Interplay between representations, practices, and stigma variables towards people with intellectual disabilities among healthcare professionals: A cross-sectional study.

Disparities in healthcare are observed among people with intellectual disabilities. They generally face stigmatisation and negative attitudes from healthcare professionals. The aim of this study is to investigate the link of diagnostic label and social distance on inclusive health representations and practices towards people with intellectual disabilities among healthcare professionals. We conducted an online survey of 163 healthcare professionals living in French-speaking Belgium. The results highlighted that the diagnostic label and a lower social distance predict better representations and practices in inclusive health. In addition, an analysis of mediation showed the mediating effect of social distance on the link between being in contact with people with intellectual disabilities (through employment) and better representations and practices in inclusive health. This study enabled us to assess the interplay between stigma variables and healthcare professionals' representations and practices towards people with intellectual disabilities and to identify potential facilitators for promoting health equity.

Exploring professionals' practices and perspectives on supporting parents with intellectual disabilities: a qualitative study.

Introduction: Evidence suggests that parents with intellectual disabilities require appropriate parenting support. However, professional practices vary widely, and several barriers and challenges persist in supporting parents with intellectual disabilities. To identify effective and collaborative practices, this study investigated practices reported by professionals and their roles in providing services to parents with intellectual disabilities. Methods: Semi-structured interviews were conducted with 22 professionals from three sectors (disability, early childhood, and healthcare), and the content was analysed using inductive thematic analysis. Results: Thematic analyses yielded four main themes: (1) Perceived professional practices, (2) professional stances, (3) the frame of reference and the ethics of support, (4) the experience of providing support. They are described in terms of content and distribution across sectors to provide an overview of practices as well as potential discrepancies. Conclusions: This study concludes by developing recommendations on good practices for support professionals to respond as adequately as possible to meet the needs of parents and future parents with intellectual disabilities, which include structural support and guidelines for professionals to provide sensitive, family-centred, and enabling support.

Frailty detection by healthcare professionals: a systematic review of the available English and French tools and their validation.

BACKGROUND: There is a wide variety of frailty detection tools, but no gold standard. Choosing the most appropriate tool can therefore be complicated. Our systematic review seeks to provide useful data on the frailty detection tools available to help healthcare professionals in choosing a tool. METHOD: We systematically searched for articles published between January 2001 and December 2022 in three electronic databases. Articles were to be written in English or French and were to discuss a frailty detection tool used by healthcare professionals in a population without specific health conditions. Any self-testing, physical testing or biomarkers were excluded. Systematic reviews and meta-analyses were also excluded. Data were extracted from two coding grids; one for the criteria used by the tools to detect frailty and the other for the evaluation of clinimetric parameters. The quality of the articles was assessed using QUADAS-2. RESULTS: A total of 52 articles, covering 36 frailty detection tools, were included and analysed in the systematic review. Forty-nine different criteria were identified, with a median of 9 (IQR 6-15) criteria per tool. Regarding the evaluation of tool performances, 13 different clinimetric properties were identified, with a mean of 3.6 (± 2.2) properties assessed per tool. CONCLUSION: There is considerable heterogeneity in the criteria used to detect frailty, as well as in the way tools are evaluated.

"Is it my job?" An exploratory qualitative analysis of medical specialists' adaptation strategies when addressing the health needs of people with intellectual disabilities.

Access to equal healthcare is a priority for people with intellectual disabilities. Most studies have focused on primary care providers; however, the administration of inclusive healthcare also relies on medical specialists, who should be considered a specific group because their practice varies significantly in this regard. Semi-directive interviews were conducted with 12 medical specialists to explore their representations regarding the care of people with intellectual disabilities. An inductive thematic analysis was applied to the data. The results highlighted a significant heterogeneity between practitioners' representations of people with intellectual disabilities in healthcare, current practices, and their perceptions and expectations in the process of ensuring quality care. This study highlights the importance of considering medical specialists' awareness raising and training to handle consultations with people with intellectual disabilities. From a broader perspective, a clear political framework to guide healthcare practices at the national level should be developed.

Is health a priority? Examining health-related support needs in adults with intellectual disability through a self-determination framework.

BACKGROUND: People with intellectual disabilities experience inequities in healthcare. Those are maintained by individual limitations as well as environmental factors. In this context, health needs are less likely to be expressed, identified and met. METHOD: We led a survey in 832 adults with intellectual disabilities to identify if health was set as a priority and if so, what were their major health-related support needs (in terms of physical, social and psychological health). RESULTS: 67.1% of participants reported at least one need. Most frequently, two or more types of needs were reported with gender and living facility having an effect on whether participants would report these needs, but these did not affect which type of needs were reported. CONCLUSIONS: Health-related support needs are highly prevalent and diversified in people with intellectual disabilities. This study emphasizes the importance to consider health as a global concept as well as the relationships between health and self-determination.

Decision-making of patients with major depressive disorder in the framework of action control.

Introduction: Patients with major depressive disorder (MDD) experience dysfunctional emotional states and cognitive impairments, leading to behavioural, social, and functional issues. Neurocognitive theory proposes that the initiation and maintenance of MDD is primarily the result of a deficit of action control which in turn would lead to decision-making impairments.Methods: We assessed 27 medicated outpatients with MDD who were demographically matched with 16 healthy participants on decision-making (DM) processes (Iowa Gambling Task (IGT) and Reversal Learning Task (RLT)), clinical variables (depressive symptoms and self-efficacy), and volition (Lille Apathy Rating Scale).Results: Patients with MDD displayed deficits on the IGT but not on the RLT. Correlational analysis of patients with MDD revealed no significant associations between IGT or RLT performance and volition, depressive symptom severity, and self-efficacy. However, differences on the IGT between patients with MDD and controls became non-significant when controlling for the variance of these scores.Conclusions: MDD appears to have an impact on dynamic DM processes, while basic processes are preserved. Limitations as well as directions for future research are discussed with regard to the neurocognitive model of depression.

