Intellectual Disability Psychiatry E-Book

Angela Hassiotis

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 441

Veröffentlichungsjahr: 2013

Beschreibung

Intellectual Disability Psychiatry is a comprehensive and accessible guide to the management of mental health problems in people with intellectual disabilities.  A clear and user-friendly handbook, it will help busy healthcare professionals develop their understanding of the mental health problems of service users with intellectual disabilities.  Most importantly, it will help them make an accurate diagnostic assessment and develop and implement an holistic, person-centred, evidence-based management plan.

Topics covered include the classification of mental disorders in intellectual disability, the clinical assessment of specific disorders, psychological, psychopharmacological and social interventions, and the practical, legal, and social aspects of supporting service users with intellectual disability who have mental health problems.

Leseprobe

Contents

List of Contributors

Foreword

1 Introduction

2 Effective Communication

2.1 Introduction

2.2 Background

2.3 Professional obligations

2.4 Language skills of people with intellectual disability

2.5 The impact of context on communication

2.6 Working with others

2.7 Conclusion

3 Clinical Assessment

3.1 Introduction

3.2 Preparing for the assessment

3.3 Establishing communication

3.4 Starting the assessment

3.5 Presenting problems

3.6 Background history

3.7 Involving others in interviews – the role of a third person

3.8 Examination

4 Assessing Mental Capacity and Making Best Interest Decisions

4.1 Introduction

4.2 Assessment of capacity

4.3 Making best interest decisions

4.4 Planning for losing capacity

4.5 Deprivation of liberty safeguards

4.6 The use of the Mental Health Act

4.7 Conducting research with people who lack capacity

4.8 Children and young people

4.9 Conclusion

5 Common Mental Disorders (Depression, Anxiety, OCD, PTSD)

5.1 Introduction

5.2 Anxiety

5.3 Mood

5.4 Aetiological considerations

5.5 Diagnosing anxiety and mood disorders in people with intellectual disabilities

5.6 Psychiatric assessment of anxiety and mood disorders

5.7 Treatment of anxiety and mood disorders: additional considerations

5.8 Prevention

6 Psychotic Illness

6.1 Introduction

6.2 Definition

6.3 Epidemiology

6.4 Aetiology and risk factors

6.5 Clinical features and diagnosis

6.6 Differential diagnosis

6.7 Assessment and investigations

6.8 Management

6.9 Outcome/prognosis

6.10 Genetic syndromes and psychosis

7 Mental Health Aspects of Autism Spectrum Disorders

7.1 Introduction

7.2 Causes of ASD

7.3 How to make a diagnosis of mental illness in ASD

7.4 Assessment

7.5 Challenging behaviour in ASD

7.6 Comorbid disorders in ASD

7.7 Sexual identity and paraphilias

7.8 Substance misuse

7.9 Impulse disorders

8 Substance Misuse

8.1 Introduction

8.2 Range of substances

8.3 Alcohol

8.4 Drugs

8.5 Assessment

8.6 Adapting treatment approaches

8.7 Working with mainstream and voluntary services

9 Challenging Behaviour

9.1 Introduction

9.2 Systemic perspectives in challenging behaviour

9.3 Assessment

9.4 Functional assessment

9.5 Management

9.6 Conclusion

10 Interaction between Mental and Physical Health

10.1 Introduction

10.2 Biopsychosocial influences

10.3 Physical morbidity

10.4 Interaction between physical and mental health

10.5 Conclusions

11 Mental Health of Older People

11.1 Introduction

11.2 Health and ageing of older adults with intellectual disabilities

11.3 Psychosocial aspects of ageing

11.4 Mental health of older people with intellectual disabilities

11.5 Dementia

11.6 Epidemiology

11.7 Screening for dementia in older people with intellectual disabilities

11.8 Presentation and diagnosis of dementia in people with intellectual disabilities

11.9 Management

11.10 Issues in advanced dementia care

12 Management of Offenders with Intellectual Disabilities

12.1 Introduction

12.2 Background

12.3 Assessment

12.4 Management

12.5 Conclusion

13 Mental Health Crises

13.1 Introduction and context

