Down's syndrome

Abstract

We congratulate Nancy Roizen and David Patterson (April 12, p 1281)1Roizen NJ Patterson D Down's syndrome.Lancet. 2003; 361: 1281-1289Summary Full Text Full Text PDF PubMed Scopus (868) Google Scholar for a comprehensive seminar on the latest developments relevant to the care of people with Down's syndrome. Although holistic health care is necessary to deal with the complex health problems that such individuals can develop, I would like to emphasise the mental health issues associated with the disease. Roizen and Patterson state that psychiatric problems arise less frequently in those with Down's syndrome than in other individuals with intellectual disability; this statement is only true of children. Adults with Down's syndrome can have a similar prevalence of psychiatric problems to other people with intellectual disability. Although due in part to the high prevalence of dementia in older people, a raised frequency of psychiatric problems is also related to the increased prevalence of depression in people with Down's syndrome.2Collacot RA Cooper SA Branford D McGrother C Behaviour phenotype for Down's syndrome.Br JPsychiatry. 1998; 172: 85-89Crossref PubMed Scopus (53) Google Scholar Given that the risk of affective disorders in those with intellectual disability compared depressive disorders than adults in the general population is already high,3Richards M Maughan B Hardy R Hall I Strydom A Wadsworth M. Long-term affective disorder in people with mild learning disability.Br J Psychiatry. 2001; 179: 523-527Crossref PubMed Scopus (85) Google Scholar those with Down's syndrome seem to be much more vulnerable to depressive disorders than adults in the general population. However, they do seem to be protected from some psychiatric disorders such as personality disorder, anxiety, and schizophrenia. Manic episodes were initially assumed not to occur in people with Down's syndrome, but several cases have been published in the past decade.4Collacot RA People with Down syndrome and mental health needs.in: Bouras N Psychiatric and behavioural disorders in developmental disabilities and mental retardation. Cambridge University Press, Cambridge1999Google Scholar Mania arises mostly in male patients and often has a rapid cycling pattern. Recognition of mental illness in people with Down's syndrome is complicated by their degree of intellectual disability and speech deficits. Presenting symptoms of depression can be atypical and easily confused with dementia or physical problems such as hypothyroidism.4Collacot RA People with Down syndrome and mental health needs.in: Bouras N Psychiatric and behavioural disorders in developmental disabilities and mental retardation. Cambridge University Press, Cambridge1999Google Scholar Diagnosis is further complicated by the difficulties in interpreting special investigations such as MRI scans.5Strydom A Hassiots H Walker Z Clinical use of structural magnetic resonance imaging in the diagnosis of dementia in adults with Down's Syndrome.Ir J Psychol Med. 2002; 19: 60-63Google Scholar Primary care doctors are advised to watch out for symptoms of depression and dementia when assessing a person with Down's syndrome, and to make use of the expertise of specialist intellectual disability teams if available.