scholarly journals Alcohol use disorders in people with intellectual disability

2018 ◽  
Vol 24 (4) ◽  
pp. 264-272 ◽  
Author(s):  
Fionnuala Williams ◽  
Christos Kouimtsidis ◽  
Alexander Baldacchino
Keyword(s):  
Intellectual Disability ◽  
Alcohol Use ◽  
Alcohol Use Disorders ◽  
Learning Objectives ◽  
List Type ◽  
Significant Issue ◽  
Successful Management ◽  
Addiction Services ◽  
Assessment And Treatment ◽  
The Individual

SUMMARYThis article initially highlights that although the prevalence of alcohol use disorders in people with intellectual disability (PWID) appears to be low, it is a significant issue. This group can be more vulnerable to the adverse effects of alcohol and it is likely that many PWID who have alcohol use disorders are not being identified. We go on to review the limited existing literature on treatment for PWID who have alcohol use disorders and the challenges in meeting the needs of this patient group. We explore how assessment and treatment of alcohol use disorders in this population can be and needs to be tailored to the needs of PWID on an individual basis. There is also discussion about the use of incapacity legislation to treat this group.LEARNING OBJECTIVES•Be aware that alcohol use disorders can be especially problematic for PWID, that such disorders can often go undetected and that adapted screening techniques may be needed to identify such problems•Understand the difficulties that this population has in accessing addiction services and that successful management of PWID who misuse alcohol is usually dependent on appropriate joint working between intellectual disability and addiction services•Be aware that PWID are not a homogeneous group, rather they vary widely in their abilities, necessitating interventions tailored to the individual, and that the use of compulsory measures to manage PWID who lack capacity regarding to their alcohol use should be done with cautionDECLARATION OF INTERESTNone.

scholarly journals Interventions for challenging behaviour in intellectual disability

2014 ◽  
Vol 20 (3) ◽  
pp. 184-192 ◽  
Author(s):  
Afia Ali ◽  
Jessica Blickwedel ◽  
Angela Hassiotis
Keyword(s):  
Intellectual Disability ◽  
Evidence Base ◽  
Current Evidence ◽  
List Type ◽  
Challenging Behaviour ◽  
Pharmacological Treatments ◽  
Current Evidence Base ◽  
The Individual

SummaryChallenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.LEARNING OBJECTIVES•Understand the aetiological basis of challenging behaviour.•Understand the role of functional analysis.•Appreciate the evidence base in relation to the psychological and pharmacological treatment of challenging behaviour.

scholarly journals Exploring the Role of Alcohol Metabolizing Genotypes in a 12-Week Clinical Trial of Naltrexone for Alcohol Use Disorder

Biomolecules ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1495
Author(s):  
João M. Castaldelli-Maia ◽  
André Malbergier ◽  
Adriana B. P. de Oliveira ◽  
Ricardo A. Amaral ◽  
André B. Negrão ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Alcohol Use Disorders ◽  
Nucleotide Polymorphisms ◽  
High Association ◽  
Unsuccessful Treatment ◽  
Naltrexone Treatment ◽  
The Individual

Background: The efficacy of naltrexone in the treatment of alcohol use disorder (AUD) has been associated with a set of variables not directly related with the expression of opioid receptors. All the variables have been found to be highly associated with AUD itself or more severe clinical levels of AUD. Objectives: Given the high association between alcohol metabolizing enzymes (AME) and the outcome of AUD, the present study aims to investigate the role of AME genotype variants in the treatment of AUD with naltrexone. Methods: We carried out a 12-week longitudinal clinical trial based on the treatment of AUD patients with naltrexone (N = 101), stratified by different alcohol metabolization genotypes. Genotyping was performed after the inclusion of the patients in the study, based on the individual presence of single nucleotide polymorphisms (SNPs) in the ADH (alcohol dehydrogenase)1B (ADH1B*2 and ADH1B*3), ADH1C (ADHC*1) and ALDH (aldehyde dehydrogenase) 2 (ALDH2*2) genes. The outcome of alcohol use has been monitored employing the timeline follow-back during the treatment. Results: The ADH1C*1 (Ile350Val, rs698) and ALDH2*2 (Glu504Lys, rs671) polymorphisms were associated with a better response to naltrexone treatment, whereas the ADH1B*3 (Arg370Cys, rs2066702) allelic variant showed a negative outcome. Conclusions: The present study explores a genomic setting for the treatment of AUD with naltrexone. According to our findings, the association between ADH1C*1 and ALDH2*2 variants and better outcomes suggests a successful treatment, whereas the ADH1B*3 mutated allele might lead to an unsuccessful treatment. Further studies should be performed to investigate the relationship between alcohol metabolizing genotypes, the family history of alcohol use disorders and the effect of naltrexone on the outcomes. Genotyping may be a valuable tool for precision-medicine and individualized approach, especially in the context of alcohol use disorders. The small number of subjects was the main limitation of the present study.

