Anna M. Palucka

Depression in intellectual disability

Purpose of review This paper examines reviews and research reports on depression in intellectual disability published from January 2003 to March 2004. Recent findings There has been much discussion about the validity of atypical symptoms of depression and the methodological and conceptual issues hampering research efforts in that area. Despite the shortcomings, research on atypical symptoms has informed the development of modified diagnostic criteria for depression in intellectual disability. In addition, three new promising instruments have been developed for the assessment of depression/mood at both the mild and more severe levels of intellectual disability. In addition, a number of standard measures were demonstrated to have adequate reliability when used with individuals with a mild to moderate degree of intellectual disability. Limited research on prevalence has indicated increased recognition of depression in clinic-based populations. Psychosocial correlates of depression received marginal attention, and no studies on treatment were published. Summary In the past year, significant emphasis was placed on symptoms of depression and its measurement across all levels of disability. In contrast, limited attention was directed to investigating causes and psychosocial factors in depression, and no studies on the pharmacological or psychological treatment of depression were published.

Predictors of Specialized Inpatient Admissions for Adults with Intellectual Disability.

Individuals with intellectual disability (ID) have complex mental health needs and may seek specialized ID psychiatric services. This study reports on predictors of specialized inpatient admissions for 234 individuals with ID who received outpatient services at a psychiatric hospital. Overall, from 2007-2012, 55 of the 234 outpatients were triaged into the specialized inpatient unit. Aggression towards others and psychotropic polypharmacy significantly predicted these admissions. Unlike previous research, schizophrenia and level of ID did not predict admissions, suggesting that these factors may have a differential impact in specialized versus mainstream inpatient services. Findings are discussed in relation to how specialized inpatient units can be most responsive to these vulnerable patients and the factors that may impact clinical decision making.

Comparative Effects of Mindfulness and Support and Information Group Interventions for Parents of Adults with Autism Spectrum Disorder and Other Developmental Disabilities

This study evaluated two community based interventions for parents of adults with autism spectrum disorder and other developmental disabilities. Parents in the mindfulness group reported significant reductions in psychological distress, while parents in the support and information group did not. Reduced levels of distress in the mindfulness group were maintained at 20 weeks follow-up. Mindfulness scores and mindful parenting scores and related constructs (e.g., self-compassion) did not differ between the two groups. Results suggest the psychological components of the mindfulness based group intervention were effective over and above the non-specific effects of group processes and informal support.

Acute inpatient treatment, hospitalization course and direct costs in bipolar patients with intellectual disability

To explore the impacts of intellectual disability (ID) on psychotropic medication use, length of hospital stay (LOS) and direct hospitalization costs during inpatient treatment for acute bipolar episodes, all 17,899 index hospitalizations due to acute bipolar episodes between 1998 and 2007 in Taiwan were identified from a total population health insurance claims database, amongst which 544 subjects had a concomitant diagnosis of ID. Pattern of psychotropic medication use, LOS, discharge outcome and direct costs during hospitalization were compared between bipolar patients with ID and without ID and multivariate models controlling for major cost confounders were used to explore the impacts of ID on LOS, discharge outcome and inpatient costs. The results indicated that, compared to bipolar patients without ID, bipolar patients with ID were younger, had longer LOS and received significantly lower daily equivalent dosages of antipsychotics, mood stabilizers, lithium and benzodiazepines. Significantly more bipolar patients with ID could not be discharged successfully. The longer LOS possibly reflected slower clinical stabilization, conservative use of medications and difficulty in community placement. The lower average daily reimbursements indicated that treatment of bipolar patients with ID were under-funded, whereas the higher total direct costs resulting from prolonged LOS placed greater economic straint on healthcare system. The findings support that bipolar patients with ID are clinically unique but relatively under-supported during acute hospitalization. Modifying current pharmacological intervention, health care resources allocation and community supporting structure is paramount to reducing LOS and improving hospitalization outcome.

