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2008 AbstractsFoster Care: Are There Differences in the Cognitive
and Psychiatric Characteristics of Young Children With
Developmental Disabilities in Kinship vs. Non-Kinship Homes? This study compares developmental, psychiatric diagnosis and global assessment of functioning of 82 young foster children who present for evaluation of a developmental disability from kinship and non-kinship homes. The children in kinship homes (n=42) had been with their foster parents longer (3.2 yrs. vs. 1.2 yrs. p<0.001) before being referred for evaluation. There were no significant differences regarding types of developmental disabilities, psychiatric diagnosis or global assessment of functioning between the groups. There was a wide spectrum of psychiatric disorders. Children with developmental disabilities in kinship homes may be as emotionally and developmentally involved as children in non-kinship homes. Ment Health Aspects Dev Disabil 2008;11(1):1-9 Attachment, Bonding, and Parental Stress in CHARGE
Syndrome Parents of 25 children with CHARGE syndrome, ages 12 to 50 months, completed measures of child attachment, parental bonding, and family stress. Twelve children were classified as securely and 13 as insecurely attached. The time it took to appear attached and parents to feel bonded were related, as were length of time to appear attached and strength of parental bonding. Visual impairment was related to an insecure attachment as well as parenting stress. Twelve parents had scores indicating significant stress. Parenting stress was related to problems with bonding, and having a challenging child was related to insecure attachment. Being able to hold the child and a shorter stay in the hospital after birth were related to more secure attachment. Ment Health Aspects Dev Disabil 2008;11(1):10-21 A Case of Obsessiveness Induced by Levetiracetam in a
Patient With Epilepsy, Intellectual Disability and Pervasive
Developmental Disorder 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. Ment Health Aspects Dev Disabil 2008;11(1):22-25 Suicidal Behavior and Community Support of Adults With
Intellectual Disability: Two Case Illustrations 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. Ment Health Aspects Dev Disabil 2008;11(1):26-30 Systems Supports for Individuals With Intellectual
Disability and Suicidality Individuals with intellectual disability and significant suicidality need comprehensive community support systems. Psychiatry is an essential component to assist in the diagnostic formulation, treatment plans, and pharmacotherapy. Staff must have extensive training and ongoing 24-hour clinical support. Environmental modifications, such as alarms, are also typically necessary. Lastly, family members, all community agencies and providers must participate in a collaborative support plan. Ment Health Aspects Dev Disabil 2008;11(1):31-32
2007 AbstractsBody Dysmorphic Disorder in People With Intellectual
Disability: A Bio Psycho Social Approach Anxiety disorders occur in children with autism spectrum disorders (ASD) at higher rates than in children Body dysmorphic disorder (BDD) is classified as a somatoform disorder that combines body image disturbances with obsessive compulsive spectrum and somatic delusional disorders. This paper explores these dimensional features of each component of BDD among individuals across the spectrum of intellectual disabilities. Ment Health Aspects Dev Disabil 2007;10(1):1-12 Medical and Mental Health Complications of Lafora
Disease: A Case Report Lafora disease is a rare neurometabolic condition caused by a mutation in the EPM2A and/or EPM2B genes. The disorder is neurologically progressive, and the disease is eventually fatal. A form of progressive myoclonic epilepsy, it can produce a variety of complications including intellectual disability, various seizure disorders, mental health difficulties, and dementia. The authors describe the symptoms of Lafora disease; a case study of a young male who was diagnosed with the disorder is presented. The etiology of Lafora disease and progression of the disorder are described. Implications for treatment of the disorder and palliative care are briefly discussed. Ment Health Aspects Dev Disabil 2007;10(1):13-17 Intellectual Disability Etiologies and Associated
Psychiatric Disorders Intellectual disability is ascribed to numerous etiologies. However, in many instances individuals with intellectual disability are undiagnosed as to etiology. This study was done to classify etiologies in a clinic population and to determine the percentage undiagnosed as to etiology. The group was also categorized as to level of intellectual disability and associated psychiatric disorders. A total 640 individuals with intellectual disability were surveyed and 61.4% were undiagnosed as to etiology. Prevention of any disorder should logically start with determination of cause. The high incidence (56.7%) of psychiatric disorders in individuals with intellectual disability emphasizes the need for readily available and specially trained personnel to address their needs. Ment Health Aspects Dev Disabil 2007;10(1):18-24 A Case of Panic Disorder Treated With Cognitive
Behavioral Therapy Techniques A case of panic disorder in a woman with mild intellectual disability is presented. Psychotherapy using cognitive behavioral techniques was successful in treating her panic disorder and eliminating her avoidance of participation in a work training program. Recommendations for recognizing this disorder in the intellectual disability population are made, in addition to suggestions for cognitive behavioral therapy treatment. Ment Health Aspects Dev Disabil 2007;10(1):25-30 Optimum Treatment of Problem Behaviors in Children
With Autism Spectrum Disorders Antipsychotic medications have a long history of use, overuse and misuse in persons with intellectual disability. This article reviews the history of the use of antipsychotic medical from the introduction of second generation antipsychotics (SGAs) in 1990. Ment Health Aspects Dev Disabil 2007;10(1):31-35 Behavioral Disorganization as an Indicator of
Psychosis in Adults With Intellectual Disability and Autism In adults with intellectual disability and autism, psychoses are rarely detected due to misinterpretation of psychotic symptoms being autism or impaired communication skills. The aim of this study was to investigate behavioral disorganization as an indicator of psychosis in this population. Forty-three adults with intellectual disability, autism, and a formerly diagnosed psychiatric disorder were recruited. Eight of these patients had moderate to severe intellectual disability and were assessed as having schizophrenia-like psychosis. Scores from a pilot study of the Psychopathology in Autism Checklist (PAC) were compared to case information on the 8 adults with psychosis. Behavioral disorganization, severely impaired global functioning, behavior suggesting hallucinations, and decreased sociability were observed in the 8 psychotic patients. Ment Health Aspects Dev Disabil 2007;10(2):37-46 Training Competency to Stand Trial in an Individual
With Intellectual Disability and Behavioral Health Concerns A man was found not competent due to an intellectual disability and dangerous, subsequent to being charged with assault and resisting arrest. By court order, and in order to avoid institutionalization, competency training was conducted in a community agency setting. Competency training included the use of the Slater Method, modeling with labeling, and training on test taking methods over a five week period. Specific generalization techniques were used in order to aid in his ability to respond at the time of re-assessment. Upon re-assessment by an outside examiner, the individual was found to be competent to stand trial, thus avoiding institutionalization. Ment Health Aspects Dev Disabil 2007;10(2):47-52 Ethological Approach to Individuals With Intellectual
