Intellectual disability

Question 1

Broad issues is dual disability assessment/diagnosis

Answer 1

As many as 1% of the general population have dual disability (co-morbid intellectual disability and psychiatric disorder). There is evidence that there are common problems in diagnosis and treatment approaches resulting in failure to recognise, diagnose and treat appropriately.

Examples of common errors are: failure to consider psychiatric diagnoses as contributing to behavioural disturbance and attribution of symptoms exclusively to the intellectual disability;
and, not modifying the approach to assessment to take account of the intellectual disability.
Yet there is also clear evidence supporting:
􀂃 the importance of a biopsychosocial approach to patients with intellectual disability;
􀂃 simple strategies that can be employed to improve the reliability and validity of the interview and assessment process; and
􀂃 significant medical co-morbidities are common in this population and should be routinely considered in a comprehensive assessment.

Question 2

Important history in dual disability

Answer 2

central importance of a biopsychosocial approach in patients with intellectual disability;
the importance of assessing for significant mental illness in the context of puzzling, complex or bizarrre behavioural change;
considering significant medical co-morbidities (e.g. epilepsy, congenital heart problems) that are common in this population;
seeking collateral information and the central importance of involving family/carers in ongoing assessment and management

Question 3

Examination in dual disability- approach considerations

Answer 3

more specific about adapting the approach because of speech deficits; adapting the interview style to use vocabulary and concepts appropriate to the developmental level of the patient; avoiding “yes/no” questions that may be answered without understanding; avoiding leading questions; adapting the clinical environment so that it is calming and understandable; the importance of being consistent and favouring more frequent and shorter consultations; supporting the patient’s ability to express mood states; supporting the patient’s ability to self-determine and maintain control.

identify the main mental state findings which are description of depressed mood, depressive themes, changes to behaviour and self-care, auditory hallucinations, description consistent with panic disorder and generalised anxiety and suicidal ideation

Question 4

Manifestations of depression that may manifest

Answer 4

Rage outbursts, aggressioin, withdrawal, fearfulness

Question 5

Diagnosis information

Answer 5

biopsychosocial approach and/or identifying relevant predisposing, precipitating, perpetuating and protective factors

consider medical co-morbidities (e.g. role of hypothyroidism and current treatment; fainting spells as new phenomenon for investigation); emphasises the importance of using standard diagnostic systems to guide detection of target symptoms. May consider range of diagnoses such as: major depression with psychotic features; psychotic disorder; PTSD; anxiety and panic