Borderline intellectual functioning and schizophrenia-like psychosis in a patient with co-occurring variants of unknown significance in NAA15 and ZNF292: insights from whole-exome sequencing

Housing First (HF) has been linked to increased tenure in housing for homeless people with mental illness, but the effect of HF on housing stability for people with borderline or lower intellectual functioning has not been examined. This study of homeless adults with mental illness in Toronto, Ontario assessed whether the association between housing stability and HF differed for adults with borderline or lower intellectual functioning, compared to adults with above borderline intellectual functioning. This study included 172 homeless adults with mental illness from the Toronto site of the At Home-Chez Soi randomized trial that compared receiving HF relative to treatment as usual. This sample was divided into two intellectual functioning groups: 1) adults with borderline or lower intellectual functioning (IQ < 85, 16%), and 2) adults with above borderline intellectual functioning (IQ ≥ 85, 84%). We compared these groups by modelling the percentage of days stably housed using a linear multivariable generalized estimating equation and included interaction between treatment and intellectual functioning. An interaction between treatment and time was also included. There were no overall differences in housing stability for individuals with borderline or lower intellectual functioning compared to people with higher than borderline intellectual functioning in either the HF or the treatment as usual groups. This study is the first to demonstrate that for homeless adults with mental illness, borderline or lower intellectual functioning did not significantly affect housing stability. This accentuates the need for more research and potentially wider consideration of their inclusion in housing interventions, such as HF.

This paper reports on the association between intellectual functioning and lifetime homelessness duration among 172 homeless adults with mental illness in Toronto, Canada. Using a standardized test of intellectual functioning, we created two groups: individuals with borderline or lower intellectual functioning (16%) and individuals with above borderline intellectual functioning (84%). Lifetime homelessness duration was approximately three years longer, or almost twice as long, for individuals with borderline or lower intellectual functioning. Implementing more systematic strategies for identifying and supporting individuals with cognitive impairments may hasten transitions out of homelessness for this population. Brief intellectual functioning assessment tools are available.

Background: Children with borderline intellectual functioning represent a unique course of behavioral and developmental challenges. One such issue is emotion regulation (ER), leading to poor interpersonal relationships and adjustment issues in adulthood. There are extensive studies highlighting the role of parenting style in emotion regulation. Aim: The present study compares the emotion regulation and parenting style in children having borderline intellectual functioning (BIF) versus average intellectual functioning (AIF). Methods: Fifty pairs of child-parent were recruited, 25 children with AIF, and 25 children with BIF. The intelligence quotient (IQ) score on Malin’s Intelligence Scale for Indian Children (MISIC) was used to identify children as BIF and AIF. Emotional Regulation Questionnaire- Child and Adolescents (ERQ-CA) was used with children to assess ER. Parental Authority Questionnaire (PAQ) was administered to either parent to assess the parenting style of parents. Results: Descriptive statistics and Chi-square test were used to analyze the data. The results suggested that children with BIF significantly differed (p=.004) from children with AIF in emotion regulation strategy at .01 level of significance. Additionally, parents of children with BIF were permissive, and the difference in parenting style was significant (p=.022) at .05 level of significance. Conclusions: The child's cognitive abilities might be influencing his functioning and interaction with parents. The intervention programs aiming at the regulation of emotions for children with BIF, along with parental training, might be helpful. More research is required to understand and assess issues of this vulnerable and neglected group.

