Antipsychotic prescribing for patients with intellectual disabilities and challenging behaviours

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Bushra Elhusein ◽  
Yassin Eltorki ◽  
Oraib Abdallah ◽  
Mohamed El Tahir
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Best Practices ◽  
Intellectual Disabilities ◽  
Challenging Behaviour ◽  
Prescribing Practices ◽  
Content Type ◽  
Antipsychotic Prescribing ◽  
Challenging Behaviours ◽  
Audit Standards

Purpose Review of antipsychotic prescribing practices, rationale and follow-up using an internationally standardized audit can be an effective tool to encourage and monitor best practices. The purpose of this study is to audit the current prescribing pattern for people with intellectual disabilities and challenging behaviours in Qatar. Design/methodology/approach This study was based on the challenging behaviour management guidelines recommended by the Royal College of Psychiatrists. All current electronic medical records in the Mental Health Service-Hamad Medical Corporation were examined to identify patients with intellectual disabilities who received antipsychotics for challenging behaviour. Demographic variables, such as age, sex and nationality, were collected. In addition, details of psychiatric diagnoses, prescribed psychotropic medications and diagnoses of epilepsy were also collected. For patients who were prescribed antipsychotic medication, the clinical rationale for such medication was collected along with evidence of side effect monitoring to allow performance against the audit standards to be measured. Findings This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The results of this study regarding the pattern of prescribing practices for patients with intellectual disability and challenging behaviour reflect the limitation in knowledge and experience among non-specialist practitioners within mental health service. The result may be helpful to support the development of specialist service provision to improve the care for such vulnerable group. The result may also help other medical centres and clinicians by providing an improved understanding of possible deviations from the best medical practices. Originality/value This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The study is also noteworthy as, to the best of the authors’ knowledge, it is one of only a few studies on antipsychotic prescribing for patients with intellectual disability and challenging behaviour in the Middle East; therefore, it will be useful in raising awareness and promoting the best practices in the Middle East region. This study is also among the first few studies that were designed based on the four audit standards by the Royal College of Psychiatrists in this area.

Predictors of challenging behaviour in adults with intellectual disability

2015 ◽  
Vol 9 (6) ◽  
pp. 312-326 ◽  
Author(s):  
Stella Koritsas ◽  
Teresa Iacono
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Living Arrangement ◽  
Evidence Base ◽  
Challenging Behaviour ◽  
Content Type ◽  
Future Assessment ◽  
Severity Of Disability ◽  
And Gender ◽  
Challenging Behaviours

Purpose – The purpose of this paper is to determine the extent to which mental health, physical health, communication, learned function of the behaviour(s), severity of disability, living arrangement, age, and gender, alone or in combination, predicted challenging behaviours in adults with intellectual disability. Design/methodology/approach – In total, 74 adults with intellectual disability and their paid carers were recruited into the study from adult disability services in Victoria, Australia. Paid carers provided information about participants with intellectual disability on a range of measures targeting each variable of interest. Findings – Based on principle components analyses of three challenging behaviour measures, two topographies of challenging behaviour emerged: contact and non-contact behaviours. Multiple regression analysis revealed that contact behaviours were predicted by anxiety scores and severity of disability. In addition to severity of disability and anxiety scores, non-contact behaviours were also predicted by sensory scores. Practical implications – The results of the current study indicate that contact and non-contact behaviours were determined by multiple factors. Clinicians and others who work with people who display challenging behaviour may, therefore, find it helpful to utilise the biopsychosocial model in their formulations of possible reasons that motivate a person to engage in challenging behaviour. Originality/value – These results contribute to the evidence base available to clinicians and researchers to guide future assessment for challenging behaviour. Expansion of functional assessment methods to explore factors not traditionally included, such as mental health and severity of intellectual disability, as causes of challenging behaviour, may prove helpful.

