Schizophrenia and Related Psychoses in People with Intellectual Disability

2020 ◽  
pp. 91-104
Author(s):  
Laura Humphries ◽  
Dasari Michael ◽  
Angela Hassiotis
Keyword(s):  
Intellectual Disability ◽  
Treatment Guidelines ◽  
Holistic Approach ◽  
Individual Characteristics ◽  
Classification Systems ◽  
Schizophrenia Spectrum Disorders ◽  
Therapeutic Modalities ◽  
Schizophrenia Spectrum ◽  
Medication Side ◽  
Atypical Presentations

Individuals with an Intellectual Disability (ID) have an increased prevalence of Schizophrenia Spectrum Disorders (SSDs). The complex interplay between the symptoms of SSD and the individual’s level of development often give rise to atypical presentations. This is more so in individuals with a significant ID. Current classification systems may not adequately cover all the conditions experienced by individuals and may not be entirely captured under SSDs. It is important that the clinician gathers appropriate information from all relevant sources, including family, carers, educational establishments, and day care providers. Evidence for interventions in ID is sparse and treatment guidelines are based on evidence from the general population, which need to be extrapolated with caution, bearing in mind individual characteristics. The management of SSDs in ID requires a holistic approach, which takes into account their level of ID, sensitivity to medication, side effects and drug interactions and consideration towards other therapeutic modalities such as individual supports or CBT. The social aspects of management play a vital part in the treatment programme and the involvement of family and carers is crucial.

scholarly journals Antipsychotic medication for women with schizophrenia spectrum disorders

2021 ◽  
pp. 1-15
Author(s):  
Bodyl A. Brand ◽  
Yudith R. A. Haveman ◽  
Franciska de Beer ◽  
Janna N. de Boer ◽  
Paola Dazzan ◽  
...  
Keyword(s):  
Side Effects ◽  
Treatment Guidelines ◽  
Premenopausal Women ◽  
Receptor Occupancy ◽  
Serum Levels ◽  
Protective Effects ◽  
Schizophrenia Spectrum Disorders ◽  
Comprehensive Overview ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders

Abstract There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.

Structured Interview for Hoarding Disorder (SIHD)

2019 ◽  
Vol 35 (4) ◽  
pp. 512-520
Author(s):  
Caterina Novara ◽  
Paolo Cavedini ◽  
Stella Dorz ◽  
Susanna Pardini ◽  
Claudio Sica
Keyword(s):  
Convergent Validity ◽  
Structured Interview ◽  
Diagnostic Process ◽  
Schizophrenia Spectrum Disorders ◽  
Clinical Environment ◽  
Obsessive Compulsive ◽  
Rater Reliability ◽  
Hoarding Disorder ◽  
Compulsive Disorder ◽  
Schizophrenia Spectrum

Abstract. The Structured Interview for Hoarding Disorder (SIHD) is a semi-structured interview designed to assist clinicians in diagnosing a hoarding disorder (HD). This study aimed to validate the Italian version of the SIHD. For this purpose, its inter-rater reliability has been analyzed as well as its ability to differentiate HD from other disorders often comorbid. The sample was composed of 74 inpatients who had been diagnosed within their clinical environment: 9 with HD, 11 with obsessive-compulsive disorder (OCD) and HD, 22 with OCD, 19 with major depressive disorder (MDD), and 13 with schizophrenia spectrum disorders (SSD). The results obtained indicated “substantial” or “perfect” inter-rater reliability for all the core HD criteria, HD diagnosis, and specifiers. The SIHD differentiated between subjects suffering from and not suffering from a HD. Finally, the results indicated “good” convergent validity and high scores were shown in terms of both sensitivity and specificity for HD diagnosis. Altogether, the SIHD represents a useful instrument for evaluating the presence of HD and is a helpful tool for the clinician during the diagnostic process.

Screening Adolescents for Schizophrenia-Spectrum Disorders

2000 ◽  
Author(s):  
B. Cornblatt ◽  
M. Obuchowski ◽  
S. Roberts ◽  
S. Pollack ◽  
L. Erienmeyer-Kimling
Keyword(s):  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders
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