13.2 Vulnerability to crises

13.3 Emergency presentations

13.4 Aetiology

13.5 Psychiatric presentations

13.6 Summary

14 Pharmacological Interventions

14.1 Introduction

14.2 Pharmacological treatment for mental disorders

14.3 Pharmacological management of problem behaviours among adults with intellectual disability

14.4 General principles underpinning the prescribing of medication

14.5 Input from the person with intellectual disabilities and their families and carers

14.6 Multidisciplinary input

14.7 Prescribing within person centred planning

14.8 Communication issues

14.9 General principles for prescribing psychotropic medications

14.10 Evidence of the risks associated with prescribing medication in adults with intellectual disabilities and problem behaviour

14.11 In instances where the behaviour re-emerges after reducing the dose or withdrawing the medication

14.12 Poly-prescribing

15 Psychological Interventions

15.1 Introduction

15.2 Frameworks for psychological work

15.3 Overview of main psychological approaches

15.4 Behaviour therapy

15.5 Cognitive behaviour therapy

15.6 Psychodynamic therapy

15.7 Systemic therapy

15.8 Work at the organizational level

15.9 Evidence for psychological interventions

15.10 Conclusions

16 Community Care

16.1 The development of care – an historical perspective

16.2 Modern mental health services for people with intellectual disabilities

16.3 Conclusion

Appendix A Critique of the ICD 10 and DSM IV based Classification of Mental Disorders in Intellectual Disability

Appendix B A to Z of Disciplines That May Contribute to the Multi- and Interdisciplinary Work as Applied to Mood and Anxiety Disorders

B.1 Audiology

B.2 Behaviour therapy

B.3 Communication/speech-language pathology

B.4 Intake, service coordination and social work

B.5 Nursing

B.6 Occupational therapy

B.7 Other therapies

B.8 Physiotherapy

B.9 Psychology

B.10 Psychiatry

Index

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Library of Congress Cataloguing-in-Publication Data

Intellectual disability psychiatry : a practical handbook / editors, Angela Hassiotis, Diana Andrea Barron, Ian Hall.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-74251-8 (alk. paper)

1. People with mental disabilities – Mental health. I. Hassiotis, Angela. II. Barron, Diana Andrea. III. Hall, Ian P.

[DNLM: 1. Mental Disorders – psychology. 2. Mental Health Services. 3. Mentally Disabled

Persons – psychology. WM 140 I606 2009]

RC570.2.I65 2009

616.89 – dc22

2009024882

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 9780470742518

Cover Illustration by Manzur Sobhan

List of Contributors

Afia Ali

East London NHS Foundation Trust

London E1 4DG

UK

Diana Andrea Barron

UCL Department of Mental Health Sciences

London W1W 7EJ

UK

Elspeth Bradley

Surrey Place Centre

Department of Psychiatry

Toronto ON M5T 1R8

Canada

Basil Cardoza

ABM University NHS Trust

Learning Disability Directorate

Cardiff CF5 5WF

UK

Peter Carpenter

Kingswood CLDT

Bristol BS15 8PQ

UK

Anna Cooper

Division of Community Based Sciences

University of Glasgow

Psychological Medicine Academic Centre

Gartnavel Royal Hospital

1055 Great Western road

Glasgow G12 0XH

UK

Shoumitro Deb

Department of Psychiatry

University of Birmingham

Edgbaston

Birmingham B15 2TT

UK

Philip Dodd

St Michael’s House

Ballymun

Dublin 9

Ireland

Rebecca Goody

Cornwall Partnership NHS Trust

Bodmin PL31 1AQ

UK

Ian Hall

East London NHS Foundation Trust

London E1 4DG

UK

Angela Hassiotis

UCL Department of Mental Health Sciences

London W1W 7EJ

UK

William Howie

Assessment and Intervention Team

South West London and St George’s Mental Health NHS Trust

London

UK

Michael Kerr

Welsh Centre for Learning Disabilities

Cardiff CF14 3BG

UK

Andrew Levitas

Department of Psychiatry

University of Medicine and Dentistry New Jersey UMDNJ/SOM

Stratford NJ 08084

USA

Shirley McMillan

Surrey Place Centre

Toronto, Ontario M5S 2C2

Canada

Helen Miller

Adult Team National Deaf Services

South West London and St George’s Mental Health Services NHS Trust London SW12 9HW

