[The new draft law on care and coercion. Concerning the use and the reduction of antipsychotics without a valid indication in people with intellectual disabilities]. / De nieuwe wet Zorg en dwang: over het gebruik en afbouwen van antipsychotica zonder geldige indicatie bij mensen met een verstandelijke beperking.

BACKGROUND: In the Netherlands, many people with an intellectual disability and challenging behavior are still prescribed antipsychotic medication, often for many years and in high doses. According to the new draft law on care and coercion, prescribing antipsychotics, without a valid indication, for people with an intellectual disability, will be regarded as coercion. The effect for clinical practice will be that such antipsychotic medication will have to be re-assessed and, in many cases, reduced and stopped. AIM: To comment on the effectiveness, the side effects and futility of prescribing antipsychotics to people with an intellectual disability and challenging behavior in order to arrive at recommendations about the evaluation of antipsychotics and, if possible, about the reduction of antipsychotics for intellectually challenged people who do not really require such medication. METHOD: Practical recommendations are made based on recent literature and clinical experience. RESULTS: Thorough evaluation and - when possible - the reduction of antipsychotics for people with an intellectual disability requires psychiatrists to invest time and energy in diagnosis and stability of patients, to invest in the patient's environment and to opt for a controlled reduction of antipsychotics. CONCLUSION: The new draft law on care and coercion highlights the urgent need for guidelines concerning the reduction of antipsychotics for people with an intellectual disability when there is no clear indication that such a step will benefit the patient.

[Diagnosing psychiatric disorders in people with (very) mild intellectual disabilities]. / Diagnostiek van psychiatrische stoornissen bij mensen met een (zeer) lichte verstandelijke beperking.

BACKGROUND: There is a good chance that you, as a psychiatrist, will come in to contact with patients who have a borderline or mild intellectual disability (50 > iq < 85). Referral to specialised care is not always an option and may not always be necessary. However, diagnosing psychiatric disorders in these patients can present challenges. AIM: To increase our knowledge about the diagnosing of psychiatric disorders in people with borderline or mild intellectual disabilities. METHOD: In this article we describe some key considerations in making a diagnosis or a differential diagnosis of psychiatric disorders in people with an intellectual disability. RESULTS/ In the differential diagnosis of psychiatric symptoms and behavioral problems in persons with a RESULTS/CONCLUSION: borderline or mild intellectual disability, one needs to take into account the patient's cognitive and social emotional level and any possible underlying somatic conditions; in addition, one must search for the cause of the intellectual disability paying attention to the context and the facilities offered by the care system.