and Developmental Disabilities Attachment is a major factor during development throughout the life cycle. Most studies conclude that attachment is a complex interaction between brain development, temperament, and life experiences. This presentation addresses the role of attachment in psychiatric disorders in people with intellectual disabilities. Ment Health Aspects Dev Disabil 2007;10(2):53-63 Changes in the Rate of Problem Behavior Associated
With the Discontinuation of the Antipsychotic Medication
Quetiapine Using analogue functional analysis, we monitored changes in the rates of aggression and self-injury in a 50-year-old female diagnosed with severe intellectual disability and mood disorder. Functional analyses were conducted while the individual was treated with quetiapine (Seroquel) and citalopram (Celexa) and after the quetiapine was discontinued. Discontinuation of quetiapine resulted in differential responding patterns for aggression and self-injury. This case study provides support for functional assessment of problem behaviors during medication changes to determine if psychotropic medications are associated with subsequent changes in behavior. Ment Health Aspects Dev Disabil 2007;10(2):64-67 Overmedication as a Manifestation of
Countertransference The treatment of patients with intellectual disability involves typical transference and countertransference issues, although these aspects of care are rarely discussed. Countertransference is important to understand in the prescribing of medication with this population. A case example illustrates the improper use of pharmacologic agents in response to aggressive behavior. Ment Health Aspects Dev Disabil 2007;10(2):68-72 Adults With Dual Diagnoses of Intellectual and
Psychiatric Disability Receiving Medicaid Home and
Community-Based Services (HCBS) and ICF/MR Recipients in Six
States This paper addresses the topic of intellectual disability and psychiatric disorder among persons receiving Medicaid Home and Community-Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services. In June 2005 HCBS and ICF/MR programs financed long-term supports for nearly 545,400 persons with intellectual disabilities and other developmental disabilities at a fiscal year 2005 cost of $29.3 billion. This paper describes and compares characteristics and experiences of persons with and without diagnosed psychiatric conditions in addition to intellectual disability in a large, six state, 2720 person sample of HCBS and ICF/MR recipients. Nearly one-third (31.4%) of the sample had psychiatric disorders. Controlling for levels of intellectual disability, they were consistently more likely to be placed in ICF/MR programs and agency-operated congregate care settings, and were less likely to live with family members. They were much more likely to receive medications for mood, anxiety and/or behavior disorders than were persons with intellectual disability only (87% and 32%, respectively). Policy implications include the need to incorporate behavioral health services and supports into state Medicaid waivers for individuals with intellectual disabilities. Ment Health Aspects Dev Disabil 2007;10(3):78-90 Creating Responsive Systems for Children With
Co-Occurring Developmental and Emotional Disorders A categorical and fragmented service structure often prevents children with co-occurring developmental and emotional or substance abuse disorders from receiving appropriate care. This article describes a federal interdepartmental initiative that is attempting to awaken awareness of the needs of these children, and to institute appropriate programmatic and policy responses. Available data related to this population is discussed. Recommendations for policy reform address improvements in accessibility and responsiveness to family needs, capacity within local communities, and interagency collaboration at the local, state and federal levels. Steps to provide more flexible financing and to support technology and research are also described. Ment Health Aspects Dev Disabil 2007;10(3):91-98 Changing Environments of Inpatient Psychiatric Care
for Individuals With Intellectual Disabilities Acute inpatient psychiatric treatment for individuals with intellectual disabilities is provided in a variety of settings and with a variety of treatment models. Regardless of the model type, the capacity of a treating hospital to respond to this population is either facilitated or hindered by its financing. Little planning or dialog has occurred on the provider, advocate or insurer side to define what are the “Best Practices.” The recent changes to the Medicare’s reimbursement of inpatient psychiatric treatment could have a series of unintended consequences for individuals with intellectual disability. Policy makers in each state must create the dialog that will not only define best practice but also address minimal standards for the inpatient psychiatric treatment of individuals with intellectual disability. Ment Health Aspects Dev Disabil 2007;10(3):99-106 Delivery of Health Care for People With “Dual
Diagnosis”: From the Person to the Policy The value of utilizing objective monitoring systems incorporating operationalized signs and symptoms of hypothesized mental health concerns in individuals with developmental disabilities is now well accepted by interdisciplinary teams supporting these individuals. This article articulates in detail the establishment and implementation of of an objective monitoring system to track cyclic changes in mood in individuals with developmental disabilities and bipolar disorder. Implementation of this system creates the opportunity for care-providers, individuals with developmental disabilities and/or their substitute consent-providers to make informed decisions regarding treatment decisions to optimize quality of life in individuals affected by this complex illness. Ment Health Aspects Dev Disabil 2007;10(3):107-117 Public Systems Supports for People With Intellectual
Disability and Mental Health Needs in the United States Since the mid-1980s there have been a number of publications and policy papers with regard to the need for a comprehensive service system to support individuals with intellectual disabilities and behavioral health needs. In spite of the expanded knowledge of this population and its service needs, the results have been mixed in the United States. In some states there is a lack of a service infrastructure equipped to provide effective services over time. It is time to take a closer look at the Home and Community-Based Waiver under the national Medicaid program to assist in the development of a more effective community-based support system throughout the United States. Ment Health Aspects Dev Disabil 2007;10(3):118-120 Recent Advances in the Diagnosis and Treatment of
Attention-Deficit/Hyperactivity Disorder in Individuals With
Intellectual Disability An extensive review of the literature supports that attention-deficit/hyperactivity disorder (ADHD) is a common and valid co-morbid diagnosis in individuals with intellectual disability. Two recently published diagnostic manuals, the Diagnostic Criteria-Learning Disability (DC-LD) and Diagnostic Manual–Intellectual Disability (DM-ID), support this assertion, and should improve diagnostic accuracy. However, standards are still urgently needed to establish the symptomatic thresholds, above which an individual with intellectual disability who demonstrates inattentive or hyperactive behavior, can be diagnosed as having co-morbid ADHD. Similar to neurotypical persons with ADHD, stimulants are the primary pharmacological treatment in for individuals with ADHD and intellectual disability, but expected treatment response may be less robust. Future research should attempt to refine symptomatic thresholds for ADHD diagnosis, and further characterize ADHD as a behavioral phenotype of intellectual disability etiologies.. Ment Health Aspects Dev Disabil 2007;10(4):121-128 Personality Disorders in Intellectual Disability:
Approaches to Pharmacotherapy Though contentious, the diagnosis of personality disorders in intellectual disability is clinically relevant. Psychotropic medication is widely prescribed in this population. The clinical approach to prescribing is based on tackling the distressing symptoms. Using the findings of an audit on pharmacotherapy in personality disorder, this paper explores the target symptoms for treatment. In addition it discusses the framework of five main symptom domains within personality disorders in intellectual disability, reviews the published evidence and sets out some drug treatment approaches. Audit standards for monitoring these treatments are proposed. Ment Health Aspects Dev Disabil 2007;10(4):129-136 Light Therapy for Seasonal Depression in Persons With
