Trine Lise Bakken

Psychiatric Disorders in People with Autism Spectrum Disorders: Phenomenology and Recognition

The prevalence and incidence rates of psychiatric disorders are higher in people with autism spectrum disorders (ASD) than in the general population (Bradley, Summers, Hayley, & Bryson, 2004; Brereton, Tonge, & Einfeld, 2006; Clarke, Baxter, Perry, & Prasher, 1999; Ghaziuddin & Greden, 1998; Ghaziuddin, 2005; Ghaziuddin, Alessi, & Greden, 1995; Ghaziuddin, Tsai, & Ghaziuddin, 1992; Glenn, Bihm, & Lammers, 2003; Howlin, 1997, 2000; Howlin, Goode, Hutton, & Rutter, 2004; Lainhart, 1999; Leyfer et al., 2006; Matson & Nebel-Schwalm, 2007; Morgan, Roy, & Chance, 2003; Simonoff et al., 2008; Tsakanikos et al., 2006).

Adults with intellectual disabilities and mental illness in psychiatric inpatient units: empirical studies of patient characteristics and psychiatric diagnoses from 1996 to 2011

Abstract Background: Adults with intellectual disabilities still have limited access to psychiatric hospitalization when they experience mental illness. Knowledge about patients admitted to inpatient psychiatric units is still sparse. The objective of this review is to investigate patient characteristics and psychiatric diagnoses of adults with intellectual disabilities admitted to psychiatric inpatient units. Methods: A broad search of four electronic databases was conducted for relevant articles, which included controlled and naturalistic studies. The search was limited to articles published in English from 1996 through 2011. Results: Out of 310 hits, 72 articles were reviewed in full text and 19 were chosen for further analyses. Only empirical studies from psychiatric units admitting patients with intellectual disabilities and confirmed or suspected mental illness were considered. The included articles encompass about 4000 patients. Psychosis was the most common psychiatric diagnosis, followed by affective disorder and anxiety disorder. Behaviour problems were observed in a majority of the patients. Practical application: It appears that patients with intellectual disabilities and mental illness admitted to psychiatric inpatient units have especially complex conditions, which may include psychosis or affective disorder, challenging behaviour, often with additional physical conditions, and sparse verbal skills. More research is needed to develop suitable treatment for patients with intellectual disabilities in psychiatric inpatient settings.

Avoiding Control and Pressure When Working with Severely Intellectually Disabled and Disturbed Patients A Study of Interaction between Professional Caregivers and Patients

The behaviouristic tradition has been the mainstream method of treating intellectually disabled persons in Norway. This study describes an alternative, or rather a supplement to behavioural methods when facing psychiatric illnesses in intellectually disabled persons. Interventions described in the present study are based on authors like Lefcourt and Goffman, combined with the impact of the newer trends of user participation and empowerment in the health care system in Scandinavia. The role of the professional caregiver is the aim of the present study. Fifty-three caregivers working in a Psychiatric Department for intellectually disabled at Ullevaal University Hospital (UUS) in Oslo answered a 41 item questionnaire. Three items assessed how caregivers handled conflict situations during self-care activities, and responses on these three items showed the same pattern. When responding and working with patients who do not cooperate during morning rituals, meals and classroom activities, they mainly engaged in verbal interactions with the patients. The caregivers were able to handle conflict situations without using control and pressure in helping patients with daily self-care activities. The authors discuss how the underlying idea of intervening in this way will strengthen the patients ability to perceive the impact on the surroundings by their own actions, and how it will influence caregiver practice.

Identification of PTSD in adults with intellectual disabilities in five patients in a specialised psychiatric inpatient unit

Purpose – The purpose of this paper is to describe and discuss assessment of post-traumatic stress disorder (PTSD) in adults with intellectual disabilities. Existing research in this area encompasses case studies, and includes, for the most part, persons with mild intellectual disabilities. Design/methodology/approach – The aim of this study is to investigate symptom presentation and subsequent identification of PTSD in persons with more severe intellectual disabilities; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about the patients was collected through case files and interviews with key informants: family, milieu therapists, and caregivers in community settings, and observations through inpatient admission. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. The five pati...

Observing Communication Skills in Staff Interacting with Adults Suffering from Intellectual Disability, Autism and Schizophrenia

Background: Related to nursing, co-morbidity of intellectual disability (ID), autism and mental health problems, generate a need for integrated knowledge from both intellectual disability nursing and psychiatric nursing. Aim: The aim of the current paper is to examine the reliability of an instrument designed for observing communication skills in professionals caring for patients with intellectual disability, autism and schizophrenia. Procedure: A naturalistic prospective observational design was chosen. Scoring categories were developed, staff and patient communications were video-recorded and then scored. Reliability was estimated by inter-rater agreement. Results: Across 370 sequences of interaction, all categories except one were observed. Inter-rater agreement on the observational categories was high. Conclusion: The instrument worked as expected according to both observer agreement and presence of staff communication skills.

