 75 had ASD (94%). Diagnoses included seizures in 40/80 (50%), frequent aggression (89%), self-injury (80%), attention-deficit hyperactivity disorder (ADHD) (64%) and obsessive compulsive disorder (OCD) (34%). The commonest medication classes adjusted were antiseizure medications, antipsychotics, and non-stimulant ADHD medications. (4) Conclusions: Clinical impressions suggested that this strategic psychiatric approach was beneficial, notably a review of antiseizure and all other medications for polypharmacy, behavioral and other side effects, followed by a review of possible childhood/current ADHD and a trial of low-dose non-stimulant ADHD medications if warranted. Low-dose risperidone was often effective and tolerable for irritability and self-injury.

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“…Notably, literature from other countries demonstrates that insufficient training of psychiatrists in the care of patients with ASD/ID is a global concern, particularly given a pervasive shortage of psychiatrists, with many low-income and middle-income countries having one psychiatrist for every 200,000 people (World Health Organization [WHO], 2013). Recent reviews of training standards in ID for psychiatrists in the European Union (Dias et al, 2020) and overall psychiatry training in Asia (Isaac et al, 2018) have identified multiple training deficits, including wide variance in the rigor and availability of training, with no required ID training in some countries, a lack of unified minimum training standards, a mismatch between the prevalence of a condition and the amount of training, and limited trainee supervision. These disparities were noted to compromise the quality of psychiatric care by contributing to inconsistent and fragmentary treatment across the lifespan.…”

Section: Discussionmentioning

confidence: 99%

“…These findings mirror reports from psychiatrists in other countries, including Canada (Lunsky et al, 2007), the United Kingdom (Kaushal et al, 2018), Australia (Edwards et al, 2007), Singapore (Sajith et al, 2019), and Israel (Werner et al, 2013). Experts in the field, both in the United States and internationally, have repeatedly recommended expanding training in this area (Bouras, 1992; Dias et al, 2020; Menolascino & Fletcher, 1992; Ruedrich et al, 2007; Syzmanski et al, 1991; Torr et al, 2008). In a 2009 study assessing psychiatry training in both ASD and ID in the United States, CAP and GEN directors of programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) were surveyed about lecture hours and patient experiences in ASD/ID in their respective programs (Marrus et al, 2014).…”

mentioning

confidence: 99%

Psychiatry training in autism spectrum disorder and intellectual disability: Ongoing gaps and emerging opportunities

Marrus

Koth

Hellings

et al. 2022

Autism

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Autism spectrum disorder and intellectual disability are associated with psychiatric comorbidities, yet a 2009 study of US child and adolescent psychiatry program directors indicated that psychiatry residents receive insufficient training in autism spectrum disorder/intellectual disability. This follow-up study surveyed child and adolescent psychiatry and general psychiatry program directors to assess (1) the current extent of residency training in autism spectrum disorder/intellectual disability, (2) program director perceptions of educational topics and resident competency in autism spectrum disorder/intellectual disability, and (3) preferred resources to strengthen autism spectrum disorder/intellectual disability training. As in 2009, many child and adolescent psychiatry program directors reported few lecture hours, although current child and adolescent psychiatry residents saw slightly more patients with autism spectrum disorder but not intellectual disability. General psychiatry program directors reported fewer lecture hours in autism spectrum disorder/intellectual disability and fewer patients with autism spectrum disorder than child and adolescent psychiatry program directors. Both child and adolescent psychiatry and general psychiatry program directors recognized the importance of a range of educational topics in autism spectrum disorder/intellectual disability. Child and adolescent psychiatry program directors reported higher resident competency, and lecture hours and patients seen moderately correlated with resident competency. Program directors indicated that online videos and other resources would help improve autism spectrum disorder/intellectual disability training in their programs. Collectively, these findings suggest minimal improvements in autism spectrum disorder/intellectual disability training over the past decade and highlight the urgent need to advance psychiatry training in this field through dissemination of resources. Lay abstract Children, adolescents, and adults with autism spectrum disorder and intellectual disability experience high rates of co-occurring psychiatric conditions throughout their lifetime. However, there is a shortage of psychiatrists to treat these populations. We evaluated how much education psychiatrists-in-training receive on how to care for individuals with autism spectrum disorder/intellectual disability. We found that in many psychiatry programs, residents receive limited training experiences in autism spectrum disorder/intellectual disability involving lectures and patient contact and that psychiatry program directors would benefit from more resources to strengthen education in autism spectrum disorder/intellectual disability.

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Are we training psychiatrists to develop skills in intellectual disability psychiatry? Current European context and future directions

Cited by 8 publications

References 7 publications

Perspectives on healthcare for people with intellectual disabilities in Poland

Perspectives on healthcare for people with intellectual disabilities in Poland

Minimally Verbal Individuals with Autism Spectrum Disorders/Intellectual Disability and Challenging Behaviors: Can Strategic Psychiatric Treatment Help?

Psychiatry training in autism spectrum disorder and intellectual disability: Ongoing gaps and emerging opportunities

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