Background: Borderline intellectual functioning (BIF) is associated with deficits in cognitive functions and effective communication or interpersonal skills, impacting socio-occupational functioning in adulthood. Aims: The current study compared individuals with BIF and average intellectual functioning (AIF) on executive functioning, emotion dysregulation, and interpersonal communication competence in relation to the quality of life. Settings and Design: The data were collected via a face-to-face interview conducted in the tertiary care hospital in an urban locality. A cross-sectional and comparative matched-group research design using purposive sampling was used. Materials and Methods: An estimated sample size of 80 was split into BIF and AIF groups. The participants were recruited as per the defined criteria. The measures used were Raven’s Standard Progressive Matrices, General Health Questionnaire, Mini-International Neuropsychiatric Interview, Stroop Test (ST), Difficulties in Emotion Regulation Scale (DERS), Interpersonal Communication Competence Scale (ICCS), and World Health Organization Quality of Life- Brief (Qol). Statistical Analysis: The differences, between BIF and AIF groups as well as males and females within each group, on measures, namely, ST, DERS, ICCS, and QoL were compared using the independent t-test. Further, the relationship among the measures was examined using Pearson correlation and regression analysis. Results: Independent t-test analysis revealed significant differences between groups on execution functioning (t = 11.83, P = 0.000), all domains of emotional dysregulation (P &lt; 0.000), and many domains of interpersonal communication, and quality of life (P &lt; 0.000). Significant correlations were found between domains of DERS and ICCS, DERS and QOL; ICCS and QOL. Conclusions: Emotional dysregulation predicted physical and psychological health and the environment, while interpersonal communication predicted social relations.

This study aims to evaluate differences in the clinical profiles and use of psychiatric services by people with schizophrenia with and without borderline intellectual functioning. Both groups in this study were receiving standard community psychiatric care. A naturalistic sample of 372 people with schizophrenia completed the National Adult Reading Test. Data were collected prospectively over 18 months on psychiatric symptoms and service use. Three hundred and thirteen had normal intellectual functioning (mean age 43, range 20-76 years) and 59 had borderline or lower intellectual functioning (mean age 45, range 21-81 years). This was defined by a National Adult Reading Test error score of more than 40. People with borderline or lower intellectual functioning had a lower quality of life, more severe psychotic symptoms, reduced functioning and fewer antidepressant prescriptions. There were no significant differences in service use including hospital admission. People with schizophrenia and borderline or lower intellectual functioning are a more disabled group within general adult psychiatric services who should be the focus of initiatives for improved service delivery.

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

De novo mutation of the TSC2 gene in patient with Tuberous Sclerosis Complex-Associated Neuropsychiatric Disorders (TAND) Phenotype: a case report.

Intellectual disability (ID) is known to be more common in incarcerated groups, especially incarcerated youth. Aboriginal young people have higher rates of ID, and make up half of all youth in juvenile custody in New South Wales (NSW), Australia. We aimed to describe the prevalence of possible ID and borderline intellectual functioning (BIF) in young people in NSW custody, and to describe the association between possible ID and Aboriginality after adjusting for the inequalities in social disadvantage. Baseline study of all youth in NSW Custodial Centres between August and October 2009, with 18-month follow-up. Using Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV) and Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) cognitive assessments, possible ID was defined as Extremely Low Intellectual Quotient range (Full Scale Intellectual Quotient, FSIQ < 70), and possible BIF was defined as Borderline IQ range (FSIQ < 80). Risk factors for possible ID and BIF included age, gender, Aboriginality, socio-economic disadvantage, offending history and psychological disorders. N = 295 (65%) of all young people in NSW custody completed cognitive and psychological assessments (87% male, 50% Aboriginal, average age 17 years). Almost one half (45.8%) of young people had borderline or lower intellectual functioning (by IQ assessment), and 14% had an IQ in the extremely low range (FSIQ < 70), indicating a possible ID. Aboriginal participants were three times more likely than non-Aboriginal participants to have a possible ID, but after accounting for the excess disadvantage in the Aboriginal group, Aboriginality was no longer a marker of ID. Incarceration from a young age and psychosis were significantly associated with possible ID in Aboriginal participants, compared with Aboriginal participants first incarcerated at a later age, and Aboriginal participants without psychosis. The inequalities in criminal justice between Aboriginal and non-Aboriginal youth may exacerbate or contribute to the intellectual impairment of those incarcerated from a young age. Aboriginal young people with psychosis are also at high risk of cognitive impairments that might indicate a possible co-morbid ID, and these patients should be diverted at court into community assessment services, rather than incarcerated. These results highlight a need for better and earlier identification of young people (particularly Aboriginal youth) at risk of ID and other co-morbidities in the juvenile justice system.