Intellectual Disability: Literature Review and Four Case
Series 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. Ment Health Aspects Dev Disabil 2007;10(4):137-144 Assessing Capacity to Execute a Health Care Proxy: A
Rationale and Protocol This article discusses the concept of capacity, various relevant mandates, and a rationale for the assessment of capacity to execute a health care proxy. Some specific New York State regulations, pertaining to the execution of a health care proxy by persons who have intellectual disabilities, are presented and contrasted with regulations in some other jurisdictions. A standard that psychologists and physicians may use in assessing the capacity of a person with cognitive impairments to execute a health care proxy is reviewed. Additionally a protocol for assessing capacity to execute a simple health care proxy is in the appendix. Ment Health Aspects Dev Disabil 2007;10(4):145-156 The Importance of Recognizing Autism Spectrum
Disorders in Intellectual Disability In the recent decade, clinical interest, research, and public knowledge of autism spectrum disorders has increased markedly. The majority of the scientific progress and controversy involves its occurrence among people who are intellectually normal. It is now considered to be a “spectrum” disorder so that an individual may have mild to severe symptoms. Many people with intellectual disability may have concurrent autism spectrum disorders that are not identified. For those who are within this spectrum, it is essential that a diagnosis be made and that subsequent therapies, programs, and supports are changed to address the unique needs of people within the autism spectrum. Ment Health Aspects Dev Disabil 2007;10(4):157-161
2006 AbstractsDialectical Behavior Therapy (DBT) for Individuals
with Intellectual Disabilities: A Program Description The use of Dialectical Behavior Therapy for the intellectually disabled population is discussed with regard to the adaptations clinicians and programs must make in the standard manualized approach developed by Marsha Linehan. A specialized program developed by The Bridge of Central Massachusetts is presented along with examples and data from its implementation. Clinical recommendations for using this psychotherapy technique are included. Ment Health Aspects Dev Disabil 2006;9(1):1-12 Clozapine in Borderline Personality Disorder and
Intellectual Disability: A Case Report of Four-Year Outcome Evidence on the usefulness of clozapine in people with borderline personality disorder is becoming more readily available. While most of the research points to the significant initial improvement, there is a paucity of information on the long-term outcome. Evidence on the use of clozapine in people with the dual diagnoses of intellectual disability and borderline personality disorder is also lacking. This case report highlights the sustained global improvement in a person with mild intellectual disability and borderline personality disorder with a low dose of clozapine. Follow up over a four-year period indicates the potential for developing long-term side effects, the need for monitoring and regular risk-benefit analysis with the active involvement of the individual receiving treatment in decision making. Ment Health Aspects Dev Disabil 2006;9(1):13-17 Metabolic Side Effects of the Atypical Antipsychotic
Olanzapine in an Inpatient Population of Adults With
Developmental Disabilities Metabolic lab results of an inpatient population of adults with developmental disabilities who were on the atypical antipsychotic olanzapine were investigated. Medical charts of these individuals were reviewed in order to obtain baseline data about weight, cholesterol, glucose and lipid panels. The same data was gathered after the introduction of olanzapine. The results indicated that on average, individuals taking olanzapine for at least six months gained 19 lbs. Diet was a controlled variable. No other statistically significant results were found. These findings are consistent with the literature on weight gain and second generation antipsychotics. This article is the first of its kind. Past articles have reported side effects with the schizophrenic population. Ment Health Aspects Dev Disabil 2006;9(1):18-22 Combination Use of Atomoxetine and Risperidone for
Hyperactivity and Impulsivity in Autistic Disorder The management of target symptoms in autistic disorder is challenging. Associated behavioral problems including hyperactivity and impulsivity may respond to risperidone or other agents but are often difficult to control. We describe the successful use of combination atomoxetine and risperidone for control of hyperactivity and impulsivity in an adult individual with autistic disorder. Ment Health Aspects Dev Disabil 2006;9(1):23-25 The History Behind the Use of Antipsychotic
Medications in Persons With Intellectual Disability: Part I Antipsychotic medications have a long history of use, overuse, and misuse in persons with intellectual disabilities. This article reviews the history of the use of antipsychotic medication from the introduction of first generation antipsychotics (FGAs) in 1953 to the advent of second generation antipsychotics (SGAs). Part II, in the next issue, will review this history since the advent of the SGAs Ment Health Aspects Dev Disabil 2006;9(1):26-32 The Diagnostic and Treatment Formulation for
Psychotropic Drug Therapy Psychiatric treatment of patients with developmental disabilities presents challenges to the clinician due to limited verbal and communication skills. In addition, the frequent presentation of behavioral problems in association with psychiatric illness often results in the behavior becoming the focus of treatment, rather than a key element of a diagnostic formulation. This article presents a method of using standard psychiatric diagnostic methods when treating patients with developmental disabilities that focuses on appropriate prescribing of psychotropic medications. Ment Health Aspects Dev Disabil 2006;9(2):34-40 Data Management Systems in the Treatment of People
With Intellectual Disabilities: A Model for
Psychopharmacologists As clinicians we monitor our treatment plans based on changes in specific target behaviors. It is not uncommon to find that even the best target symptom data misses significant changes. These gaps may be crucial to understanding responses to both behavioral and psychopharmacological treatments. This paper explores data collection methods that may help close these gaps. Ment Health Aspects Dev Disabil 2006;9(2):41-43 Applying a Continual Quality Improvement Model to Make
Data-Based Clinical Decisions Continual quality improvement is essential to the provision of excellent services for people with intellectual disability. When helping individuals who have behavioral or psychiatric problems, it is often necessary to use data analysis to track symptoms and improvement. Simple frequency charts are often inadequate, and analytic procedures differentiating patterns of variation in key performance indicators will provide superior information. A case report illustrating the need for such data analysis is presented. Ment Health Aspects Dev Disabil 2006;9(2):44-53 CHARTING FOR A PURPOSE-PHASE II: Optimal Treatment of
Bipolar Disorder in Individuals With Developmental
