Predictors of mental illness onset in adolescents and adults with intellectual disability: A retrospective cohort study in New South Wales, Australia.

Objectives To describe the incidence of recorded mental illness and challenging behaviour in people with intellectual disability in UK primary care and to explore the prescription of psychotropic drugs in...

The risk of mental illness in people living with HIV in the UK: a propensity score-matched cohort study.

While it has been reported that the prevalence of mental illness is higher in homeless people than in the national population, few studies have investigated the prevalence of intellectual and developmental disability among the homeless. In this study, we conducted a survey to comprehensively assess these mental problems among homeless people in Nagoya, Japan. The subjects were 18 homeless men. Mental illness was diagnosed with semi-structured interviews conducted by psychiatrists. We used the Wechsler Adult Intelligence Scale III to diagnose intellectual disability. Discrepancies between Wechsler Adult Intelligence Scale III subtest scores were used as criteria for developmental disability. Eleven of the 18 participants were diagnosed with mental illness: six with mood disorder, two with psychotic disorder, and six with alcohol problems. The mean IQ of all subjects was 83.4 ± 27.4. The 95% confidence interval (CI) was 96.2-69.1. Seven participants were found to have intellectual disability. Three men showed discrepancies of more than 10 between subtest scores, and all of them were diagnosed with a mental illness. We divided the participants into four groups: those with mental illness only; those with intellectual disability only; those with both problems; and those without diagnosis. The men with intellectual disability only were significantly younger and had been homeless since a younger age than the other groups. Participants diagnosed with a mental illness had been homeless for longer than those without mental health problems. Although the sample size was limited, this study revealed the high prevalence of mental illness and intellectual disability, 61% (95%CI, 35-83%) and 39% (95%CI, 17-64%), respectively, in homeless people in Nagoya, Japan.

More people with an intellectual disability are now living to older age and there is a paucity of information about this group of people. Mental illness is 2-3 times more prevalent in people with an intellectual disability than in the general community; however, this often goes undiagnosed and undetected. Additional issues complicate assessment if the person is also ageing. Little is known about the prevalence and nature of mental illness in this group of older people. Instruments used to assist in the diagnosis of mental illness in the general community are not suitable for use with individuals who have an intellectual disability. The Developmental Behavioural Checklist for Adults (DBC-A) (Mohr, Tonge & Einfeld, 2005) is a well established screen for psychopathology; however, it has no standardised norms and has not been specifically validated for older adults. Lack of knowledge and inadequate assessment processes can result in inappropriate service delivery and therefore reduced quality of life for older people with an intellectual disability and their carers. The general aim of the research was to contribute knowledge about older people with an intellectual disability and more specifically to investigate their mental health. In addition, the validity of the DBC-A for use with older adults was examined. An epidemiological study of adults aged 55 years and older, who lived in representative areas in South Australia, and who were registered with intellectual disability service agencies, were surveyed. Familiar informants completed a questionnaire booklet (see Appendix A). The Adaptive Behaviour Dementia Questionnaire (ABDQ) (Prasher, Farooq & Holder, 2004) and, for a subset of the participants, the Dementia Screening Questionnaire for Individuals with Intellectual Disability (DSQIID) (Deb, Hare, Bhaumik et al., 2007a) were also completed (see Appendices F and G). There was a participation rate of 91.7% and participants’ ages ranged from 55-86 years, the majority being males (56.6%), except in the oldest cohort. Those aged 55-64 years appears to differ from those who are older and younger. They have more severe intellectual impairments, more chronic health conditions, they are less likely to be engaged in activities, and have fewer relationships. Those older than 65 years are more similar to older people without an intellectual disability except that more live in nursing homes or larger congregate care settings. Standardised normative data was established for the DBC-A for older people. The DBC-A profile showed age-associated decline in psychopathology; however, the intensity of behaviours was higher in older people with more severe cognitive impairment. Significant psychopathology was found in 16% of older adults. There were no gender differences but those with a moderate level of intellectual disability had the highest rates. Being younger, having fewer hours in activity, living in large congregate care and significant life events were all risk factors. Rates of dementia of between 5-7% were found using the ABDQ, DSQIID and respondent report. A dementia screen using items from the DBC-A (DBC-A Dem) identified almost double that number. There was no association between age and dementia status in this study, which differs from other research, as does the lack of relationship between having Down syndrome and dementia status. The results of this study confirm a picture of differential mortality and the presence of a healthy survivor cohort who have fewer chronic health problems and are more likely to have a mild level of intellectual disability. Although there is an age-related decline in the prevalence of mental illness, rates are still one and a half times more than older people who do not have an intellectual disability. With minor amendments, the DBC-A is a valid screening instrument for use with older people with an intellectual disability. It can record changes in a wide range of emotional and behaviour disturbances including those that may affect older people, including dementia. When used with other DBCs for children and adolescents (Einfeld & Tonge, 1995) it provides a simple and familiar way to record psychopathology throughout the lifespan. This offers clinicians, researchers and service providers a means to monitor and maintain the mental health and well-being of older people with an intellectual disability.