Background: Borderline intellectual functioning (BIF) and schizoid personality disorder (Schizoid PD) are clinical conditions under-researched and poorly understood. The principal aim of this retrospective study was to investigate cognitive abilities in people with BIF and Schizoid PD. Clinical, demographic, and neuropsychological data of forty-seven Schizoid PD participants, with an average age of 35, were analyzed. The sample split into two groups: Schizoid PD with BIF (BIF+: n = 24; intelligence quotient – IQ range: 71-84) and Schizoid PD without BIF (BIF-: n = 23; IQ range: 89-121). A descriptive analysis of the clinical and demographic characteristics of the two groups was performed.&#x0D; Methods: Neuropsychological measures (Wechsler Adult Intelligence Scale-Revised – WAIS-R IQ, factor index, subtest scores) and cognitive performance deficits in the two groups were compared using parametric and non-parametric tests, as necessary. Correlation coefficients were calculated for relationships between variables. Regression analyses were conducted to identify predictors associated with negative outcomes, such as substance use behavior.&#x0D; Results: The results revealed that the cognitive profile of BIF+ deviated significantly from that observed in BIF-. Peculiar BIF+ dysfunctions were found in the domains of verbal and perceptual reasoning, attention, memory, processing speed, planning, and problem-solving. The verbal IQ had the highest discriminative value for the presence of BIF in patients with Schizoid PD.&#x0D; Conclusions: The BIF condition and the verbal comprehension index were the predictors most associated with substance use behavior. Early identification of BIF should be relevant to planning targeted intervention strategies to improve daily life skills and outcomes.

PurposeStudies on psychiatric comorbidity in individuals with borderline intellectual functioning (BIF) are scarce, particularly with respect to certain diseases frequently observed in clinical practice. The purpose of this paper is to discuss the relevance of epidemiological research to psychiatric comorbidity in people with BIF.Design/methodology/approachSystematic searches of MEDLINE, EMBASE and Cochrane databases. Inclusion criteria: publications about BIF appearing between 1995 and 2017; epidemiological findings about comorbid mental disorders in individuals with BIF; and studies comparing BIF, mild intellectual disability (ID) and normal intellectual functioning. The discussion covers 24 of the 224 studies initially considered.FindingsThe most frequent psychiatric comorbidity reported was personality, post-traumatic as well as psychotic disorders, followed by psychosis, attention deficit and hyperactivity disorder, bipolar and sleep disorders. Individuals with BIF exhibit psychiatric comorbidity more frequently than individuals with normal intellectual functioning. Some psychiatric comorbidities were similarly prevalent in patients with BIF and those with mild or moderate ID; however, the prevalence was always higher in people with severe ID. Environmental factors, especially psychosocial adversity, seem to play an important mediating role. Pharmacotherapy is the most common treatment approach, including behavioural disorders.Originality/valueThis review of literature on mental disorders in people with BIF demonstrates the epidemiological relevance of psychiatric comorbidity, especially personality and post-traumatic disorders. Mental health professionals, general practitioners and other workers in outpatient settings have to be aware about the vulnerability and even fragility of people with BIF.