Disabilities The value of utilizing objective monitoring systems incorporating operationalized signs and symptoms of hypothesized mental health concerns in individuals with developmental disabilities is now well accepted by interdisciplinary teams supporting these individuals. This article articulates in detail the establishment and implementation of of an objective monitoring system to track cyclic changes in mood in individuals with developmental disabilities and bipolar disorder. Implementation of this system creates the opportunity for care-providers, individuals with developmental disabilities and/or their substitute consent-providers to make informed decisions regarding treatment decisions to optimize quality of life in individuals affected by this complex illness. Ment Health Aspects Dev Disabil 2006;9(2):54-68 Methods for Assessing Sleep Problems Sleep problems are common among the general population, but identified infrequently in people with developmental disabilities. Due to their difficulties in self-reporting sleep problems, assessment methods are critically important when evaluating patients with communication limitations. Methods for sleep assessment appropriate for this population are reviewed. Ment Health Aspects Dev Disabil 2006;9(2):69-71 The Parent's Role in the Treatment of Anxiety Symptoms
In Children With High-Functioning Autism Spectrum Disorders Anxiety disorders occur in children with autism spectrum disorders (ASD) at higher rates than in children with other developmental disabilities and children with typical development. Research on childhood anxiety supports cognitive-behavioral therapies as the treatment of choice to reduce anxiety symptoms. Parent involvement also positively impacts treatment outcome for these children. Research on the efficacy of psychosocial interventions for children with ASD and anxiety symptoms is sparse. This paper will review the literature on parental involvement in anxiety treatment and provide suggestions for involving parents of children who have both ASD and anxiety symptoms. Implications for future research will be offered. Ment Health Aspects Dev Disabil 2006;9(3):73-80 Psychiatric Syndromes by Proxy in Persons With
Developmental Disabilities Whether in institutional settings or in the community, reporting of symptoms experienced by persons with developmental disabilities is mostly done by caregivers. Diagnosis of mental illness is often given based on such observations and reports, and medication treatment is frequently prescribed. The recent trends requiring the reduction of psychotropic medications could create substantial anxiety among caregivers about the worsening of challenging behaviors, and potentially encourage the perception or embellishment of symptoms of mental illness. This problem is described, and some practical solutions are suggested in this article. Ment Health Aspects Dev Disabil 2006;9(3):81-84 Anger Attacks and Mood Disorders Anger attacks have been described in the general psychiatric literature for the past two decades. They have received little attention in the field of intellectual disabilities (ID). This paper will briefly summarize the history of aggression and mood disorders in persons with ID. Diagnostic criteria for anger attacks in the general population will be reviewed and criteria in the ID population will be proposed. Ment Health Aspects Dev Disabil 2006;9(3):85-89 A Case Study of Insomnia-More Than Meets the Eye The relationship between sleep and psychiatric disorders is more akin to a mosaic than a linear one. This case study provides an example of this complexity, as well as some of the clinical pitfalls in the differential diagnosis. Ment Health Aspects Dev Disabil 2006;9(3):90-92 The History Behind the Use of Antipsychotic
Medications in Persons With Intellectual Disability: Part II Antipsychotic medications have a long history of use, overuse and misuse in persons with intellectual disability. This article reviews the history of the use of antipsychotic medical from the introduction of second generation antipsychotics (SGAs) in 1990. Ment Health Aspects Dev Disabil 2006;9(3):93-101 Under Recognition of Prenatal Alcohol Exposure in a
Child Inpatient Psychiatric Setting Prenatal alcohol exposure results in significant risk for psychiatric disorders, yet under recognition of exposed individuals in psychiatric settings may be common. A chart review was conducted on 130 consecutive admissions to the child psychiatry inpatient service at a large university medical center. Thirty percent of child inpatients had documented prenatal alcohol exposure and, within the exposed group, 26% met full criteria for fetal alcohol syndrome (FAS). None of the children had been diagnosed with FAS prior to admission. Children with prenatal alcohol exposure were more likely to be hospitalized for externalizing disorders compared to unexposed children. Prenatal alcohol exposure may represent a key risk factor for many children with externalizing psychiatric disorders. Ment Health Aspects Dev Disabil 2006;9(4):105-108 The Assessment and Differential Diagnosis of Insomnia
in People With Developmental Disabilities Sleep is a complex neurobiological state that is essential for health and cognition. Insomnia is a disturbance in sleep initiation and maintenance that results in significant daytime complications. Insomnia in individuals with intellectual disabilities is a common problem that is often overlooked as a cause of disruptive or aggressive behavior. In most clinical circumstances, sleep data collection is limited to recording the quantity of sleep, offering little information about quality. This paper provides a model of data collection that helps to correct these shortcomings and provide basic data for appropriate referral for more extensive sleep studies. Ment Health Aspects Dev Disabil 2006;9(4):109-118 Developing Best Practices for Behavioral and Mental
Health Treatment for Individuals With Developmental
Disabilities: Maryland’s Efforts We describe efforts by providers and stakeholders in Maryland to develop Best Practices for behavioral and mental health treatment for individuals with developmental disabilities. The Maryland initiative was characterized by inclusion of expert opinion and stakeholder experience to achieve consensus on Best Practices for the treatment of individuals dually diagnosed with a developmental disability and mental health or behavioral problems. An innovative, open space technology format was used during the Maryland Best Practices Conference that was held in February 2004. The planning and processes that resulted in the Maryland initiative are discussed and highlight the impact of these efforts. Results of the conference, workgroups and survey suggest many strengths in current practice as well as areas in need of development. Ment Health Aspects Dev Disabil 2006;9(4):119-124 Neonatal Cranial Ultrasound Leads to Early Diagnosis
and Intervention in Baby of Alcohol-Abusing Mother Typically, fetal alcohol spectrum disorders (FASD) are not diagnosed in children until developmental problems become apparent. To diagnose these children earlier would benefit both them and their caregivers. Neonatal cranial ultrasound has great potential diagnostic utility in the presence of known heavy prenatal alcohol exposure, in that it allows us to gather critical neuroanatomical information before the fontanel closes. This report describes the case of Baby S, in which the neonatal ultrasound was crucial in obtaining early fetal alcohol syndrome (FAS) diagnosis and facilitating an array of interventions for which the baby would not otherwise have been eligible. Now four years old, Baby S has received care in many different forms, and is making substantial progress. The early FAS diagnosis and subsequent interventions may have ameliorated, and continue to ameliorate, the poor developmental prognosis for many individuals with FASD. Ment Health Aspects Dev Disabil 2006;9(4):125-127 Monitoring Side-Effects to Psychiatric Medicines in
Patients With Intellectual Disability Psychotropic medications are commonly prescribed for people with intellectual disability. The recognition of side-effects is especially challenging because of cognitive and self-awareness limitations of many of the individuals. This article discusses how clinicians can approach the detection of side-effects in this population. Ment Health Aspects Dev Disabil 2006;9(4):128-130
2005 AbstractsAn Unusual Case of Recurrent Emesis in a Patient With