A growing body of research implicates inflammation as a potential pathway in the aetiology and pathophysiology of some mental illnesses. A systematic review was conducted to determine the association between parasitic infection and mental illnesses in humans in Africa and reviewed the state of the evidence available. The search focused on publications from Africa documenting the relationship between parasites from two parasite groups, helminths and protozoans, and four classifications of mental illness: mood affective disorders, neurotic and stress-related disorders, schizotypal disorders and unspecified mental illnesses. In the 26 reviewed papers, the prevalence of mental illness was significantly higher in people with parasitic infection compared to those without infection, i.e., 58.2% vs 41.8% (P < 0.001). An overall odds ratio found that the association of having a mental illness when testing positive for a parasitic infection was four times that of people without infection. Whilst the study showed significant associations between parasite infection and mental illness, it also highlights gaps in the present literature on the pathophysiology of mental illness in people exposed to parasite infection. This study highlighted the importance of an integrated intervention for parasitic infection and mental illness.

Down's syndrome

There are a few studies in the literature analyzing the prevalence of mental illness in people with intellectual disabilities (ID). This study explores the prevalence of mental disorders in adults without previous mental disorder and different degrees of ID. We assessed 142 individuals with varying degrees of ID and with unknown previous psychiatric disorder. We applied the diagnostic battery PAS-ADD based on criteria ICD-10 and DSM-IV TR to analyzed the prevalence of mental disorders in people with mild / moderate ID. We applied the Spanish version of the scale DASH-II to analyze the prevalence of mental disorders in people with severe and profound ID. We found a psychiatric disorder previously undiagnosed in 29.57% of our sample. In people with mild/ moderate ID the most common psychiatric disorder was depressive disorder (33.3%), but in people with severe and profound ID was the anxiety disorder. The most prevalent medical comorbidity was epilepsy (22.5% of the total sample and 39.2% in the population with severe / profound intellectual disabilities). Psychiatric disorders seem to be more common in the population with ID than in the general population, increasing their prevalence and medical comorbidity in severe and profound ID.

Gender Differences in Police Encounters Among Persons With and Without Serious Mental Illness

This study examined the rates, patterns, and types of police contacts among men and women with and without serious mental illness. Data on type of contact, type and number of offenses, dispositions, and repeat offenses were extracted from an administrative database of all police encounters in a midsized Canadian city over a six-year period (N=767,365). Men and women with serious mental illness represented, respectively, .5% and .4% of men and women who had at least one contact with the police; however, they were involved in 3.2% and 3.0% of all interactions, respectively. Persons with mental illness were more likely than those without mental illness to be in contact with police as suspected offenders, to have a greater number of offenses, to reoffend more quickly, and to be formally charged for a suspected offense. Among persons without mental illness in contact with police, men were much more likely than women to be offenders, to have a greater number of offenses, and to reoffend more quickly. Among persons with mental illness, however, the gender gap for these measures was significantly smaller. More resources should be allocated to support persons with mental illness in the community because they tend to have high rates of repeated police contacts for a variety of offenses. The findings highlight the need for gender-specific intervention programs. Administrative databases can be useful tools in examining police contacts among persons with mental illness and monitoring change after policy and program implementation for those at risk of police encounters.