UK

Deirdre O’Brady

East London NHS Foundation Trust

London E1 4DG

UK

Katrina Scior

Research Department of Clinical, Educational and Health Psychology

London WC1E 6BT

UK

Neill Simpson

East Dunbartonshire JLDT

Kirkintilloch G66 1XQ

UK

Amanda Sinai

Camden Learning Disabilities Service

London NW1 7JR

UK

David Smith

CAMHS

South West London and St George’s Mental Health NHS Trust London

UK

Andre Strydom

Department of Mental Health Sciences

Hampstead Campus

London NW3 2PF

UK

Jennifer Torr

Centre for Developmental Health Victoria

Monash University

Notting Hill

Australia

Petricia Noonan Walsh

Centre for Disability Studies

University College Dublin

Belfield, Dublin 4

Ireland

Emma Whicher

Adult Team National Deaf Services

South West London and St George’s Mental Health Services NHS Trust

London SW12 9HW

UK

Emma Winn

Camden Learning Disabilities Service

London NW1 7JR

UK

Evan Yacoub

East London NHS Foundation Trust

London E1 4DG

UK

Foreword

People with intellectual disabilities are among the most complex and most rewarding of people to work with and the changes in attitudes, in services and in working practices that have occurred in this field in the UK and in some other parts of the world have been truly remarkable. Central to such changes has been the recognition of the importance of respect for the human rights of people with intellectual disabilities, as exemplified by the recent UN Convention on the Rights of Persons with Disabilities, together with an understanding that people with intellectual disabilities vary considerably in the nature and extent of their needs and in their strengths and vulnerabilities. The skills necessary to meet such needs are diverse and require collaborative work across disciplines and between staff from different agencies, including education, health, social services and different service providers.

Achieving much of what people with intellectual disabilities, their families, support workers and others working with people with intellectual disabilities might aspire to, in terms of social inclusion, choice and participation, will depend not just on the opportunities available to people with intellectual disabilities. Also central is ensuring, as far as is possible, sound physical and mental health, and the provision of support and communication strategies that are based on an understanding of individual need. This approach requires a clear understanding of the responsibilities of all those concerned with respect to the prevention, detection and treatment of ill health and ready access to primary and secondary health services and to specialist services as and when required. The extent of health inequalities and the attitudinal and practical barriers to primary, secondary and specialist health care services are increasingly acknowledged, if not, as yet, exactly resolved.

This book is a very welcome contribution to the literature with its specific focus on the mental health of people with intellectual disabilities. As exemplified by the different chapters, this has been an area of substantial development over the last few years. Clinicians and researchers have gained a much better recognition of the relevance of different conceptual models of understanding of the various developmental, biological, psychological and social factors that might predispose to, precipitate and/or maintain the occurrence of particular behaviours and/or abnormal mental states affecting people with intellectual disabilities, and of the range of interventions that should be considered. The focus for the early chapters is on assessment and on the complex issues that can arise with respect to consent and the capacity of individuals to consent to interventions. The subsequent chapters address various aspects of psychiatric comorbidity and focus on specific issues that are becoming increasingly relevant, particularly with respect to people with mild intellectual disabilities, such as substance misuse and the needs of those arrested, charged with and/or convicted of offences. Other chapters focus on challenging behaviour and also on the mental health needs of older people with intellectual disabilities – perhaps best exemplified by the age-related needs of people with Down’s syndrome. The final chapters are on interventions and on services.

This book brings together under one cover present-day knowledge and through its very publication makes a clear statement about the importance of these issues and of what can be done. This book is fundamentally optimistic in that its emphasis is on the benefits of sound assessment and informed intervention, yet it also brings to our attention the limitations of our knowledge and the complexity of the field.