Autistic Disorder We describe an individual with autistic behavior who presents with a long standing history of recurrent emesis, refractory to prior pharmacologic and behavioral interventions. As a consequence of the emesis, the individual was unable to maintain an adequate body weight and was significantly underweight. His physical status was of sufficient severity to warrant consideration of invasive feeding methods. In an effort to control his symptoms, a trial with fluvoxamine was initiated. The individual's dramatic and sustained response is described. Ment Health Aspects Dev Disabil 2005;8(1):1-4 Body Dysmorphic Disorder: A Subset of Self-Injurious
Behaviors With Intellectual Disability? This paper focuses on two case studies that suggest a relationship between selected typologies of self-injurious behavior, affective symptoms and suspected body dysmorphic disorder (BDD). It is largely an exploratory endeavor since there is limited data available regarding BDD in people with intellectual disabilities. The author hopes that this review will increase clinician sensitivity to the presence of and generate research into this intriguing somatoform disorder. Ment Health Aspects Dev Disabil 2005;8(1):5-12 Psychiatry in Mental Retardation and Developmental
Disabilities: A Training Program for Psychiatry Residents This article describes a program that was initiated in 1995 in Cleveland, Ohio to train psychiatry residents in intellectual disability and developmental disabilities. The article provides a brief review of the literature on training psychiatry residents in developmental disability and an extensive description of our program. The training program was based in part on 1995 curricular recommendations advanced by the American Psychiatric Association Committee on Psychiatric Services for Persons with Mental Retardation and Developmental Disabilities. The article concludes with an informal appraisal of the program. Ment Health Aspects Dev Disabil 2005;8(1):13-21 Group Dynamics in the Treatment of People With
Intellectual Disabilities: Optimizing Therapeutic Gain Group psychotherapy is an effective treatment modality for psychological disorders in the general population. Growing interest in the mental health treatment of people with intellectual disabilities and psychological disorders suggests that group psychotherapy is similarly beneficial for this population. Clinical training programs, however, typically provide only limited training in group therapy techniques. This article describes the utility of group psychotherapy for individuals with intellectual disabilities and common forms of psychopathology, and details specific recommendations for treatment in an effort to add to the clinical expertise of treatment providers. Ment Health Aspects Dev Disabil 2005;8(1):22-28 Premenstrual Syndrome and Premenstrual Dysphoric
Disorder in Individuals With Intellectual Disability Premenstrual syndrome and premenstrual dysphoric disorder can occur in women who have intellectual disability. Because most symptoms required by DSM necessitate the ability to give accurate self-report of internal feelings, many women with intellectual disability are unable to meet criteria although they have this disorder. Families and caregivers of women with intellectual disability must be alert to the possibility of these conditions and carefully watch for changes in mood or behavior associated with menses. Suggestions for systematizing observations are discussed. Ment Health Aspects Dev Disabil 2005;8(1):29-30 Quality of Life and Psychosocial Profile Among Young
Women With Fetal Alcohol Spectrum Disorders Prenatal alcohol exposure can result in a range of neurodevelopmental disorders termed fetal alcohol spectrum disorders (FASD). Clinical reports indicate a poor quality of life (QOL) among individuals with FASD; however, QOL has not been formally assessed and reported in this population. We describe psychosocial and QOL assessment scores among 11 women with FASD. These women had poor QOL scores and high levels of mental health disorders and behavioral problems relative to standardization samples and other at-risk populations. We suggest that psychiatric distress may play a substantial role in the reduced quality of life reported among adults with FASD. Ment Health Aspects Dev Disabil 2005;8(2):33-39 Early Onset Schizophrenia in a Young Woman With Mild
Intellectual Disability and Unbalanced Chromosomal
Translocation Genetic contribution to mental illness, particularly schizophrenia, is considerable. Reporting chromosomal abnormalities which coincide with schizophrenia can suggest possible loci of interest. We report a case of a young woman with a rare chromosomal abnormality, early onset schizophrenia and mild intellectual disability. We suggest that our patient's chromosomal abnormality played a role in her intellectual disability and her schizophrenia. While the genetic implications are unclear, this case is an example of the richness and complexity of the possible psychiatric presentations in individuals with intellectual disability. Ment Health Aspects Dev Disabil 2005;8(2):40-44 A Multidisciplinary Approach in Treatment of Major
Depressive Disorder With Psychotic Features and Mild
Intellectual Disability A multidisciplinary approach was developed to treat an individual (Ms. A ) with a dual diagnosis of severe Major Depressive Disorder, with Psychotic Features and Mild Intellectual Disability. Ms. A was aggressive, suicidal, and experiencing command hallucinations to kill self and others. The treatment included medications, weekly psychotherapy, case management and therapeutic behavioral modification at home and school for eight months. Ms. A internalized coping mechanisms, and showed improvement in self-care, impulse control, and peer relationships. At a follow-up after one year from the termination of the treatment, Ms. A continued to show improvement and was employed in a sheltered workshop setting. Ment Health Aspects Dev Disabil 2005;8(2):45-51 Diagnosis and Treatment of Adjustment Disorders in
People With Intellectual Disability The adjustment disorders are a group of conditions in which a person suffers mild emotional and behavioral symptoms as the result of a stressor. Although common, there is little research on these conditions compared to other disorders, such as schizophrenia or major depression. For people with intellectual disability, there is very little research. We review what is known, and present two cases of adjustment disorder in people with intellectual disability. Ment Health Aspects Dev Disabil 2005;8(2):52-60 The SSRI Controversy The SSRIs (specific serotonin reuptake inhibitors) are a class of medications which treat depression, anxiety disorders, and obsessive-compulsive symptoms and disorders. In the last two years, government alerts in the UK, Canada, and U.S. warned against the use of these for children and adolescents due to increased reports in some studies of suicidality. Clinicians must understand these alerts as the result of government-drug industry, and political forces. Recommendations for practicing clinicians are made. Ment Health Aspects Dev Disabil 2005;8(2):61-67 Specialized Inpatient Mental Health Units in Ontario:
Their History and Program Characteristics In Ontario, the psychiatric hospitals currently provide the only available specialized inpatient treatment settings for individuals with developmental disabilities and mental health needs. The policy context for service provided by five specialized inpatient units is reviewed, with the results of a survey regarding the number of beds, team composition, staffing ratio and environmental adaptations. Since 1990, there has been an overall expansion of the specialized services offered by the psychiatric hospitals. Additionally, all programs have adopted a multidisciplinary biopsychosocial approach and have undertaken environmental adaptations to address the specific needs of individuals with developmental disabilities and mental health needs living in a hospital environment. The role of these units within the developing continuum of specialized services in Ontario requires further consideration by policy makers and service providers. Ment Health Aspects Dev Disabil 2005;8(3):69-76 The Psychosexual Assessment & Treatment Continuum:
A Tool for Conceptualizing the Range of Sexuality-Related
