Mental Health Aspects of Developmental Disabilities

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ISSN 1057-3291

Publications in this journal

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    ABSTRACT: Some individuals with intellectual disabilities exhibit aggressive and self-injurious behaviors. When such behaviors are associated with an underlying psychiatric disorder marked by mood dysregulation, it may be quite difficult to obtain a specific psychiatric diagnosis and initiate specific and successful treatment. In this article, three case reports are presented in which a poly-pharmaceutical approach targeting aspects of mood dysregulation resulted in dramatic decreases in aggression and self-injurious behaviors. There were improvements in participation in other psychosocial treatments for these three individuals with extremely challenging behaviors residing in high-security psychiatric hospital settings. Implications for future practice and research are discussed.
    No preview · Article · Jan 2009 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: This study examined changes in diagnosis and challenging behavior for 38 individuals as a result of treatment at a university-affiliated hospital outpatient interdisciplinary clinic. Patients were referred to the specialty clinic because of challenging behavior not resolved by treatment in the community. Demographic and psychiatric information was collected. Challenging behavior was measured on the Aberrant Behavior Checklist at the time of initial assessment and six months after the treatment. The most common diagnosis for each axis was autism (Axis I), mild intellectual disability (Axis II), and seizure disorder (Axis III). The majority of subjects had changes made to the pharmacotherapy regimen, as well as referrals for consultation and therapies. Subjects had significantly less stereotyped behavior and less hyperactivity after interdisciplinary assessment and treatment. A satisfaction survey found that caregivers believed the consultation resulted in an improved quality of life for the subjects.
    No preview · Article · Jan 2009 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: Schizophrenia in adults with intellectual disability and autism is rarely detected due to the patients' limited ability to report psychotic symptoms, and due to the complex task of differentiating between behavioral problems, psychotic disorders and depression in these patients. Behavioral indicators are therefore needed in the assessment process. Disorganization is one of the main symptoms of schizophrenia. It is observable and therefore of special interest for investigation. This paper examines the co-occurrence of behavioral disorganization and disorganized speech in a patient with schizophrenia, autism and mild intellectual disability. Data on the presence of disorganized behavior and disorganized speech was rated by two experienced nurses through observation of video-taped patient-staff interaction. The strong relationship between disorganized behavior and disorganized speech generate a hypothesis of a general concurrence of the two. Valid behavioral indicators will facilitate the recognition of schizophrenia in patients with limited verbal skills. The results from this study support behavioral disorganization as a valid indicator.
    No preview · Article · Jan 2009 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: In the previous Ask the Doctor we addressed the basic neurology of both normal and abnormal movements. We emphasized the complex relationship between these basal ganglia disorders, psychiatric symptoms and various aspects of learning and conditioning This segment will focus on the differential diagnosis of movement disorders for clinicians with regard to autism and severe/profound intellectual disability.
    No preview · Article · Jan 2009 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: We evaluated the attitudes of psychiatric resident graduates and current psychiatry residents, regarding community living for individuals with intellectual disability. Thirty-two graduates, and 17 current psychiatric residents, of a single residency program were surveyed regarding their attitudes toward community living for individuals with intellectual disability. All graduates had completed a three month, half-time residency rotation in intellectual disability. The Community Living Attitudes Scale-Mental Retardation version, Short Form (CLAS-MR) was administered by mail to the graduates, and in person to current residents. Twenty-one of 32 (66%) of graduates, and 16/17 (94%) of current residents completed surveys. On the CLAS-MR, 7/17 (41%) questions demonstrated statistically-significant differences between the two resident groups. For two of the four CLAS-MR subscales (Empowerment and Sheltering), there were statistically significant differences between resident graduates and current residents. It is important to expose psychiatric, residents to persons with intellectual disability during residency training because it is associated with subsequent attitudes that favor the empowering, and oppose the sheltering, of these patients.