Infants born at extremely low birthweight (ELBW: ≤1000g) are vulnerable to intellectual disabilities, but the factors that may distinguish between ELBW survivors with and without these impairments are not well understood. In this study, prospective associations between neonatal factors and functional outcomes in childhood and adolescence were compared in ELBW survivors with and without borderline intellectual functioning (BIF). Borderline intellectual functioning was defined by IQ<85, assessed at 8years. Among 146 ELBW survivors, 48 (33%) had IQ scores under 85, and 98 (67%) had scores equal to or over 85. Group differences in demographic and risk factors were assessed via t-test, chi-squared analysis or non-parametric tests. Neonatal factors that differed between ELBW groups were tested for association with adaptive behaviour assessed at age 5years, and reading and arithmetic skills assessed at ages 8 and 15years, using hierarchical regression models. Extremely low birthweight survivors with BIF had significantly lower birthweights than ELBW survivors without BIF (790 vs. 855g, P<0.01) and were more likely to be born to mothers with lower socioeconomic status (SES) (78% vs. 48%, P<0.01). These ELBW survivors also were more likely to be diagnosed with significant neurosensory impairment (NSI; 35% vs. 19%, P<0.04), experienced more bronchopulmonary dysplasia (56% vs. 38%, P<0.04), received more days of respiratory support (median 33 vs. 14days, P<0.01) and remained in hospital for longer periods (median 81 vs. 63days, P<0.03). Birthweight, familial SES, NSI and duration of respiratory support were significant predictors for one or more outcomes. Across groups, lower familial SES was associated with lower academic scores (Ps<0.05), and NSI predicted lower adaptive functioning (Ps<0.001). Other associations were moderated by group: among ELBW survivors with BIF, heavier birthweights predicted better arithmetic skills, the presence of NSI was associated with poorer arithmetic skills and more ventilation days predicted poorer reading skills. At birth, ELBW survivors with BIF faced more physiological and social disadvantages and required more medical intervention than their ELBW peers without BIF. Smaller birth size, NSI burden and prolonged neonatal ventilatory support displayed gradients of risk for childhood and adolescent academic outcomes across groups. Whereas academic performance in ELBW survivors with BIF was sensitive to variation in birth size, NSI or ventilation days, ELBW survivors without BIF attained thresholds of intellectual ability that were sufficient to support higher levels of academic performance at both ages, regardless of their status on these factors. The findings are discussed in relation to Zigler's developmental theory of intellectual disability.

BackgroundThe demand for support for persons with mild intellectual disability or borderline intellectual functioning is growing rapidly. These persons often encounter individual and familial limitations that influence their human functioning, and often have difficulty coping with the demands of modern society. Although in the areas of policy, research and practice, people with mild intellectual disability or borderline intellectual functioning are generally approached as one group, important differences between them have been reported. Current support seems to be both suboptimal and insufficiently differentiated.MethodsIn this Delphi study we aimed to explore the need for appropriate and differentiated support for individuals with mild intellectual disability or borderline intellectual functioning. The study was based on five unique profiles of persons with mild intellectual disability or borderline intellectual functioning that are associated with individual and environmental variables. The opinions of expert primary caregivers, professional caregivers and scientists were analysed for potentially appropriate types of support for each of the five profiles.ResultsA total of 174 statements, divided over the five profiles, were presented to the participants. For 74 statements, consensus was reached between the expert groups. For each profile, these consensual statements represented specific items (e.g. concrete personal goals) and non-specific items (e.g. the attitude towards persons with mild intellectual disability or borderline intellectual functioning, and the coordination of health care) related to the support needs.ConclusionThis Delphi-based study generated consensual opinions contributing to a more differentiated system of support for individuals with mild intellectual disability or borderline intellectual functioning. Although these findings need additional investigation, they address actions that might enhance the support programmes for these individuals into more personalized support.

Borderline intellectual functioning is associated with poor social functioning, increased rates of psychiatric diagnosis and drug use – A cross sectional population based study

An integrative review of 41 Korean research articles(Korea Citation Index, KCI) on the students with ‘borderline intellectual functioning (BIF)’ which were published from 2010 to May 2022 was conducted. The research trend, the use of terms related with ‘BIF’, the common characteristics of the ‘BIF’ students, and the educational supports to each characteristic were all examined. One controversial topic in the Korean contemporary special education delivery system is an increase in interest toward students who do not belong to the 10 disability types(e.g., intellectual disability, physical disability, etc.) that constitute the eligibility for Korean special education but still need educational supports. One of them is a group of ‘BIF’ students. As a result of this literature review, six terms related to ‘BIF’ were identified and their definitions were presented. The common characteristics of ‘BIF’ students were identified by four factors: cognitive and learning, language, social and emotional, and motor functional characteristics; furthermore, the detailed descriptions and each of their educational supports were summarized. This study proposes the coherent use of the term ‘borderline intellectual functioning’ and calls for cooperative brainstorming among professionals, parents, and education authorities to establish a system of public educational supports for BIF students and follow-up research.