Issues and Support Needs of Individuals With Developmental
Disabilities The sexuality-related issues and service needs of people with developmental disabilities (DD) have received increasing attention over the past two decades. This article introduces the Psychosexual Assessment and Treatment (PSAT) Continuum as a comprehensive schema for conceptualizing the broad range of sexuality-related issues and needs of this population. Each of the Continuum's five categorical domains (psycho-education, interpersonal, trauma, psychosexual disorder, forensic) are described and a discussion of its utility for practice is included. Ment Health Aspects Dev Disabil 2005;8(3):77-90 Pseudohallucinations in People With Intellectual
Disabilities: Two Case Reports This is the first case report of two people with mild intellectual disabilities presenting with chronic perceptual anomalies that can best be described as pseudohallucinations. Alongside the two case histories we present a discussion of the validity of the concept of pseudohallucinations, especially in people with intellectual disabilities, as well as a framework to assess auditory hallucinations in this population. Ment Health Aspects Dev Disabil 2005;8(3):91-93 The Abnormal Involuntary Movement Scale (AIMS) and
Tardive Dyskinesia in Persons With Developmental Disability:
The Benefit of Videotaped Exams Several methodologies now exist for appropriate screening and quantification of movement disorders that complicate treatment with neuroleptic medications. Neuroleptic-induced tardive dyskinesia is most often identified through the use of multi-item rating scales, such as the Abnormal Involuntary Rating Scale (AIMS). The authors review the AIMS and other rating scales, and present their experience with videotaping AIMS examinations over time. Videotaping of such examinations provides several advantages, including enhancement of inter-rater reliability, permanent visual archiving of movement disorders, and improved examination of uncooperative individuals. Ment Health Aspects Dev Disabil 2005;8(3):94-99 Specialized Inpatient Mental Health Care for People
With Intellectual Disabilities The experience of a specialized acute inpatient unit for people with intellectual disabilities (ID), designed specifically to diagnose and treat those individuals, will be examined. Trends after six years of service with regard to diagnosis, treatment, and follow-up care indicate that medical and medication issues must be addressed. The inpatient service incorporates mental health, psycho-social and medical treatment and close collaboration with community providers. Proactive discharge and follow-up planning as well as direct support training are essential. Ment Health Aspects Dev Disabil 2005;8(3):100-103 Problem Behavior in Children With Intellectual
Disabilities: Parenting Stress, Empowerment and School
Services The Child Behavior Checklist was used to examine the relationship between child behavior problems and various positive and negative stress and support outcomes in 100 Canadian parents of children with intellectual disability (ID). The highest scores were observed on the Thought, Attention, and Social Problems subscales, suggesting the Internalizing and Externalizing broad-band scales may underestimate behavior problems in children with ID. The parents of the 43% of children with clinically significant scores on the Total Problems scale reported more stress and lower levels of well-being, social support, and family-centered school services than the parents of the children without clinically significant scores on the Total Problems scale; however, their levels of empowerment were similar. Parents who reported both Internalizing and Externalizing problems in their children reported the most negative experiences. Ment Health Aspects Dev Disabil 2005;8(4):105-114 Psychogenic Nonepileptic Seizures (Pseudoseizures) in
Individuals With Intellectual Disabilities: Part I Psychogenic Nonepileptic Seizures (PNES) or pseudoseizures pose an under-recognized problem for people with intellectual disabilities (ID). Many individuals with apparent refractory seizures suffer from PNES and end up on multiple anticonvulsants. This paper explores PNES in individuals with ID. Ment Health Aspects Dev Disabil 2005;8(4):115-119 Staff Training in Applied Behavior Analysis: Improving
Knowledge Competencies of Service Providers for People With
Developmental Disabilities Direct care service providers for people with developmental disabilities participated in a training program that targeted applied behavior analysis knowledge competencies in three content areas: basic learning principles, instructional strategies, and prompting/prompt fading procedures. A standardized training curriculum was administered during 2-3 hour group lessons with staff at three settings serving children, adolescents, and adults. Compared to pretraining results, staff performance on assessment of knowledge tests improved posttraining and was maintained at a one month follow up. Elements of the training program are discussed. Ment Health Aspects Dev Disabil 2005;8(4):120-125 The Referral Dilemma of Challenging Behaviors,
Psychiatric Diagnoses and Treatment: Are There Shortcuts in
2005? Clinicians face increasing time pressures in today's health care. If a prescriber could go from chief complaint to the treatment intervention within minutes, more people with intellectual disability could be seen. For instance, if self-injurious behavior was actually a depressive equivalent, the usual diagnostic process could be greatly shortened. This paper will review whether shortcuts in the diagnostic process realistically are possible. Ment Health Aspects Dev Disabil 2005;8(4):126-127 The Significance of Applied Behavior Analysis in the
Treatment of Individuals With Autism Spectrum Disorders (ASD) Applied Behavior Analysis (ABA) is an approach to understanding and changing human behavior based on the principles of learning from experimental psychology. Presently, these approaches have shown great value for children and adults within the Autism spectrum. For preschoolers, much needed training in language and social communication can be conducted effectively using a discrete trial approach. Behavioral difficulties can be addressed using ABA approaches, and the most successful emphasize positive methods as well as antecedent analysis and prevention. Resources for locating ABA professionals are given. Ment Health Aspects Dev Disabil 2005;8(4):128-130
2004 AbstractsA Psychopharmacological Treatment Regimen for
Hypersexual Behavior: A Case Study of Kluver Bucy Type
Symptomatology A cluster of neurobehavioral symptoms resembling the Kluver Bucy Syndrome (KBS) is described in a 42 year old man with developmental disabilities residing in a state developmental center. Etiology is not certain, but may have originated in pre adolescence during a prolonged seizure with hypoxia and fever, or from Reye's syndrome, attributed to aspirin treatment of an ongoing childhood febrile seizure disorder. Utilizing multiple references and consultations, the treatment team created a poly pharmaceutical treatment plan that proved successful in reducing many aspects of this condition. The treatment of this patient (Mr. A) is described with supporting data, and a proposed algorithm for treating these symptoms is also included. Ment Health Aspects Dev Disabil 2004;7(1):1-9 A Retrospective Analysis of the Efficacy of
Risperidone in People With Developmental Disabilities Living
in Institutional Settings This study retrospectively examined the efficacy of the atypical antipsychotic risperidone in people with developmental disabilities living in institutional settings. Specifically, this study examined the impact of risperidone on clinical global impression (CGI) ratings of medical/psychiatric and behavioral status and other clinical measures. The study collected data from 294 individuals receiving either risperidone or haloperidol, alone or in combination with other psychotropic medications, from a population residing in several state run, ICF/MR certified developmental centers in one state. Comparisons were made on retrospective data between those receiving risperidone and those receiving haloperidol on several measures based on intensive record reviews. Clinical characteristics of subjects were related to psychotropic medications and specifically to dose ranges. Significant differences were obtained on both medical and behavioral CGI measures between the risperidone and haloperidol groups. Implications of these and other findings are discussed. Ment Health Aspects Dev Disabil 2004;7(1):10-20 Evaluation of a Bedtime Medication Regimen on Daytime
