Asit B. Biswas

A Study of the Use of an Acute Inpatient Unit for Adults with Learning Disability and Mental Health Problems in Leicestershire, UK

(2004). A Study of the Use of an Acute Inpatient Unit for Adults with Learning Disability and Mental Health Problems in Leicestershire, UK. The British Journal of Development Disabilities: Vol. 50, No. 98, pp. 59-68.

Cognitive phenotype of velocardiofacial syndrome: a review.

The behavioural phenotype of velocardiofacial syndrome (VCFS), one of the most common human multiple anomaly syndromes, includes developmental disabilities, frequently including intellectual disability (ID) and high risk of diagnosis of psychotic disorders including schizophrenia. VCFS may offer a model of the relationship between ID and risk of major mental health difficulties. This paper reviews literature on the cognitive phenotype and its relationship with a polymorphism of the gene coding for catechol O-methyltransferase (COMT), a gene haploinsufficient in VCFS which modulates prefrontal dopamine levels. Principal features of the variable cognitive phenotype of VCFS in young people are ID, superiority of verbal over performance I.Q. and verbal over visuospatial memory, and difficulties with number and object magnitude comparisons, time perception and memory for serial order, and orienting of attention. Despite some improvements with age, problems with higher order attentional tasks involving planning persist, possibly modulated by COMT activity levels. Candidate cognitive endophenotypes include problems with retrieval of contextual information from memory and in executive control and focussing of attention. Longitudinal research using common core batteries of psychometric assessments, and experimental measures of cognitive function capable of direct translation for use with animal models, will further advance understanding of the developmental dynamics of VCFS.

Cognitive phenotype and psychiatric disorder in 22q11.2 deletion syndrome: A review

The behavioural phenotype of 22q11.2 deletion syndrome syndrome (22q11DS), one of the most common human multiple anomaly syndromes, frequently includes intellectual disability (ID) together with high risk of diagnosis of psychotic disorders including schizophrenia. Candidate cognitive endophenotypes include problems with retrieval of contextual information from memory and in executive control and focussing of attention. 22q11DS may offer a model of the relationship between ID and risk of psychiatric disorder. This paper reviews research on the relationship between the cognitive phenotype and the development of psychiatric disorders in 22q11DS. Aspects of cognitive function including verbal I.Q., visual memory, and executive function, are associated with mental health outcome in people with 22q11DS. This relationship may result from a common neurobiological basis for the cognitive difficulties and psychiatric disorders. Some of the cognitive difficulties experienced by people with 22q11DS, especially in attention, memory retrieval, and face processing, may, however, in themselves constitute risk factors for development of hallucinations and paranoid delusions. Future research into factors leading to psychiatric disorder in people with 22q11DS should include assessment of social and psychological factors including life events, symptoms associated with trauma, attachment, and self-esteem, which together with cognitive risk factors may mediate mental health outcome.

Marriage and family life in people with developmental disability

It has been reported that people with developmental disability are less likely to marry and have a family life compared to the general population. However, it has yet to be fully ascertained if this is true. This study aimed to establish the number of married people with developmental disability on the Leicestershire Learning Disability Register, whether or not any differences exist with regard to marriage and family life between ethnic groups in adults with developmental disability. The study sample was obtained from the Leicestershire Learning Disability Register and classified by ethnic origin as Asian, White or other. Case ascertainment of marital status showed that 4.6% of the study sample had ever married, the rate in the white ethnic group was 4.4% while in the Asian group 9.4%, the difference not being statistically significant. Individuals from the Asian group who had ever married, were significantly younger, significantly more likely to have children living within the household and had a significantly lower mean IQ than their white counterparts.

Meeting the Health Care Needs of People with Learning Disabilities

This article aims to highlight the delivery of health care to people with learning disabilities (PWLD) in the context of new Department of Health guidance and implementation of the Mental Capacity Act (2005). We seek to identify a myriad of barriers to health care delivery in this population and look at strategies to tackle these barriers. We will also consider the issue of capacity, which is particularly important for PWLD. We will highlight the importance of recognizing this populations enhanced baseline medical morbidity and how a best interests team approach is optimal when targeting interventions.

