Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community‐based population aged between 16 and 64 years

Deb, Shoumitro; Thomas, Michael S. C.; Bright, Charlotte Lyn

doi:10.1046/j.1365-2788.2001.00373.x

Cited by 205 publications

(169 citation statements)

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“…The rate of PBs in people with ID is high (5) and their presentation is determined by many complex factors. The pathogenic contribution of organic conditions, psychiatric disorders, environmental influences, or a combination of these has to be carefully established for every single case.…”

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International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

et al. 2009

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Intellectual disability (ID) or mental retardation or learning disability is a lifelong condition included in the group of mental disorders in all the international classification systems. It is a syndrome grouping (meta-syndrome) including a heterogeneous range of clinical conditions characterized by a deficit in cognitive functioning prior to the acquisition of skills through learning (1). Over 30% of people with ID have a comorbid psychiatric disorder, which often has its onset in childhood and persists through adolescence and adulthood (2,3).In spite of this evidence, ID and related conditions are still considered a marginal area of psychiatry. In many countries there is little or no training provision on ID during undergraduate medical training or psychiatric specialization. The World Health Organization (WHO) has recently highlighted the unmet care needs of persons with ID (4). Psychiatrists are the first health professionals in contact with this population group and there is a global gap in training and guidelines on mental health issues related to ID.Within the ID field, the assessment, differential diagnosis and treatment of problem behaviours (PBs) deserve special attention. The rate of PBs in people with ID is high (5) and their presentation is determined by many complex factors. The pathogenic contribution of organic conditions, psychiatric disorders, environmental influences, or a combination of these has to be carefully established for every single case.The prevalence of PBs in people with ID seems to be sufficiently high (5,6) to constitute a major concern in this population. Depending on the definition and methodology, rates have been reported to vary from 5.7 to 17% (7-10). Using the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities (DC-LD) (11), Cooper et al (12,13) aggression and self-injurious behaviour to be 9.8% and 4.9%, respectively, among adults (16 years and over) with ID in a community setting.It has been reported that 20-45% of people with ID are receiving psychotropic medication and 14-30% are receiving psychotropic medication to manage PBs such as aggression or self-injurious behaviours (14,15) in the absence of a diagnosed psychiatric disorder. Examples of psychotropic medications used for adults with ID are antipsychotics, antidepressants, anti-anxiety drugs (benzodiazepines, buspirone, beta-blockers), mood stabilizers (lithium, anticonvulsants), psychostimulants, and opioid antagonists. Spreat et al (16) reported that as many as two thirds of psychotropic medications prescribed to people with ID are antipsychotics.Studies suggest that PBs are not only prevalent but also persistent in people with . Totsika et al (20) found that serious physical attacks, self-injury and stereotypy were the most likely types of PBs to persist over time. It is therefore suggested that it may be necessary to start interventions as early as possible to prevent the behaviours from becoming more serious and to reduce the number of emergent behaviours. It has...

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International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

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“…On the other hand, some authors suggested that a low IQ excludes the pre sence of psychiatric dis orders [2], considering intellectual disability and psychiatric disorders as being mutually exclusive [3]. Other authors believed that persons with intellectual disability are protected from certain psychological stress and therefore are less prone to develop psychiatric illness [4]. Today, psychiatric disorders are considered as being linked to intellectual disability.…”

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Intellectual disability and psychiatric disorders: more than a dual diagnosis

2009

Swiss Arch Neurol Psychiatr

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“…Actual estimates of co-morbidity of learning disability and psychiatric illness have ranged across studies from 10% to 39%, 3 but all are significantly higher than the general population and the prevalence of behaviour disorders (which often reflect psychiatric disorder in this group) has been found to be even higher at 60.4%. 4 The World Health Organisation, 5 in its definition of learning disability, points to the importance of holistic approaches to understanding individual needs; however there is still a tendency to attribute much emotional distress experienced by an individual to the disability rather than to particular emotional needs or psychiatric disorder.Over the last 20 years many changes have taken place in the development of care and services for people with learning disabilities. The philosophies of normalisation 6 and inclusion have brought about a change in focus for these services, with more emphasis on individual characteristics and needs than disabilities, so that even people with severe problems are seen as having a right to be supported in community settings.…”

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Psychotherapy and learning disability

Dodd¹,

McGinnity²

2003

Ir. j. psychol. med.

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In Ireland today it is considered that approximately 6.7% of the population have learning disabilities.' According to the National Intellectual Disability Database Report, 2 26,760 people are registered as being in receipt of, or in need of, a learning disability service (prevalence rate of 7.38/1000 total population). Many of these people have coexisting physical disabilities and psychiatric disorder, both of which increase in prevalence in proportion to the severity of the learning disability. Actual estimates of co-morbidity of learning disability and psychiatric illness have ranged across studies from 10% to 39%, 3 but all are significantly higher than the general population and the prevalence of behaviour disorders (which often reflect psychiatric disorder in this group) has been found to be even higher at 60.4%. 4 The World Health Organisation, 5 in its definition of learning disability, points to the importance of holistic approaches to understanding individual needs; however there is still a tendency to attribute much emotional distress experienced by an individual to the disability rather than to particular emotional needs or psychiatric disorder.Over the last 20 years many changes have taken place in the development of care and services for people with learning disabilities. The philosophies of normalisation 6 and inclusion have brought about a change in focus for these services, with more emphasis on individual characteristics and needs than disabilities, so that even people with severe problems are seen as having a right to be supported in community settings.Increasingly, people with mild and moderate learning disabilities now find themselves working and living within the community, where they benefit from the advantages of choice in many aspects of life but also have to endure the many stresses and disadvantages, including difficulties with access to mainstream services. It is within this changing context that the whole issue of psychotherapy provision for people with learning disabilities is beginning to be addressed. Psychological difficultiesThe development of a child with learning disabilities will be Therapeutic difficultiesTraditionally, people with learning disabilities were excluded from the 'talking therapies'.' 3 In the first instance, many emotional and mental health problems were not recognised as such, and when they were, low IQ was commonly used as an exclusion criterion for suitability for therapy. In practice, there are significant problems in adapting psychotherapeutic approaches to working with this patient group. These include a high frequency of sensory disabilities, communication problems, dependence on others to access therapy, and related to this, consent to engage. However, regarding the dynamic based treatments, an acknowledgement of the importance of the therapeutic relationship between therapist and patient has allowed a rethink of the capacity of people with learning disabilities to participate and benefit.' 4 ' 5 Similarly the cognitive based therapies require some adap...

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Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community‐based population aged between 16 and 64 years

Cited by 205 publications

References 19 publications

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

Intellectual disability and psychiatric disorders: more than a dual diagnosis

Psychotherapy and learning disability

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Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community‐based population aged between 16 and 64 years

Cited by 205 publications

References 19 publications

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

Intellectual disability and psychiatric disorders: more than a dual diagnosis 

Psychotherapy and learning disability

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Intellectual disability and psychiatric disorders: more than a dual diagnosis