Sleep and Challenging Behaviors of an Adult With
Intellectual Disabilities Sleep problems are common among people who have developmental disabilities and may be responsible for daytime challenging behaviors. This case study evaluated the effects of medication (trazodone) given at bedtime on aggression, self injury, sleep attempts, and physical restraint encountered during the day with a man who had intellectual disabilities, comorbid psychiatric diagnoses, and a history of erratic sleep. The medication regimen was associated with a clinically significant reduction in challenging behaviors and elimination of physical restraint. The therapeutic implications of these results are discussed. Ment Health Aspects Dev Disabil 2004;7(1):21-25 The Use of Psychostimulants in Children With
Disruptive Behavior Disorders and Developmental Disabilities
in a Community Setting This study was done to provide information about the use of stimulants in children with disruptive behavior disorders and developmental disabilities in a community setting. A randomized retrospective chart review was conducted for 115 children, ages 3 13 years, who as outpatients, were referred for a multidisciplinary workup. Twenty one (18.2%) of the children had a diagnosis of attention deficit/hyperactivity disorder (ADHD) only, while 94 (81.8%) had comorbid diagnoses, with intellectual disabilities being the most common developmental disability (N=27, 23%). The target symptoms were hyperactivity, inattention, impulsivity or aggression. Four different preparations of two stimulants were used. The children were treated for as long as nine years. Satisfactory responses were noted in 76% of the children with ADHD only, and in 69% of the children with comorbid diagnoses. Side effects were reported in 42 children (36.5%). Stimulants were augmented with other drugs in 25% of the cases. Thus, the use of stimulants for symptoms of ADHD in children with developmental disabilities and disruptive behavior disorders is effective when ADHD occurs alone, and is also effective, with augmentation in some cases, when comorbid conditions are present. Ment Health Aspects Dev Disabil 2004;7(1):26-36 Aggression and Maladaptive Behaviors: Not Necessarily
Symptoms of a Psychiatric Disorder Aggression is the most frequent chief complaint for patients with intellectual disability seeking psychiatric services. Although it may be a symptom of a psychiatric disorder, i.e., a symptom of depression, it may also signify many other conditions. For example, aggression is just as frequently a sign of dissatisfaction, environmental stressors or a medical condition. Because of these factors, all possible causes must be considered and assessed prior to a diagnostic formulation. In addition, if other causes are suspected, the clinician must insist on evaluation of life supports, possible referral for psychotherapy, and most importantly, the consultation of a professional in applied behavior analysis. Ment Health Aspects Dev Disabil 2004;7(1):37-40 Challenging Behavior in CHARGE Syndrome Little is known, beyond anecdotal reports, concerning the challenging behaviors of some children with CHARGE Syndrome. One hundred respondents from the US (74%) and seven foreign countries, primarily mothers (91%), completed a web-based survey regarding the behaviors of a person with CHARGE (median age of 7). Included was a medical history and a list of 71 behaviors based on the diagnostic categories most frequently reported anecdotally. Findings supported these reports. Behaviors typical of autistic disorder, attention deficit/hyperactivity disorder, obsessive-compulsive disorder, Tourette syndrome, and deaf-blindness were characteristic of these children. Those who were deaf-blind received higher ratings on these challenging behaviors Ment Health Aspects Dev Disabil 2004;7(2):41-52 Aripiprazole Use in an Individual With Intellectual
Disability and Schizoaffective Disorder The treatment of individuals with intellectual/developmental disabilities and schizophrenia or related disorders represents a challenge for clinicians. Individuals with cognitive impairment may be especially vulnerable to the adverse effects of conventional and atypical antipsychotic drugs. We report on the successful treatment of an individual with schizoaffective disorder and intellectual disability with aripiprazole, a novel antipsychotic agent with a favorable side effect profile. Ment Health Aspects Dev Disabil 2004;7(2):53-56 The Developmental Psychiatric Approach to Aggressive
Behavior Among Persons With Intellectual Disabilities Aggressive behavior is encountered relatively often among persons with intellectual disabilities and can cause great difficulties in the care management of these persons. By applying a developmental psychiatric approach to the assessment and diagnostics of persons with intellectual disabilities who display aggressive behavior, the author points out how one may come to a better understanding of the onset mechanisms, presentation, and course of this disorder. A schema of emotional development is presented and different manifestations of aggression and their relationship to personality development is revealed. By means of a developmental psychiatric examination, various psycho-social aspects such as the basic emotional needs, adaptive and maladaptive traits, and coping strategies come to light. This serves as the background from which more accurate diagnostics and more appropriate planning of an integrative treatment can take place. Integrative treatment is multidimensional, implying that it is based on the biological, psychological, social and developmental aspects of the individual. The intention of the article is to stimulate the application of the developmental perspective in the diagnostics and treatment of persons with intellectual disabilities who have mental health problems and to challenge professionals to carry out more scientific research in this field. Ment Health Aspects Dev Disabil 2004;7(2):57-68 Behavioral and Psychiatric Disorders in Children and
Adolescents With Down Syndrome Not all children and adolescents with Down syndrome are happy and sociable. Some have behavioral problems, such as aggression or self-injury. Others may suffer with major depression or obsessive-compulsive disorder. There are few epidemiologic studies of psychiatric disorders in Down syndrome. Consequently, clinicians often have limited guidance from peer-reviewed literature, in selecting treatment options. This paper will review the behavioral disorders of aggression and self-injurious behavior as well as depression, bipolar disorder, psychosis, and obsessive-compulsive disorder. Although more research is needed in almost all areas, there are a few observations. Before using a psychotropic for aggression, attempt to rule out communication, social, environmental or medical etiologies. Similar to the general population, the first-line treatment for major depression is a SSRI (with the exception of paroxetine). Ment Health Aspects Dev Disabil 2004;7(2):69-76 Therapeutic Engagement of the Family for Treatment of
Individuals With Intellectual Disability: Chronic Sorrow Parents of individuals with intellectual disability (ID) experience a chronic sorrow throughout their lives. This begins with the diagnosis of ID, and is similar to the process of grief. Parents experience denial, anger, sadness, and acceptance; this cycle repeats itself when the child is passing through major developmental milestones as well as during crises and times when the service system is providing inadequate supports. Suggestions for awareness and helping parents and families are made. Ment Health Aspects Dev Disabil 2004;7(2):77-80 Problems and Questions in the Dual Diagnosis of