Self-Injurious Behavior: Overview and Behavioral Interventions

Self-injurious behavior (SIB) is a serious problem for some people with pervasive developmental disorders (PDDs) which is a common focus of clinical treatment and has received extensive attention in the research literature. This is the first of two related chapters. The first provides an overview of SIB and behavioral approaches to its treatment. The second reviews pharmacological approaches to treatment of SIB and then work which attempts to integrate behavioral and pharmacological treatments. Although other approaches to treatment of SIB, such as psychotherapy, counseling, and sensory approaches, may be used in practice, there is little research evidence to review on their efficacy in people with ASDs. Additionally, single-case experiments suggest that reported effects of interventions such as sensory integration with particular individuals may be more parsimoniously explained by the social interaction or reduction in task demands associated with the therapy and that function-based behavioral interventions are equally or more effective in reducing SIB (Devlin, Leader, & Healey, 2009; Mason & Iwata, 1990). Hence, these two chapters focus on behavioral and pharmacological interventions.

Clozapine use in personality disorder and intellectual disabilities

Purpose – Clozapine is a well-known antipsychotic medication licensed for treatment-resistant schizophrenia, but there is limited research available to suggest its efficacy in the context of personality disorder and intellectual disabilities presenting with high-risk behaviour with or without psychotic symptoms. The purpose of this paper is to raise awareness of the benefits of using clozapine in patients with intellectual disabilities and personality disorder that present with a complex picture of serious risk of harm to both their life and the lives of others. Design/methodology/approach – The authors present five patients with intellectual disabilities and serious life-threatening challenging behaviour whom were started on clozapine as part of their multidisciplinary treatment plan to manage their presentation. The authors completed baseline assessment of five main symptom domains and then repeated this assessment following treatment with clozapine. Findings – In all five cases use of clozapine was objectively associated with an improvement in symptomatology, quality of life and a safe transfer to the community. Originality/value – The findings suggest that judicious use of clozapine could be considered as one of the effective pharmacological strategies in the management of patients with intellectual disabilities and personality disorder who present with serious life-threatening challenging behaviours.

Treatment of Self-injurious Behaviour in Children with Intellectual Disabilities

Definitions of self-injurious behaviour (SIB) generally describe such behaviour as comprising nonaccidental self-inflicted acts causing damage to or destruction of body tissue and carried out without suicidal ideation or intent (Yates, 2004). For the clinician working with children with severe intellectual disabilities, such behaviours are likely to be a frequent cause for concern. Between 4% and 12% of such children exhibit SIB (Oliver, Murphy, & Corbett, 1987), which may present as repetitive head banging or face slapping, self-biting to the hands or other parts of the body, removing scabs from old wounds, self-pinching or scratching, hair-pulling and eye-poking, often presented in multiple forms in the same child. Selfinjury may emerge as early as 11–13 months of age (Berkson, Tupa, & Sherman, 2001; Hall, Oliver, & Murphy, 2001a), increases in prevalence and severity throughout the school-age years and young adulthood (Oliver et al. 1987), and once established in adulthood is likely to be chronic in nature (Emerson et al., 2001). Presentation of SIB is associated with

A Lithium Register for Adults with Intellectual Disabilities – Can It Work?

*Dr Sabyasachi Bhaumik MB BS DPM FRCPsych Consultant in Learning Disability Psychiatry, Leicestershire Partnership NHS Trust, Leicester Frith Hospital, Groby Road, Leicester, LE3 9QF, UK Honorary Senior Lecturer, University of Leicester, UK Email: bhaumikuk@yahoo.co.uk Tel: + 44 (0) 166 225 5310 Fax: + 44 (0) 166 225 5202 Dr Joanna M Watson MA MB BChir FFPH Associate Specialist in Learning Disability Psychiatry, Leicestershire Partnership NHS Trust, Leicester Frith Hospital, Groby Road, Leicester, LE3 9QF, UK Research Associate, University of Leicester, UK James F Falconer Smith DM FRCP FRCPath Consultant Chemical Pathologist, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Groby Road, Leicester, LE3 9QP Sanyogita Nadkarni MB BS MRCPsych Former Staff Grade in Learning Disability Psychiatry, Leicestershire Partnership NHS Trust, Leicester Frith Hospital, Groby Road, Leicester, LE3 9QF, UK Asit Biswas MD MRCPsych DPM MMedSci Consultant in Learning Disability Psychiatry, Leicestershire Partnership NHS Trust, Leicester Frith Hospital, Groby Road, Leicester, LE3 9QF, UK Satheesh Kumar Gangadharan MRCPsych MD (Psych) Consultant in Learning Disability Psychiatry, Leicestershire Partnership NHS Trust, Leicester Frith Hospital, Groby Road, Leicester, LE3 9QF, UK * For Correspondence Introduction

Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial

BACKGROUND Staff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability. Aims To evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276). METHOD We carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants. RESULTS No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = -2.14, 95% CI: -8.79, 4.51) or secondary outcomes. CONCLUSIONS Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour. Declaration of interest None.