Mind Matters: a psychoeducation programme for individuals with intellectual disabilities and co-morbid diagnoses of mental disorder

2017 ◽  
Vol 8 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Sarah Ashworth ◽  
Krista Jansen ◽  
Lydia Bullock ◽  
Paul Mooney
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Intellectual Disability ◽  
Personality Disorder ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Intellectual Disabilities ◽  
Psychological Intervention ◽  
Content Type ◽  
Group Members

Purpose The purpose of this paper is to describe a feasibility study into the development and pilot of a psychoeducational group for people with intellectual disability and co-morbid mental disorder (including mental illness and personality disorder) within forensic settings. Design/methodology/approach “Mind Matters”, a psychoeducational programme for people with an intellectual disability and co-morbid mental disorders is a group based programme in a medium secure hospital, adapted and developed to be suitable for people with intellectual disability therapist multidisciplinary approach was key to its development. An open group on a 16-bedded ward for individuals with mild to moderate intellectual disability and co-morbid mental illness was delivered over a six-week period. Findings The group was positively received in pilot by participants and members of the clinical teams. Attendance and engagement of participants were key measures of the success of the programme. In addition to the apparent increased social skills and motivation to engage with future psychological intervention. Practical implications The authors believe that this approach benefitted both the group members and staff on ward, reinforcing strategies for maintaining positive mental health. It also stimulated engagement, discussion about mental disorders including mental illness, personality disorder and intellectual disabilities. Originality/value This paper shows how a psychoeducational approach to mental disorder and mental health in individuals with an intellectual disability is possible, beneficial and well received.

scholarly journals Working together: making the case for integrated forensic services for people with intellectual disabilities

2015 ◽  
Vol 6 (3/4) ◽  
pp. 204-210 ◽  
Author(s):  
Kenneth MacMahon ◽  
Ricky McClements
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Integrated Model ◽  
Content Type ◽  
Fully Integrated ◽  
Forensic Service ◽  
Working Together ◽  
People With Intellectual Disabilities ◽  
Integrated Service

Purpose – There is a general consensus that healthcare for people with intellectual disabilities should be provided by multi-disciplinary teams. Within a forensic setting, recommendations are often made for separate or “parallel” forensic teams, operating independently of generic mental health or intellectual disability teams. An alternative to this model is an “integrated” service, where specialist forensic clinicians work within the general intellectual disability service, to provide support for clients with forensic needs. For clients with intellectual disabilities and forensic needs, there may be advantages to providing access to a wider multi-disciplinary team, through the application of an integrated model. The purpose of this paper is to illustrate the working of an integrated forensic service within a learning disability team, to identify positive aspects of this model, and how potential shortcomings may be overcome. Design/methodology/approach – Literature review, description of service outline with case example. Findings – Although some studies have compared parallel and integrated forensic models within mental health services, there are no evaluations that compare models of forensic services for individuals with intellectual disabilities. However, specific advantages of an integrated model may include availability of multi-disciplinary clinicians, development of forensic skills across wider groups of clinicians, reduction in stigma and avoidance of delay in transfer of care between services. In addition, in areas with smaller populations, parallel services may not be feasible due to low case numbers. Originality/value – There has been no formal evaluation of parallel vs integrated forensic services within an intellectual disability setting. However, the authors describe a fully integrated service and suggest means by which the potential shortcomings of an integrated model may be overcome.

Psychiatry and intellectual disabilities: navigating complexity and context

2017 ◽  
Vol 12 (4) ◽  
pp. 224-236 ◽  
Author(s):  
Jo Jones ◽  
Kiran Jeenkeri ◽  
Peter Cutajar
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Health Practitioner ◽  
Current Policy ◽  
Content Type ◽  
General Mental Health ◽  
Neurodevelopmental Model ◽  
Wide Range ◽  
Potential Factors

Purpose The paper is a review, for the general adult mental health practitioner, of the issues to consider when managing a mental health presentation of a person with intellectual disability (PWID). The paper aims to discuss these issues. Design/methodology/approach A neurodevelopmental model is outlined to assist practitioners in unravelling the wide range of potential factors relevant to intellectual disabilities (IDs). This includes an emphasis on complexity and interdisciplinary formulation within an individual’s context, and implications of the current policy changes. Findings In practice, managing the mental health of PWID can be challenging within usual mainstream services; there is more to consider than is usual for the general population. Originality/value The paper provides general mental health practitioners with a framework for a greater depth of understanding of the issues involved in the management of people with intellectual disability (ID). This includes discussion of the current policy context in ID, and some of its limitations.