Schizophrenia and Intellectual Disability Although the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition allows for the simultaneous diagnosis of intellectual disability and schizophrenia, no one has demonstrated the validity of this practice. A literature review suggests that this particular dual diagnosis be limited to persons with a significant family history of schizophrenia, or in whom the clinical decline from a pre-morbid baseline is unequivocal. Future research should consider novel interventions for patients with intellectual disability and apparent schizophrenia because there is very little evidence to support the use of the same treatments in patients with and without intellectual disability. Ment Health Aspects Dev Disabil 2004;7(3):81-90 Physical Restraint Intervention: Case Report
Evaluation of an Implementation-Reduction Strategy and Long
Term Outcome Although physical restraint is sometimes required in therapeutic intervention, methods to reduce restraint use and assessment of long term outcome have not been researched extensively. This case study evaluated an implementation-reduction strategy to decrease physical restraint of an adolescent girl who had developmental disabilities and severe aggressive behavior. The focus of intervention was manipulating the duration of restraint incidents by changing from a behavior-contingent release criterion to a time-based release criterion. Restraint frequency and duration decreased with intervention and were maintained through a 21-month follow-up assessment. Clinical and experimental issues are discussed. Ment Health Aspects Dev Disabil 2004;7(3):91-96 Assessing Capacity for Informed Consent: A Rationale
and Protocol There has been a growing consensus about the importance of assessing capacity to give consent. A number of procedures (e.g., elective medical treatment, pharmacotherapy, electroconvulsive therapy), use of restrictive behavioral interventions, and signing a power of attorney) require informed consent. In the mental health system informed consent is very important relative to the issues of pharmacotherapy and electroconvulsive therapy. A protocol for assessing capacity has been developed and used by the Center for the Disabled in Albany, New York, a community-based agency that serves persons with intellectual disabilities or other developmental disabilities. The proposed Center for the Disabled protocol for assessing capacity to give informed consent is based upon three legal criteria-knowledge, rationality, and voluntariness. Ment Health Aspects Dev Disabil 2004;7(3):97-106 Vagus Nerve Stimulation in an Adult Male With Fragile
X Syndrome We present a case study of vagus nerve stimulation to treat epilepsy in an adult male with fragile X syndrome. This patient had seizures beginning at about two years of age. He did relatively well on anticonvulsant medications until reaching his thirties, when he experienced a resurgence of seizures, occurring about twice per week, and a decline in overall functioning. During one year of vagus nerve stimulation, he had a total of four to five seizures, his adaptive behavior and socialization improved, and he had reduced irritability and aggression. The possible benefits of vagus nerve stimulation in relation to what is known about brain morphology and function in fragile X is explored. Ment Health Aspects Dev Disabil 2004;7(3):107-113 Antipsychotics and the Risk of Obesity and Diabetes Recent concerns have arisen regarding the link between the antipsychotic medicine Zyprexa (olanzapine) and the development of diabetes. This risk must be seriously considered prior to initiating treatment with this drug, as well as other antipsychotic medications. Guidelines have been established to monitor patients in treatment and are discussed. For patients with intellectual disability, care providers must be educated in watching for the symptoms and signs of diabetes as well as weight gain, and being proactive in helping individuals to achieve a healthy lifestyle. Ment Health Aspects Dev Disabil 2004;7(3):114-116 Suicide Cases in a Population-Based Cohort of Persons
With Intellectual Disability in a 35-Year Follow-Up Suicides of persons with mental retardation are considered rare. In a 35-year (1962-1998) follow-up study of a nation-wide, population-based cohort of 2,677 persons with intellectual disability, only 10 suicide cases were discovered. Suicide risks of persons with mental retardation include psychiatric morbidity with challenging care needs, social problems and difficulties in adjusting to them and ageing. Those working with intellectually disabled individuals need to be aware of these risks in order to recognize severe depression, emotional instability and lack of will to live, possibly leading to either attempted or completed suicide. Ment Health Aspects Dev Disabil 2004;7(4):117-123 The Differential Diagnosis of Anxiety in Individuals
With Epilepsy and Intellectual Disability Anxiety is the result of a complex interaction between environmental stimuli and a network of brain regions devoted to assessing and responding to threat, conflict, or potential danger. Focal seizures may present with a range of affective symptoms that may be difficult to distinguish from anxiety states. The process is complicated further among individuals with intellectual disabilities. In uncertain cases, clinicians need to consider not only the type of anxiety, but also the nature and duration of symptoms, associated neurocognitive changes, previous treatment response, and in some circumstances, more invasive neurodiagnostic procedures. Ment Health Aspects Dev Disabil 2004;7(4):124-130 Posttraumatic Stress Disorder and Phenotype-Specific
Challenging Behavior in an Individual With Smith-Magenis
Syndrome: A Multimodal Approach The systematic evaluation of psychopharmacological and psychosocial interventions in treating an individual with Smith Magenis syndrome (SMS), who has a lengthy history of challenging behavior, is illustrated by means of case evaluation. Developmental disability, distinct physical features and behavioral phenotypes including significantly challenging behavior characterize SMS, a genetically based disorder due to a deletion of chromosome locus 17p11.2. This case demonstrates the efficacy of a biopsychosocial interdisciplinary approach in making the difficult distinction between challenging behavior consistent with the syndrome's behavioral phenotype and signs and symptoms of a comorbid posttraumatic stress disorder, in an individual with SMS. The elimination of mechanical restraints and overall improvement in quality of life are illustrated. Further longitudinal studies, documenting the prevalence of co morbid psychiatric disorders in individuals with SMS, may offer further clues to the location of genetic anomalies associated with co morbid disorders. Ment Health Aspects Dev Disabil 2004;7(4):131-141 Treatment of Multiple Phobias and Agoraphobia in a Man
With Down Syndrome This is the first report of agoraphobia with panic attacks in an adult with Down syndrome. He was a 34-year-old man with mild intellectual disability and since early childhood had a fear of heights. This generalized in adulthood to fear of elevators, bridges, and agoraphobia with panic attacks. Cognitive behavioral treatment using graded exposure with homework assignments yielded significant improvements. Ment Health Aspects Dev Disabil 2004;7(4):142-146 Rational Use of Benzodiazepines for Patients With
Intellectual Disability Recent concerns have arisen regarding the link between the antipsychotic medicine Zyprexa (olanzapine) and the development of diabetes. This risk must be seriously considered prior to initiating treatment with this drug, as well as other antipsychotic medications. Guidelines have been established to monitor patients in treatment and are discussed. For patients with intellectual disability, care providers must be educated in watching for the symptoms and signs of diabetes as well as weight gain, and being proactive in helping individuals to achieve a healthy lifestyle. Ment Health Aspects Dev Disabil 2004;7(4):147-149
2003 Abst |