ABSTRACT
Services for people with Intellectual Disability (ID) and coexisting mental health problems remain undeveloped; research into their effectiveness has been lacking. Three linked recent studies in the UK have provided evidence on essential service provision from staff, service users and carers. Interfaces with mainstream mental health services were seen as problematic: the area of crisis response was seen as a particular problem. Further services' research is needed, focusing on service components rather than whole service configurations. There was not support for establishing more intensive mental health services for people with ID only. The way forward is in developing new ways of co-working with staff in "mainstream" mental health services. Mental health of ID staff might often be best situated directly within these services.
Subject(s)
Community Mental Health Centers , Community Mental Health Services , Intellectual Disability/rehabilitation , Community Mental Health Centers/organization & administration , Community Mental Health Centers/trends , Community Mental Health Services/organization & administration , Community Mental Health Services/trends , Humans , Mental Health , United KingdomABSTRACT
We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N=124) as compared to adults with ID only (N=562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD.
Subject(s)
Child Development Disorders, Pervasive/epidemiology , Intellectual Disability/epidemiology , Mental Disorders/epidemiology , Adolescent , Adult , Aged , Child , Child Development Disorders, Pervasive/etiology , Comorbidity , Female , Humans , Intellectual Disability/etiology , Intelligence Tests , Logistic Models , Male , Mental Disorders/etiology , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Severity of Illness Index , Young AdultABSTRACT
PURPOSE OF REVIEW: This review will examine the most recently published studies of community services for people with intellectual disabilities and mental health problems. RECENT FINDINGS: There is a continuing lack of evidence regarding these community-based services. Few studies have been published at all whilst even fewer still have reported outcomes in any detail. Recent studies have attempted to evaluate assertive community treatment for this service user group; however, they have been unsuccessful owing to inconsistency about what an assertive community treatment service should be for people with intellectual disabilities. SUMMARY: An evidence base is urgently needed for these community-based services. Research should utilize the opinions of service users and their carers as well as professionals and focus on those people with intellectual disabilities and more severe mental health problems. It may be more fruitful to examine the components of community-based services rather than use the terminology of specific models such as assertive community treatment. The service components considered to be essential need first to be identified using a systematic methodology and then evaluated using a broad range of outcomes.
Subject(s)
Community Mental Health Services , Intellectual Disability/therapy , Mental Disorders/therapy , Adult , Aggression/psychology , Community-Institutional Relations , Comorbidity , Deinstitutionalization , Evidence-Based Medicine , Humans , Intellectual Disability/diagnosis , Intellectual Disability/epidemiology , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Needs Assessment , Patient Care Team , Patient Readmission , Schizophrenia/diagnosis , Schizophrenia/epidemiology , Schizophrenia/therapy , Treatment Outcome , United KingdomABSTRACT
Associations between demographic and clinical variables and severe behavioural problems in people with intellectual disabilities were examined in a cross-sectional survey of 408 adults consecutively referred to a specialist mental health service. Severe behavioural problems were present in 136 (33.3%) of the sample. The demographic and clinical predictors of severe behavioural problems in this sample were identified by logistic regression. Age and gender were not associated with severe behavioural problems. The presence of severe ID independently predicted the presence of severe behavioural problems. Schizophrenia spectrum disorders and personality disorders independently predicted the presence of severe behavioural problems, whereas the presence of an anxiety disorder independently predicted their absence. There is an increasing evidence base of relationships between mental disorders and behavioural problems in people with ID although the pattern of these relationships remains unclear.
Subject(s)
Intellectual Disability/epidemiology , Mental Disorders/epidemiology , Adult , Comorbidity , Cross-Sectional Studies , Disability Evaluation , Female , Humans , Intellectual Disability/diagnosis , Intellectual Disability/psychology , Intelligence , London , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Referral and Consultation/statistics & numerical data , Retrospective StudiesABSTRACT
PURPOSE OF REVIEW: To examine most recently published studies of schizophrenia spectrum disorders in people with intellectual disabilities. RECENT FINDINGS: Studies that have been published in the review period have advanced understanding of the epidemiology, presentation, assessment, suspected neuropathology, genetics and treatment of, and service issues relating to, schizophrenia spectrum disorders in people with intellectual disabilities. SUMMARY: The number of published studies investigating schizophrenia spectrum disorders in people with intellectual disabilities continues to increase slowly. The evidence base, however, needs to be strengthened, particularly by randomized controlled trials in pharmacotherapy, psychosocial interventions and service delivery.