Best Practices: Racial and Ethnic Effects on Antipsychotic Prescribing Practices in a Community Mental Health Center

2003 ◽  
Vol 54 (2) ◽  
pp. 177-179 ◽  
Author(s):  
Scott W. Woods ◽  
Michelle C. Sullivan ◽  
Elizabeth C. Neuse ◽  
Esperanza Diaz ◽  
C. Bruce Baker ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Best Practices ◽  
Health Center ◽  
Community Mental Health Center ◽  
Mental Health Center ◽  
Prescribing Practices ◽  
Antipsychotic Prescribing

FC28-05 - Prevalence of psychiatric diagnoses and challenging behaviours in a community based population of individuals with intellectual disability

2011 ◽  
Vol 26 (S2) ◽  
pp. 1975-1975 ◽  
Author(s):  
I. Grey ◽  
B. McClean ◽  
N. MacAuley
Keyword(s):  
Intellectual Disability ◽  
Psychiatric Disorder ◽  
Intellectual Disabilities ◽  
Psychiatric Disorders ◽  
Prevalence Rate ◽  
Behaviour Problem ◽  
Challenging Behaviour ◽  
Community Based ◽  
Diagnostic Categories ◽  
Challenging Behaviours

IntroductionPrevious research has suggested substantial variation in prevalence rates of psychiatric disorders in individuals with intellectual disability and also differential patterns of associations between psychiatric disorders and challenging behaviours in people with intellectual disabilities. The aim of this study was to determine with the prevalence rate of specific psychiatric disorders and challenging behaviours and the relationship between them in a community based sample of individuals with intellectual disability.MethodA community based sample of 159 adults primarily with mild and moderate intellectual disabilities was surveyed for the presence of psychiatric disorders and challenging behaviour using the Behaviour Problem Inventory (BPI) and the Psychiatric Assessment Schedule (PAS-ADD). Individuals who met threshold on the PAS-ADD were subsequently evaluated using the Mini- PAS-ADD Interview.ResultsScreening for psychiatric disorder using the PAS-ADD indicated a prevalence rate of 10%. There was a large discrepancy between the overall rate of challenging behaviour (45%) and the rate of psychiatric disorders identified by the Mini PAS-ADD Interview (6%). However, the rate of more severe behaviour problems (8%) was closer to the rate of psychiatric disorders (6%). Thirty one percent of people with severe challenging behaviours also were rated as having psychiatric disorders and odd ratio analysis indicates that individuals with severe challenging behaviour are substantially more likely to present with a psychiatric disorder. However, there does not appear to be a relationship between different topographies of challenging behaviour and discrete diagnostic categories of psychiatric disorder.

How can mental health clinicians, working in intellectual disability services, meet the spiritual needs of their service users?

2015 ◽  
Vol 9 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Benjamin Loynes ◽  
Jean O'Hara
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Literature Review ◽  
Intellectual Disabilities ◽  
General Health ◽  
Disability Services ◽  
Spiritual Needs ◽  
Service Users ◽  
Mental Health Clinicians ◽  
Content Type

Purpose – The purpose of this paper is to identify approaches that mental health clinicians, working in intellectual disability services, can adopt to ensure the spiritual needs of their service users are met. Design/methodology/approach – A narrative literature review examining original research, expert opinion pieces and book chapters was undertaken. To broaden the perspective of the paper, publications from different academic areas were reviewed including intellectual disabilities, mental health, neurodevelopmental disorders, general health and spirituality literature. Findings – The main principles of spiritual assessment tools from the general health literature can be applied to this group. However, the literature would suggest that certain approaches are of particular importance in intellectual disabilities mental health including advocating for service users to attend the religious services they wish to and working collaboratively with families and carers when addressing spiritual issues. Research limitations/implications – The question of how to meet the spiritual needs of people with autism and severe intellectual disability is a neglected research area. Research examining the spiritual needs of service users with intellectual disabilities, on mental health inpatient units, is also needed as well as a review of whether spiritual needs are being met in current person-centred care plans. Originality/value – No published literature review was identified that specifically addressed the question of how mental health clinicians should approach the spiritual needs of their service users.