PTSD in adults with intellectual disabilities: stabilisation during inpatient stay

Purpose – The purpose of this paper is to describe and discuss interventions of stabilisation of emotions and behaviour in adults with post-traumatic stress disorder (PTSD). This topic is understudied in persons with intellectual disability. Design/methodology/approach – The aim of this study was to investigate interventions of stabilisation in persons with more severe intellectual disability; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about treatment of the patients was collected through case files, observations, and interviews. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. Findings – Six main areas of stabilisation of emotions and behaviour were identified: validation, anxiety relief, treatment of depressed mood, increased mastering of daily activities, protection ...

The Use of Validation in Mental Health Nursing for Adults with Intellectual Disabilities and Mental Illness: A Descriptive Study

Abstract Mental health nursing for adults with intellectual disabilities and mental illness is understudied. The aim of this study was to investigate the use of validation in mental health nursing for patients with intellectual disabilities and additional mental illness in a specialised psychiatric inpatient setting. Ten nurses/social educators and four individual therapists described the use of validation; each provided three vignettes with clinical examples. The clinical examples support the view that interventions developed for patients in the general population are feasible also for patients with intellectual disabilities. Clinical implications relate to the use of validation as an important factor in mental health nursing for adults with intellectual disabilities. Skills required include being capable of interpreting behavioural equivalents of mental illness symptoms, responding adequately to unusual utterances, and occasionally communicating in a predominantly non-verbal way.

Asperger syndrome or schizophrenia, or both? Case identification of 12 adults in a specialized psychiatric inpatient unit

Abstract Background: Asperger syndrome (AS) may be difficult to distinguish from psychosis in the schizophrenia spectrum (PSS), as the two conditions share core features. Aim: The aim of this paper is to identify symptoms which are useful in the differential diagnostic process, and which symptoms cause confusion in the assessment. Methods: Twelve patients, consecutively referred to a specialized psychiatric inpatient unit for re-diagnostic assessment, were recruited in a 3-year period. The patients were systematically assessed for both AS and for psychotic disorder in the schizophrenia spectrum. Results: Symptoms that caused misdiagnosis in the present sample were especially idiosyncratic speech taken for delusions (or the reverse), dysfunction related to self-care, task solving, and relationships, and social impairment taken for negative symptoms (or the reverse). Useful areas were symptom onset, symptoms of disorganized speech, occurrence of hallucinations, and occurrence of relapses. The latter contributed to diagnostic clarity related to PSS only. Conclusion: Patients with both AS and PSS may show severe symptoms which usually are difficult to distinguish. When both AS and PSS are suspected in severely impaired adult patients, comprehensive assessment including both AS and PSS is required. Symptoms that may differentiate PSS from AS are age of onset, presence of hallucinations, presence of disorganized speech and behaviour, and occurrence of relapses. Confusing symptoms include social impairments, and idiosyncratic opinions in persons with AS, which may be mistaken for delusions (or the reverse). Also bizarre behaviour and general dysfunction may be wrongly attributed to AS or PSS.

Adjustment of the UKU Side Effect Rating Scale for adults with intellectual disabilities. A pilot study

Purpose – Patients with intellectual disabilities (ID) and additional psychiatric disorders are often treated with psychotropic medication. However, examinations of side effects among these patients are scarce. The purpose of this pilot study is to examine the most frequently used side effect scale, UKU Side Effect Rating Scale (UKU-SERS), in this patient population. Design/methodology/approach – The aim of the present study is to explore whether the UKU-SERS is feasible for patients with ID. The UKU-SERS consists originally of 48 items, measuring side effects of psychotropic medication. In the study, UKU-SERS was used to score a group of 13 adults with ID admitted to a specialised inpatient psychiatric unit. First, an expert panel of seven psychiatrists and five psychiatric nurses independently evaluated the UKU-SERS and decided which items they considered possible to score after observation alone. Second, a total of 26 staff members, based on observation, scored the 13 patients on the ward. These result...

Specialized psychiatric services: patient characteristics, referral practice and length of stay in a representative clinical sample 2010–2016

Background Mental health services for patients intellectual disabilities (ID) and additional mental illnesses are only sparsely studied. Objective The objective was to describe a representative sample of patients with ID in a specialized psychiatric department. Methods Data were collected from case files in a 7-year period. Of 143 invited patients, 133 participated. Results More than 60% were admitted involuntarily. Schizophrenia was found in 30.1%, mood disorder in 25.6%, and anxiety disorders in 15.8%, Obsessive Compulsive Disorder (OCD) in 8.4% and Post Traumatic Stress Disorder (PSTD) in 12.9%, PD in 14.3%, and ADHD in 12%. Average waiting time was 6.1 months. Length of stay was 9.1 months for the inpatients. Conclusion Services for patients with ID appear to still be reliant on inpatient units for at least a proportion of their patients. More research is needed to find out why this is. The results raise questions about referring, compliance between psychiatric diagnosis, and interventions.