scholarly journals Sexual rights, mental disorder and intellectual disability: principles and law

2018 ◽  
Vol 24 (5) ◽  
pp. 334-345 ◽  
Author(s):  
Isabelle Le Gallez ◽  
Keith J. B. Rix ◽  
Kartina A. Choong ◽  
Helen Dewson
Keyword(s):  
Intellectual Disability ◽  
Mental Disorder ◽  
Well Being ◽  
Case Law ◽  
Sexual Relationships ◽  
Learning Objectives ◽  
Sexual Expression ◽  
List Type ◽  
Sexual Rights ◽  
Staff Attitudes

SUMMARYPeople with mental disorder and intellectual disability have the same rights to sexual expression as other people, albeit that in some cases a lack of capacity may require curtailment of those rights and regard must be had to protecting the vulnerable. Furthermore, the formation or maintenance of sexual relations, or the attainment of sexual fulfilment, may assist in the maintenance or restoration of mental health or well-being. This article demonstrates how the courts in England and Wales, applying statute law and judicial precedent, are largely supportive of the rights of people with mental disorder or intellectual disability to make decisions about sexual expression, sexual relationships and related matters, notwithstanding some societal and staff attitudes that act to prevent them fulfilling their sexual needs and making decisions about sexual and reproductive matters.LEARNING OBJECTIVES•Understand the underlying principles that apply to the exercise of their sexual rights by people with mental disorder or intellectual disability•Understand some of the obstacles to the exercise of sexual rights by people with mental disorder or intellectual disability•Understand the statute and case law that apply to the exercise of sexual rights by people with mental disorder or intellectual disabilityDECLARATION OF INTERESTNone.

scholarly journals Assessment and Treatment of Patients with Comorbidity of Mental Health Problems and Alcohol Use Disorders: Experiences of Clinicians and Patients in the UK and Poland

2019 ◽  
Vol 54 (3) ◽  
pp. 279-286
Author(s):  
Justyna Klingemann ◽  
Marta Welbel ◽  
Pablo Nicaise ◽  
Stefan Priebe ◽  
Aleksandra Matanov ◽  
...  
Keyword(s):  
Mental Health ◽  
Alcohol Use ◽  
Mental Health Problems ◽  
Alcohol Use Disorders ◽  
Health Problems ◽  
Assessment And Treatment ◽  
The Uk

scholarly journals Meaningful patient engagement

2018 ◽  
Vol 24 (4) ◽  
pp. 245-251
Author(s):  
Clare Gerada
Keyword(s):  
Risk Factors ◽  
Mental Illness ◽  
Patient Engagement ◽  
Mentally Ill ◽  
Patient Perspective ◽  
Learning Objectives ◽  
List Type ◽  
Access To Services ◽  
The Individual ◽  
Health Programme

SUMMARYHolding a medical degree does not magically protect the individual from ever becoming unwell or needing medical help. However, for various reasons, most of which relate to personal, professional and institutional stigma, doctors are often denied the care they so readily provide to their own patients. The author has been running a ‘sick doctor’ service for 10 years and this article describes, from the practitioner-patient perspective, the barriers to care and what can be done to improve doctors' access to services.LEARNING OBJECTIVES•Appreciate the external and internal risk factors for mental illness in doctors•Understand why doctors do not attend for care when mentally unwell•Acknowledge how mentally ill doctors are exposed to stigma and how this can be overcomeDECLARATION OF INTERESTC.G. is a partner of the Hurley Group who won the contract for PHP in 2008 and is employed by and leads the NHS Practitioner Health Programme.

scholarly journals Psychotherapeutic leadership and containment in psychiatry

2018 ◽  
Vol 25 (2) ◽  
pp. 133-141
Author(s):  
Russell Gibson ◽  
Alex Till ◽  
Gwen Adshead
Keyword(s):  
Professional Development ◽  
Theoretical Background ◽  
Learning Objectives ◽  
List Type ◽  
Staff Morale ◽  
Clinical Leadership ◽  
Factors Influencing ◽  
The Individual ◽  
Organisational Level

SUMMARYLeadership is a key role for psychiatrists, with many models that can be adopted depending in part on the nature of the individual and their training, the primary task of the team and the nature of the organisation. In this article we suggest a new concept and model of leadership, ‘psychotherapeutic leadership’. We discuss the theoretical background to this model, its benefits and the implications for training and professional development.LEARNING OBJECTIVES•Understand the concept and role of the psychiatrist in providing psychotherapeutic leadership at an individual patient, team and organisational level•Explore how applying an understanding of psychodynamic principles in practice can provide containment in psychiatry and aid clinical leadership•Understand the role of psychotherapeutically informed approaches in recognising factors influencing staff morale and burnoutDECLARATION OF INTERESTNone.

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