scholarly journals Prevalence of Challenging Behaviour in Adults with Intellectual Disabilities, Correlates, and Association with Mental Health

2019 ◽  
Vol 6 (4) ◽  
pp. 173-181 ◽  
Author(s):  
Darren L. Bowring ◽  
Jon Painter ◽  
Richard P. Hastings
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Challenging Behaviour ◽  
Institutional Settings ◽  
Framework Model ◽  
Adults With Intellectual Disabilities ◽  
Communication Impairments ◽  
Congregate Care

Abstract Purpose of Review To summarise findings about the prevalence and correlates of challenging behaviour in adults with intellectual disabilities from robust research. We also describe findings on the interplay between challenging behaviour and mental health. Recent Findings Recent studies that have utilised psychometrically evaluated tools, with clear operational definitions, show similar findings on the prevalence of challenging behaviour of about 1 in every 5–6 adults known to services. We describe common correlates identified such as communication impairments, severity of intellectual disability, and living in institutional settings or congregate care. We also describe the complex and multifaceted relationship between challenging behaviour and mental health. Summary Based on recent studies, we propose a revised framework model to help understand challenging behaviour. We propose a number of areas where more research is required, particularly the development of risk tools clinicians can utilise in practice.

Intellectual disability (mental retardation)

2017 ◽  
pp. 485-512
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Mental Health ◽  
Mental Retardation ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Mental Health Problems ◽  
Fragile X ◽  
Mild Intellectual Disability ◽  
Assessment And Treatment ◽  
The Life Course ◽  
Challenging Behaviours

‘Intellectual disabilities’ covers the life course, with a focus on the assessment and treatment of the intellectual disabilities at younger ages. This chapter outlines current understanding of the aetiology of the more common intellectual disabilities. The clinical features are discussed for severe/profound, moderate, and mild intellectual disability, and the more common psychiatric presentations for those with intellectual disabilities. Mood disorders, anxiety disorders, and dementia are discussed in greater detail, as are the more common presentations of intellectual disability, with sections on Down’s syndrome and fragile X. The importance of prevention of mental health problems and better understanding and management of more challenging behaviours are discussed alongside other treatments for psychiatric disorders.

Getting unstuck along the clinical pathway: an integrated multi-agency approach

2014 ◽  
Vol 8 (3) ◽  
pp. 192-196
Author(s):  
Luci Richards ◽  
Nwamaka Uchendu ◽  
Jean O’Hara
Keyword(s):  
Mental Health ◽  
Intellectual Disabilities ◽  
Social Services ◽  
Clinical Pathway ◽  
Care Pathway ◽  
Tertiary Care ◽  
Community Support ◽  
Team Approach ◽  
Challenging Behaviour ◽  
Content Type

Purpose – The purpose of this paper is to highlight how the management of an adult with intellectual disabilities and complex medical conditions by a multi-disciplinary and multi-agency team approach across a clinical pathway (primary, secondary and tertiary care, health, social and third sector agencies) can be used to improve the person's physical and mental health outcome. Design/methodology/approach – Literature review and case report in which the paper describes the presentation of the patient with multiple complex physical health conditions, mild intellectual disability and challenging behaviour and description of the management process and the observed outcome. Findings – The patient required input from the multi-disciplinary community intellectual disabilities team and multi-agency team including social services and community support team, admission to a specialist intellectual disabilities ward to optimise her management. She improved relatively well and was discharged to the community. On discharge she continued to receive ongoing psychiatric, psychological and community psychiatric nurse input and maintains the sustained improvement in her mental health. She no longer displays risky or challenging behaviour, her mood has improved and there is no self-harm ideation. She remains anxious at times, however, her symptoms are much improved and do not affect her daily functioning. Originality/value – This case highlights the profound and enduring psychiatric and behavioural sequelae following brain malignancy and treatment and how essential a multi-disciplinary and multi-agency approach is in the successful management of complex issues. Her symptoms appeared relatively treatment resistant until she had a specialist inpatient admission. This case study also demonstrates the strengths and advantages of having specialist care pathway for such complex presentations, allowing for integrated community, secondary and tertiary care, and for the care system to work together in a coordinated and managed way.

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