Inpatient Mental Health Services

This chapter provides a review of key issues concerning inpatient psychiatric services for individuals with intellectual disabilities (ID). Such a review is very much impacted by the time in which it is written. A similar chapter written 20–30 years prior would focus on long-stay hospitals for individuals with ID. However, with the deinstitutionalisation movement impacting many parts of the developed world, the purpose of hospitalisation has shifted to short-term treatment of acute psychiatric issues. This chapter focuses on papers published within the past 10–20 years. Section “Profiles of Inpatients with ID” describes what we know about the profile of individuals with ID that are hospitalised for mental health or behavioural concerns. We review in some detail the two main models of inpatient care: mainstream or general services and specialist units. We will describe what is known about how the two models differ as well as the risks and benefits of each. Section “Issues Pertaining to Hospitalization” focuses on clinical considerations and challenges with inpatient care. Finally, the chapter concludes with new directions for models of inpatient care and areas requiring further research.

Correlates of Police Involvement Among Adolescents and Adults with Autism Spectrum Disorder

This study aimed to describe police interactions, satisfaction with police engagement, as well as examine correlates of police involvement among 284 adolescents and adults with autism spectrum disorder (ASD) followed over a 12- to 18-month period. Approximately 16% of individuals were reported to have some form of police involvement during the study period. Aggressive behaviors were the primary concern necessitating police involvement. Individuals with police involvement were more likely to be older, have a history of aggression, live outside the family home, and have parents with higher rates of caregiver strain and financial difficulty at baseline. Most parents reported being satisfied to very satisfied with their children’s police encounters. Areas for future research are discussed in relation to prevention planning.

Emergency service experiences of adults with autism spectrum disorder without intellectual disability

This study aimed to describe patterns of emergency department use and police interactions, as well as satisfaction with emergency services of 40 adults with autism spectrum disorder without intellectual disability over 12–18 months. Approximately 42.5% of the sample reported visiting the emergency department and 32.5% reported interactions with police during the study period. Presenting concerns for emergency department use and police interactions varied widely, highlighting the heterogeneous needs of this population. On average, participants reported being dissatisfied with care received in the emergency department while police interactions were rated relatively more favourably.

Predictors of emergency department use by adolescents and adults with autism spectrum disorder: a prospective cohort study

Objectives To determine predictors of emergency department (ED) visits in a cohort of adolescents and adults with autism spectrum disorder (ASD). Design Prospective cohort study. Setting Community-based study from Ontario, Canada. Participants Parents reported on their adult sons and daughters with ASD living in the community (n=284). Main outcome measures ED visits for any reason, ED visits for medical reasons and ED visits for psychiatric reasons over 1 year. Results Among individuals with ASD, those with ED visits for any reason were reported to have greater family distress at baseline (p<0.01), a history of visiting the ED during the year prior (p<0.01) and experienced two or more negative life events at baseline (p<0.05) as compared with those who did not visit the ED. Unique predictors of medical versus psychiatric ED visits emerged. Low neighbourhood income (p<0.01) and living in a rural neighbourhood (p<0.05) were associated with medical but not psychiatric ED visits, whereas a history of aggression (p<0.05) as well as being from an immigrant family (p<0.05) predicted psychiatric but not medical emergencies. Conclusions A combination of individual and contextual variables may be important for targeting preventative community-based supports for individuals with ASD and their families. In particular, attention should be paid to how caregiver supports, integrative crisis planning and community-based services may assist in preventing or minimising ED use for this vulnerable population.

Changing profiles of individuals with autism spectrum disorder admitted to a specialized inpatient unit

Purpose The purpose of this paper is to study the profiles of adults with autism spectrum disorder (ASD) requiring an inpatient psychiatric admission. Design/methodology/approach This paper examines profiles of 27 inpatients with intellectual disability (ID) and ASD who were admitted to a specialized inpatient unit in two time periods (January 2005 to June 2009 and July 2009 to December 2013) to explore changes over time in patient profiles. Findings Findings suggest that individuals who were admitted more recently between July 2009 and December 2013, were younger and more likely to come from other ethnic backgrounds than those admitted between January 2005 and June 2009. There was a trend for recent admissions to come from family homes, have moderate to profound ID and have longer hospital stay. Originality/value This is the first study to compare profiles of adults with ASD receiving inpatient services over time. The value of the study lies in illustrating that the needs of this growing patient group are changing which has implications for the treatment provision including specialized inpatient treatment.