    No preview · Article · Oct 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: This is a retrospective chart review of a group of adults with developmental disabilities and seizures, and/or psychiatric and behavioral disorders treated with lamotrigine. All patients were residents of a large facility. Each was treated with the anticonvulsant lamotrigine during a specific nine month period, either for psychiatric disorder or seizures. Challenging behavior and side-effects were studied comparing pretreatment and posttreatment data. We identified 31 patients who had been treated with lamotrigine and of those, 22 showed an improvement in challenging behavior, seven showed no change, and five had side-effects that led to discontinuation in two patients. The results suggest that lamotrigine is a well-tolerated anticonvulsant and that it has other therapeutic effects on challenging behaviors.
    No preview · Article · Oct 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: Identification of psychiatric disorders in individuals with autism and intellectual disability may be complex, especially due to the difficulty of separating psychiatric symptoms from the core symptoms of autism. However, differentiating conceptually between these disorders is a prerequisite for developing more accurate and reliable diagnoses. A panel study design was applied to investigate which symptoms clinicians use to discriminate between autism and four major psychiatric disorders - psychosis, depression, anxiety disorder and obsessive-compulsive disorder. The result was a set of symptoms which were rated as specific to a psychiatric disorder and not characteristic of autism as it appears in individuals with intellectual disability. These symptoms may be used as indicators of psychiatric disorders in this group.
    No preview · Article · Oct 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: The present clinical case report describes an intervention procedure to reduce the duration of time spent in physical restraint with a 13-year-old boy who had intellectual disability and serious aggressive behavior. Starting with a 60-seconds fixed-time release (FTR) criterion from physical restraint, the criterion was gradually decreased to 30-seconds, 15-seconds, and 7-seconds. In a final phase, physical restraint was terminated. Duration of physical restraint decreased as the FTR criterion was lowered. Restraint frequency also decreased during the study. After achieving a 7-seconds FTR criterion, physical restraint was eliminated successfully. FTR fading appears to be an effective strategy for reducing the amount of time physical restraint has to be applied. By establishing a low FTR criterion, it may be possible to avoid using physical restraint in favor of alternative intervention procedures.
    No preview · Article · Oct 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: Velocardiofacial syndrome (VCFS) is an autosomal dominant 22q11.2 microdeletion syndrome, the most common microdeletion syndrome in humans. Its phenotype includes learning difficulties, intellectual disability, congenital heart disease, abnormalities of the palate, hypocalcemia, immune deficiency and characteristic facial features. The behavioral phenotype includes intellectual abilities ranging from borderline intelligence to moderate intellectual disability, poor communication skills and a high frequency of psychiatric disorders with psychotic and affective symptoms developing in adolescence or early adulthood. The occurrence of borderline personality disorder with VCFS as part of its behavioral phenotype is yet to be reported. A case report of a 34-year-old Caucasian woman with mild intellectual disability is described with a history of fleeting psychotic and affective symptoms with poor response to treatment. It was when her diagnosis of borderline personality disorder was confirmed that clozapine was commenced, with a remarkable improvement in her affective symptoms, instability of mood and fleeting psychotic symptoms. Self-injurious and other maladaptive behaviors abated and meaningful engagement with services became possible. The case highlights that borderline personality disorder needs to be recognised as part of the behavioral phenotype of VCFS. The treatment implications include the need to consider treatment for resolution of cognitive-perceptual (psychosis like) symptoms, symptoms of affective instability, symptoms of behavioral dyscontrol, anxiety symptoms and self-injurious behavior. Further longitudinal research is needed to investigate the strength of the association between VCFS and presence of borderline personality disorder symptoms and intellectual disability. Treatment options need to be explored with evidence based research of VCFS for treatment of psychiatric disorders associated with the condition.
