Identifying bipolar disorders in individuals with intellectual disability

Abstract

Objective The aim of the present study was to characterize adults with intellectual disability (ID) and concomitant clinical diagnoses of bipolar disorder (BPD), and determine whether DSM-IV criteria would distinguish individuals with BPD from patients with other psychiatric diagnoses. Methods A retrospective chart review was done of a convenience sample of adult patients seen over a  -year period in a specialty clinic for adults with ID and psychiatric disorders. The DSM-IV criteria were used to differentiate individuals with clinical symptoms of BPD from groups of patients with other mood or thought disorders with behavioural symptoms which frequently overlap those of BPD. Behavioural symptoms were also catalogued and used to distinguish the diagnostic groups. Results Subjects with clinical symptoms of BPD had significantly more DSM-IV mood-related and nonmood-related symptoms, as well as functional impairments, compared to individuals with major depression, depression with psychosis or schizophrenia/ psychosis NOS (not otherwise specified). Likewise, behavioural profiles of the BPD group of patients differed significantly from patients in the other three groups. Conclusions Bipolar disorder can be readily recognized and distinguished from other behavioural and psychiatric diagnoses in individuals with ID, and DSM-IV criteria can be useful in the diagnosis of BPD.

What symptoms predict the diagnosis of mania in persons with severe/profound intellectual disability in clinical practice?

“…While there have been many efforts to examine the accuracy of diagnosing mania in the ID population, the present study lends support to the use of DSM‐IV criteria with a particular focus on observable, measurable behaviours such as sleep and psychomotor agitation (Lowry 1993; Ruedrich 1993). This provides further support to the existing line of thought that DSM‐IV criteria can be applicable to individuals with ID (Cain et al. 2003).…”

Treating Childhood Psychopathology and Developmental Disabilities

“…Symptoms such as "exhibits inappropriate repetitive vocalizations", "makes embarrassing comments", "curses", "demands excessive attention or praise", and "disturbs others" appear to be associated with symptoms of mania (e.g., irritability, pressured speech, increased goal-directed activity). Attention-seeking behavior, intrusive behavior, and difficulty interacting with peers and/or staff are equally disabling at all levels of intellectual disability (Cain et al, 2003;Ruedrich, 1993;Lowry, 1993). Interestingly, these features, when they occur in patients with autism may make the autistic features appear to have diminished (Kerbeshian, Burd, & Fisher, 1987).…”

Handbook of Intellectual and Developmental Disabilities

“…Psychopharmacological or behavioral interventions should not occur in the absence of a psychiatric diagnosis. Cain et al (2003) evaluated the validity of identifying bipolar disorders in individuals with ID utilizing DSM IV criteria. Blind reviewers adhered to DSM IV criteria for the diagnosis of bipolar disorder and retrospectively reviewed the charts of a convenience sample of 166 participants that had been seen at an outpatient clinic for adults with ID.…”