Attribution of intentions and context processing in psychometric schizotypy.

INTRODUCTION: Impairment in Theory of mind (TOM) has frequently been associated with schizophrenia and with schizotypy. Studies have found that a tendency to over-attribute intentions and special meaning to events and to people is related to positive psychotic symptoms. Further, it has been suggested that this intentionality bias may be due to a broader deficit in context processing (CP). The aim of the present study was thus to investigate the relationship between positive schizotypy and both over-attribution of intentions and contextual processing. METHODS: One-hundred and nineteen healthy individuals completed the Schizotypal Personality Questionnaire and were assessed with tasks measuring contextual treatment and ToM. RESULTS: Results revealed that positive schizotypy was significantly related to an over-attribution of intentions on the ToM task and with a faster processing of implicit context. Partial correlational analyses indicated that the association between the attribution of intentions and positive schizotypy was not explained by a deficit of CP. In contrast, stepwise multiple regression analyses showed that both an over-attribution of intentions and a faster processing of implicit context significantly predicted positive schizotypy. CONCLUSIONS: These results show that an over-attribution of intention is independent from a broader deficit in context information processing and that they both possibly contribute to the development and maintenance of positive psychotic symptoms.

Thinking About One's Feelings: Association Between Alexithymia and Cognitive Styles in a Nonclinical Population.

Alexithymia is described as a disturbance in the cognitive and affective processing of emotions. Little is known about the cognitive styles associated with this personality trait. In this article, we examine to what extent alexithymia is linked with poorer rational cognitive style. A total of 685 participants from a nonclinical sample completed the Toronto Alexithymia Scale-20 along with self-reported and behavioral measures of cognitive styles. Results suggest that people with a high level of self-reported alexithymia show lower rational abilities. The findings of this study extend previous work on cognitive processes underlying emotional self-regulation impairments in alexithymia, suggesting that these difficulties may be linked to a poorer use of rational process.

Goal-directed behaviors in patients with schizophrenia: Concept relevance and updated model.

Goal-directed behaviors are formulated to pursue a given objective by constructing a plan and selecting actions that lead to the intended goal, either immediately or over an extended period. This concept is important to the study of human behavior because of its involvement in the majority of complex or novel situations that an individual may encounter, regardless of the cognitive, affective, or social abilities required. In this paper, we aim to demonstrate the relevance of goal-directed behaviors to our understanding of the cognitive deficits and other symptoms associated with schizophrenia. A systematic analysis of this relation may allow us to develop integrative hypotheses regarding positive, negative, and disorganized symptoms of schizophrenia rather than consider them to be distinct issues. In this article, we review previous studies of goal-directed actions in patients with schizophrenia in order to clarify the relevant concepts and provide a theoretical basis for the integration of existing results. Based on available theoretical models and data, we propose an updated model to facilitate further investigation of schizophrenia-related impairments in goal-directed behaviors.

Cued fluency protocol reveals dynamic symptomatic-dependent processes of goal-directed behaviours in schizophrenia.

INTRODUCTION: Differential impairments of willed actions and routine behaviours are the subject of many studies into schizophrenia. These impairments in generating and controlling goal-directed behaviours are reported in studies showing the effect of cueing in cognitive or motor tasks in people with schizophrenia. The aim of this study was to assess the performance of people with schizophrenia in a cued fluency protocol reworked to fit the concept of goal-directed behaviour. The extent to which results could be better explained by goal-directed generation issues, according to a symptomatic framework, than by semantic retrieval or semantic processing impairments, was also investigated. METHODS: We compared the performance of 43 individuals with schizophrenia to a control group of 26 participants. Participants were assessed with neuropsychological tests. The dominance of positive and negative symptoms, and apathetic profile, were also evaluated. All participants completed a cued fluency protocol. RESULTS: Despite a significant improvement, not all people with schizophrenia exhibited equal cueing benefits. The participants with negative symptom dominance appeared to benefit more from cueing, even though their baseline performance was lower. CONCLUSIONS: These results suggest that, in addition to semantic memory impairments, some cognitive tasks may be more broadly influenced by difficulties in generating goal-directed behaviours.

Shall we use non-verbal fluency in schizophrenia? A pilot study.

Over the last few years, numerous studies have attempted to explain fluency impairments in people with schizophrenia, leading to heterogeneous results. This could notably be due to the fact that fluency is often used in its verbal form where semantic dimensions are implied. In order to gain an in-depth understanding of fluency deficits, a non-verbal fluency task - the Five-Point Test (5PT) - was proposed to 24 patients with schizophrenia and to 24 healthy subjects categorized in terms of age, gender and schooling. The 5PT involves producing as many abstract figures as possible within 1min by connecting points with straight lines. All subjects also completed the Frontal Assessment Battery (FAB) while those with schizophrenia were further assessed using the Positive and Negative Syndrome Scale (PANSS). Results show that the 5PT evaluation differentiates patients from healthy subjects with regard to the number of figures produced. Patients׳ results also suggest that the number of figures produced is linked to the "overall executive functioning" and to some inhibition components. Although this study is a first step in the non-verbal efficiency research field, we believe that experimental psychopathology could benefit from the investigations on non-verbal fluency.