Tony HollandApril 2009

1

Introduction

Angela Hassiotis1, Diana Andrea Barron1 and Ian Hall2

1Department of Mental Health Services, University College London, UK

2East London NHS Foundation Trust, UK

Clinical involvement with, and awareness of, disability is a core component of the current undergraduate medical curriculum. It is one of eight key themes recommended by the General Medical Council which run through the entire five-year medical programme. Despite this, the majority of clinicians who only meet individuals with intellectual disabilities occasionally, often only have limited experience or training in how to work with this group where communication difficulties and variable symptom presentation create particular challenges in the consulting room.

Intellectual Disability Psychiatry: A Practical Handbook has been written and edited by working clinicians and academics in intellectual disabilities with the aim of creating a concise and practical text that addresses the clinical uncertainties that we face in everyday practice.

Working with people with intellectual disability is intellectually stimulating and professionally rewarding. All contributors have day-to-day clinical contact with people with intellectual disabilities, run diverse and innovative services and train undergraduate medical students and psychiatrists in training.

The complex clinical case work and emerging advances in epidemiological and health services research make this an exciting and interesting field. Recent government policy guidance provides an impetus for service innovation and the results of public enquiries help to prioritize initiatives to combat discrimination that people with intellectual disabilities can be subjected to when accessing health services.

People with intellectual disabilities experience high rates of mental disorders especially if problem behaviours are included in the prevalence rates. They are more likely to have associated physical health problems particularly people with more severe intellectual disabilities. There are many challenges in supporting people with intellectual disabilities overcome mental health problems. The ascertainment of mental disorders in this population is far from straightforward: the existing major classification systems, ICD-10 and DSM-IV-TR, are difficult to apply because the criteria for many mental disorders assume a level of ability and development that is lacking in our population. Furthermore, onset or relapse of a mental disorder may be unrecognized because of assumptions that people with intellectual disabilities behave in a certain way. Conditions that are treatable may therefore remain untreated and consequently the individual’s needs are not met and their quality of life is reduced. Intellectual Disability Psychiatry will enable readers to effectively challenge this diagnostic overshadowing.

Chapters cover the key topics in the psychiatry of intellectual disability and include illustrative cases and examples of good practice. Communication is the topic of our first main chapter, and returned to many times in Intellectual Disability Psychiatry because it is so essential. Good communication skills can make all the difference for a clinician to be able to identify mental health problems in people with intellectual disabilities, and deliver treatment interventions.

In many parts of the world, there are no specific mental health services for people with intellectual disabilities. In other places, people with intellectual disabilities use a combination of specialist and mainstream services. We hope Intellectual Disability Psychiatry, written from a practice perspective, will help enable all psychiatrists to have the confidence and skills to work with people with intellectual disabilities. We have designed it to be an invaluable aid in achieving professional competencies and passing professional exams such as the MRCPsych. It is also highly relevant to other health professionals and social workers working with this client group.

We have deliberately avoided making Intellectual Disability Psychiatry an exhaustive research guide, though references to important papers are included as well as suggestions for further reading.

Psychiatry for people with intellectual disabilities is a very well established specialty in the United Kingdom, and several of our contributors use UK legislation and services to illustrate important principles. However, the content and information presented in Intellectual Disability Psychiatry can be adapted and applied in other settings outside the UK. We have intentionally adopted an international perspective in our community care chapter, and solicited contributions from three continents to help ensure an outward looking, forward thinking focus.

2

Effective Communication

Diana Andrea Barron1 and Emma Winn2

1Department of Mental Health Sciences, University of London, UK

2Camden Learning Disabilities Service, London, UK

2.1 Introduction

This chapter aims to give some good practice points to facilitate communication with people with intellectual disability. In reality very few practitioners will have any training specific to the communication needs of this group of people. Our Health, Our Care, Our Say: A New Direction For Community Services [1] drew attention to the lack of skills and training; stating that there is a need to build up skills, especially in basic communication, in social care settings where only 25% of employees have a qualification. Healthcare for All [2] recommends that training for all health care professionals at undergraduate and postgraduate level must include intellectual disabilities on the curriculum.

People communicate in a variety of different ways and all have a right to communicate. A simple definition of communication is dependent upon three things:

1. a message to communicate

2. people who need to communicate with each other

3. a shared way of communicating.

This simple definition applies to everyone regardless of their age and ability to communicate.