    No preview · Article · Jul 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: Research suggests that psychiatric problems may be common in children with prenatal alcohol exposure. The purpose of the current study was to examine psychiatric diagnoses in a non-clinic referred sample of 130 children ages 6 to 12 years old, with and without prenatal alcohol exposure. A standardized diagnostic interview procedure was employed, comparing children with prenatal alcohol exposure and social skills deficits to children without prenatal alcohol exposure and social skills deficits. Findings suggest that children with prenatal alcohol exposure exhibit significantly more psychopathology, including symptoms of anxiety, disruptive behaviors, and mood disorders, when compared to children without alcohol exposure.
    No preview · Article · Jul 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: Aggression and self-injurious behavior are frequent impediments to optimizing quality of life in individuals with developmental disabilities and mental health concerns, living in community settings. The safe and efficacious use of Pro Re Nata medication can compliment the development of multimodal support plans to optimize outcome in this context. This article discusses the application of pharmacokinetic principles to the development and revision of these plans.
    No preview · Article · Jul 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: The present case illustrates the importance of ruling out developmental disorders before making a diagnosis of schizophrenia. The case demonstrates how an initial mind set can perpetuate the "reasonableness" of an inaccurate diagnosis (of schizophrenia), and points to the need for constant review of the psychiatric diagnosis as new information becomes available and as clinical concepts change with the infusion of new understanding.
    No preview · Article · Apr 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: People diagnosed with fetal alcohol spectrum disorders (FASD) have neuropsychological deficits that may contribute to increased risk for suicide. This paper describes clinical profiles of eleven individuals with FASD and differentiates six who attempted suicide from five who did not, with regard to risk and protective factors. Attempters were more likely to have mental health disorders, substance abuse disorders, a history of trauma or abuse, financial stress, and unstable social support compared to non-attempters. We discuss ways in which clinicians can reduce risk among individuals with FASD by modifying standard suicide assessment and intervention protocols to accommodate the person's deficits.
    No preview · Article · Apr 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: Routine health care guidelines for adults with Down syndrome (DS) often get less attention than those guidelines for children with DS. This article reviews recent recommendations including the challenge that psychiatrists (as well as other mental health professionals) be aware of potential health concerns.
    No preview · Article · Apr 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: Some adults with intellectual disability perform self-harming behaviors of potential lethality and in some cases, these appear to be intentional acts of suicide. Suicidal behavior, non-suicidal self-injury, and parasuicide among people who have intellectual disability are complex clinical concerns confronting mental health professionals. We present two case illustrations of adults with mild to moderate intellectual disability, psychiatric disorders, and multiple suicide attempts. Each adult was treated at a community-based residential setting with therapeutic support focused on their life-threatening behavior. The case illustrations detail treatment formulation, report outcome data, and describe long-term results.
    No preview · Article · Jan 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: We describe an individual with mild intellectual disability, pervasive developmental disorder, and childhood-onset epilepsy with primary generalized seizures. In the period following initiation of treatment with levetiracetam, one of the newer anticonvulsant medications, this individual experienced the onset of symptoms of obsessiveness. Following our speculation regarding a possible association between the symptoms and the medication, the levetiracetam was tapered and eventually discontinued. The symptoms dissipated as the levetiracetam was reduced and discontinued. We believe that this is the first demonstration of an association between levetiracetam and symptoms related to obsessive-compulsive disorder.
    No preview · Article · Jan 2008 · Mental Health Aspects of Developmental Disabilities
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    ABSTRACT: Light therapy has proven to be an efficacious treatment for seasonal and non-seasonal depression in the general population. A literature search identified only two reports discussing the effective use of light therapy for seasonal depression in five persons with intellectual disabilities and seasonal depression. In this article, the effective use of light therapy as an adjunct treatment for major depression with seasonal patterns in four adults with intellectual disability is being reported. No side effects were noted. Light therapy must be further promoted, applied and studied as an effective, benign and inexpensive treatment for seasonal depression in persons with intellectual disability.
    No preview · Article · Oct 2007 · Mental Health Aspects of Developmental Disabilities