Geraldine Holt

Multiple exposure to life events and clinical psychopathology in adults with intellectual disability

BackgroundRelatively few studies have examined the impact of life events on mental health in the field of intellectual disability (ID), despite the possibility that adults with ID and mental health problems might be particularly vulnerable to multiple events.AimsTo examine the impact of multiple life events on mental health in people with ID.MethodThe sample consisted of 281 men and women with ID consecutively referred to a specialist mental health service in South-East London. For each participant, key informants completed the PAS-ADD Life Events list, while psychiatric diagnoses were made by clinicians based on ICD-10 criteria.ResultsLogistic regression analysis revealed that single exposure to life events was significantly associated with female gender, schizophrenia, personality disorders and depression. However, multiple exposure to life events was associated with personality disorder, depression and adjustment reaction.ConclusionsThe present results suggest an increased vulnerability to life events in people with ID. A better understanding of the relationship between life events and mental health can enhance the development of interventions, which may benefit substantially this particular population.

Psychiatric Inpatient Admissions of Adults with Intellectual Disabilities: Predictive Factors.

Information on admission to psychiatric inpatient units is lacking from the literature on contemporary services for people with intellectual disability and mental health needs. Here we report on predictors of admission for a cohort of 752 adults from this population living in community settings; 83 were admitted. We also report on two subsamples of this cohort for whom different psychometric measures concerned with psychiatric symptoms and behavior had been completed. Schizophrenia spectrum disorders and mild intellectual disabilities independently predicted admission for the total cohort. The presence of symptoms associated with psychosis and the presence of physical aggression predicted admission in the subsamples.

Referral trends in mental health services for adults with intellectual disability and autism spectrum disorders

Researchers have paid increasing attention to mental health issues in adults with autism spectrum disorders (ASDs) over the last decades. However, little is known about how rates of clinical referrals, types of mental health diagnoses and treatment in adults with ASDs and intellectual disability have changed. We examined patterns of change in referral trends to specialist mental health services in south London from 1983 to 2000 (N = 137). The majority of the cases (58.4%) did not have a diagnosable psychiatric disorder. Schizophrenia was the most frequent psychiatric diagnosis followed by depression, adjustment reaction and anxiety. There was a significant change in the rate of referrals, an increase in the diagnosable psychiatric disorders over time and a significant reduction of medication at time of referral. There were no significant changes in the use of other therapeutic interventions. The proportion of participants living independently increased. Implications for services and future research are discussed.

Descriptive psychopathology in people with mental retardation

This article considers variables associated with the presence of a psychiatric diagnosis in those referred to a specialist mental health service for people with mental retardation (MR). Data were collected on 752 newly referred clients. The presence of a psychiatric diagnosis was assessed by two psychiatrists based on International Classification of Diseases, 10th Revision, criteria. A series of binary logistic regression analyses were conducted. Older age, mild MR, admission to an inpatient unit, referral from generic mental health services, and detention under current mental health legislation were associated with an increased presence of any psychopathology. Severe MR, the presence of epilepsy, and residence with the family were associated with a lower incidence of any psychopathology. Findings relating to specific psychiatric diagnoses on the whole supported previous research. Clear service arrangements are necessary for people with mild MR who have a high incidence of psychiatric disorders.

Risperidone and olanzapine in adults with intellectual disability: a clinical naturalistic study.

Atypical antipsychotics are the first-line treatment for psychosis and are commonly used for behavioural problems in people with intellectual disabilities (ID), but a comprehensive evidence base for this approach is lacking. We studied prescription trends and the clinical effectiveness of risperidone and olanzapine in people with ID in a clinical, naturalistic setting. The results suggest that both drugs are well tolerated and effective in treating target symptoms across a range of diagnoses and ID. Both risperidone and olanzapine appear to reach full efficacy within 3 months, after which improvement reaches a plateau, as reflected in the Clinical Global Impression–Improvement scale. Compliance with both drugs is high. Olanzapine tended to be prescribed mostly for psychotic disorders, and showed good rates of response, whereas risperidone was prescribed mostly for people with behavioural disturbance associated with a psychiatric diagnosis. Furthermore, approximately one-quarter of the risperidone group were prescribed the medication for a behavioural disorder associated with a pervasive developmental disorder. Again, the medication was broadly effective in treatment. Both medications were also used to effectively treat affective disorders in a small percentage of patients. This study appears to indicate that both medications could be of significant clinical benefit for people with ID across a wide range of diagnoses and level of ID, although further controlled trials are required.

Professional training for those working with people with intellectual disabilities and mental health problems

• Many, and in some countries most, health care professionals receive little training in the assessment, treatment and management of mental health problems in people with ID. • In the UK, ID is a compulsory component of the training of psychiatrists. This is not the case in the USA, Canada, Australia and Austria. • ID is included in some training programmes for psychologists, but clinical experience in the field is less available, is optional and usually post-qualifications. • Primary car physicians in all the countries reviewed receive little or no exposure to the health care needs of people with ID, including mental health, at both an undergraduate and postgraduate level. • Positive developments in training were evident in all the countries reviewed. these often are linked to charismatic individuals who pioneer the initiatives. • An infrastructure is necessary to support training, including national standards of care for people with ID and mental health problems, to drive accreditation and certification of courses, together with secure career paths.

Mental Health and Challenging Behaviour Services

Changes have occurred in the pattern of services for people with learning disabilities and mental illness and/or challenging behaviour over recent years, with the development of a variety of service models across the UK. In SE London, residential services are based predominantly on a supported housing model and the strong philosophical premise that people should not be excluded from a community residential service because they have complex physical, behavioural or mental health needs. Local services, therefore, are supporting individuals with a wide range of need. This paper describes the development of specialist mental health and challenging needs services in support of this model. The issues raised are outlined, together with a list for action and priorities to overcome the difficulties encountered, including the maintenance of an effective infrastructure.