Accessible summaryPeople with intellectual disability have multiple health problems.People with intellectual disability have more physical and mental health conditions than people without intellectual disabilities.People with intellectual disability may need more health checks due to increased prevalence of physical and mental illnesses.More studies are needed to understand what interventions are effective to reduce health problems in people with intellectual disability.AbstractBackgroundStudies have reported increased prevalence of physical and mental health conditions in people with intellectual disabilities (ID) compared to people without intellectual disabilities. However, there are no studies looking into specific health conditions at a national level and comparing with areas that are socio‐economically disadvantaged (e.g. low income and low education attainment). This study examines and compares the prevalence of physical and mental health morbidity in people with and without intellectual disabilities at a local and national level in the UK.MethodThis study was an anecdotal analysis of physical and mental health data and annual health check‐up for England (national), London (regional) and Haringey (inner‐city borough of London) in 2016/17 using data from the NHS Digital database.ResultsPatterns of mental and physical conditions for people with and without intellectual disabilities were similar across Haringey, London and England data. Severe mental illness was more prevalent among people with intellectual disabilities compared to non‐intellectual disability peers. This further increased in the inner‐city London borough for the intellectual disability group. Certain physical health conditions were also more prevalent in people with intellectual disabilities. Certain activities such as monitoring blood pressure, recording body mass index and checking HbA1C were better in people with intellectual disabilities. Uptake of annual health checks for people with intellectual disabilities remained around 50%.DiscussionThis study further highlights the increased prevalence of mental and physical disorders in people with intellectual disabilities compared to people without intellectual disabilities. Further increased risk of mental disorders in an inner London borough compared to national data aligns with existing literature that highlights the negative impact of socio‐economic deprivation on mental and physical health. Further studies are needed to assess the health and social care measures that can reduce the physical and mental health morbidity in people with intellectual disabilities.

Diagnostic Manual–Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons With Intellectual Disability, by R. Fletcher, E. Loschen, C. Stavrakaki, and M. First

The central place of psychiatry in health care worldwide.

Part I. Assessment and Diagnosis: 1. Diagnosis of mental disorders in people with intellectual disabilities Peter Sturmey 2. Mental health assessment and monitoring tools for people with intellectual disabilities Caroline Mohr and Helen Costello 3. Interdisciplinary multi-modal assessment for mental health problems in people with intellectual disabilities Jean O'Hara 4. The relationship between challenging behaviour and psychiatric disorders in people with severe intellectual disabilities Collin Hemmings 5. The interface between medical and psychiatric disorders in people with intellectual disabilities Nick Lennox Part II. Psychopathology and Special Topics: 6. The psychopathology of children with intellectual disabilities Bruce Tonge 7. Depression, anxiety and adjustment disorders in people with intellectual disabilities Chrissoula Stavrakaki and Yona Lunsky 8. Schizophrenia spectrum disorders in people with intellectual disabilities David Clarke 9. Personality disorder W. Lindsay 10. Dementia and mental ill health in older people with intellectual disabilities Sally-Anna Cooper and Anthony J. Holland 11. People with intellectual disabilities who are at risk of offending Glynis Murphy and Jonathan Mason 12. Behavioural phenotypes: growing understandings of psychiatric disorders in individuals with intellectual disabilities Robert Hodapp and Elizabeth Dykens 13. Mental health problems in people with autism and related disorders Celine Saulnier and Fred Volkmar 14. Self-injurious behaviour John Hillery and Philip Dodd 15. Mental health and epilepsy among adults with intellectual disabilities Sumitro Deb 16. Neuroimaging and intellectual disabilities Max Pickard and Dene Robertson Part III. Treatment and Therapeutic Interventions: 17. Treatment methods for destructive and aggressive behaviour in people with severe developmental and intellectual disabilities R. Matthew Reese, Jessica Hellings and Stephen Schroeder 18. Behavioural approaches to treatment: principles and practices Betsy Benson, Susan Havercamp 19. The psychopharmacology in intellectual disabilities Bryan King 20. Psychosocial interventions for people with intellectual disabilities Dave Dagnan 21. Psychodynamic approaches to people with intellectual disabilities: individuals, groups/systems, and families Georgina Parkes and Sheila Hollins Part IV. Policy and Service Systems: 22. Mental health and intellectual disabilities: the development of services Stuart Cumella 23. Clinical services for people with intellectual disabilities and psychiatric or severe behaviour disorders Philip Davidson and Jean O'Hara 24. Staff supporting people with intellectual disabilities and mental health problems Chris Hatton and Fiona Lobban 25. Professional training for those working with people with intellectual disabilities and mental health problems Helen Costello and Geraldine Holt, Nancy Caine, Elspeth Bradley, Jennifer Torr, Robert Davis, Niki Edwards and Nicholas Lennox.

People with serious mental illnesses increasingly are being treated in jails and prisons, and during incarceration are afforded a constitutional right to medical care. This right pertains to both general medical and mental illnesses and both acute and chronic conditions. However, incarcerated patients with treatment-resistant schizophrenia (TRS) often are not offered clozapine, the only medication for this debilitating illness approved by the U.S. Food and Drug Administration. In this column, the authors argue that incarcerated individuals with TRS have a statutory and constitutional right to treatment with clozapine.

Mental illness in patients with end-stage kidney disease in South Korea: a nationwide cohort study