scholarly journals Characteristics and outcome indicators in a specialist inpatient intellectual disability unit: an independent sector experience

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S309-S309
Author(s):  
Mike Apio ◽  
Witold Skalbania ◽  
Muhammad Aamer Khan ◽  
Bolanle Lotsu
Keyword(s):  
Intellectual Disability ◽  
Length Of Stay ◽  
Environmental Enrichment ◽  
Mixed Model ◽  
Physical Violence ◽  
Response To Treatment ◽  
Common Denominator ◽  
Neurocognitive Deficits ◽  
Prosocial Skills ◽  
Therapeutic Activities

AimsTo elucidate critical elements for effective outcomes in patients with complex and challenging behaviours admitted to specialist inpatient ‘locked rehabilitation’ intellectual disability unit (LRU).BackgroundPeople with intellectual disability of varying severity with or without associated mental disorder are at risk of deterioration presenting with problem behaviours at critical times of transition. In the context of their pre-set neurocognitive deficits, protective factors during early development include a robust psychosocial ‘parenting’ environment that optimises their strengths through nurturing and embedding a positive mind-set. Such environment is critical for the development of resilience as against reliance on external factors with high likelihood of change. The effect of early exposure to prenatal and or postnatal childhood adversities is a common denominator. The experience of abuse; from deprivation and neglect to physical violence and indeed sexual trauma predisposes to further perturbation and kindling effect on risks for early and later onset affective disorders. Specialist ID services become critical to the resetting of a distorted premorbid neuronal circuitry. A biopsychosocial approach to recreating a stable base and environmental enrichment may offer opportunities for enhancing neurocognitive remediation and enhance prosocial skills. Indicators for better outcomes may offer scope for focused intervention. This review highlights extent patients progress (response to treatment and symptom remission), length of Stay and discharge pathway could be predicated on their engagement with offered structured therapeutic activities.MethodUsing a mixed model approach, 12-months data regarding patient characteristics, elements from HoNOs LD, with patient's self-reported experience and utilization of therapy, progress of patients in the service were reviewed to elucidate factors that may predict improved outcomes..ResultOf 48 patients, 18 females and 30 males identified in the 12-months from January 2019, 7 females were discharged/transferred with one stepped up to LSU and another side-moved to a LRU. 6 have identified places and 5 require ongoing care. Of the males, 8 were discharged and 5 have identified placements. 16 inpatients with support completed questionnaires (10 males, 6 females). Majority identified structured therapeutic activities as helpful in their progress. Data for length of stay ranged from 12 to over 120 months with a mean of 31 months ignoring potential discharges.ConclusionFindings suggest patients able to engage in structured therapeutic activities in conjunction with concordance to treatment are more likely to progress earlier in their care.

scholarly journals The cGMP Pathway and Inherited Photoreceptor Degeneration: Targets, Compounds, and Biomarkers

Genes ◽  
2019 ◽  
Vol 10 (6) ◽  
pp. 453 ◽  
Author(s):  
Arianna Tolone ◽  
Soumaya Belhadj ◽  
Andreas Rentsch ◽  
Frank Schwede ◽  
François Paquet-Durand
Keyword(s):  
Cell Death ◽  
Gene Mutations ◽  
Interdisciplinary Cooperation ◽  
Response To Treatment ◽  
Common Denominator ◽  
Photoreceptor Degeneration ◽  
Diverse Range ◽  
Cell Death Pathway ◽  
Cgmp Signaling ◽  
Dependent Cell

Photoreceptor physiology and pathophysiology is intricately linked to guanosine-3’,5’-cyclic monophosphate (cGMP)-signaling. Here, we discuss the importance of cGMP-signaling for the pathogenesis of hereditary retinal degeneration. Excessive accumulation of cGMP in photoreceptors is a common denominator in cell death caused by a variety of different gene mutations. The cGMP-dependent cell death pathway may be targeted for the treatment of inherited photoreceptor degeneration, using specifically designed and formulated inhibitory cGMP analogues. Moreover, cGMP-signaling and its down-stream targets may be exploited for the development of novel biomarkers that could facilitate monitoring of disease progression and reveal the response to treatment in future clinical trials. We then briefly present the importance of appropriate formulations for delivery to the retina, both for drug and biomarker applications. Finally, the review touches on important aspects of future clinical translation, highlighting the need for interdisciplinary cooperation of researchers from a diverse range of fields.

scholarly journals Re-establishment of the epigenetic state and rescue of kinome deregulation in Ts65Dn mice upon treatment with green tea extract and environmental enrichment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
I. De Toma ◽  
M. Ortega ◽  
S. Catuara-Solarz ◽  
C. Sierra ◽  
E. Sabidó ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Green Tea ◽  
Environmental Enrichment ◽  
Projection Neuron ◽  
Synaptic Proteins ◽  
Chromosome 21 ◽  
Neuron Development ◽  
Epigenetic State ◽  
Neuronal Projection ◽  
Tea Extract

Abstract Down syndrome (DS) is the main genetic cause of intellectual disability due to triplication of human chromosome 21 (HSA21). Although there is no treatment for intellectual disability, environmental enrichment (EE) and the administration of green tea extracts containing epigallocatechin-3-gallate (EGCG) improve cognition in mouse models and individuals with DS. Using proteome, and phosphoproteome analysis in the hippocampi of a DS mouse model (Ts65Dn), we investigated the possible mechanisms underlying the effects of green tea extracts, EE and their combination. Our results revealed disturbances in cognitive-related (synaptic proteins, neuronal projection, neuron development, microtubule), GTPase/kinase activity and chromatin proteins. Green tea extracts, EE, and their combination restored more than 70% of the phosphoprotein deregulation in Ts65Dn, and induced possible compensatory effects. Our downstream analyses indicate that re-establishment of a proper epigenetic state and rescue of the kinome deregulation may contribute to the cognitive rescue induced by green tea extracts.

EVALUATING SURVEY METHODS OF HORTICULTURAL THERAPEUTIC ACTIVITIES FOR INTELLECTUAL DISABILITY

2008 ◽  
pp. 115-120
Author(s):  
S. Koura ◽  
K. Nagata ◽  
K. Yamagishi ◽  
Y. Imamura ◽  
U. Masaki
Keyword(s):  
Intellectual Disability ◽  
Survey Methods ◽  
Therapeutic Activities

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

2014 ◽  
Vol 32 (1) ◽  
pp. 21-30 ◽  
Author(s):  
J. Cotter ◽  
M. Kaess ◽  
A. R. Yung
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Childhood Trauma ◽  
Psychotic Disorders ◽  
Functional Disability ◽  
Clinical Work ◽  
Borderline Personality ◽  
Response To Treatment ◽  
Neurocognitive Deficits

ObjectivesWe aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.MethodsNarrative review of the peer-reviewed English language literature in the area.ResultsHigh rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment.ConclusionsRoutine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.

Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care

2017 ◽  
Vol 35 (7) ◽  
pp. 945-950
Author(s):  
Lisa C. Lindley
Keyword(s):  
Intellectual Disability ◽  
Length Of Stay ◽  
Residential Care ◽  
Hospice Care ◽  
Care Staff ◽  
Care Services ◽  
Life Trajectory ◽  
The Relationship ◽  
Children With Intellectual Disability

Background: Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. Objective/Hypothesis: This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Methods: Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. Results: The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. Conclusions: The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.

scholarly journals 182 Environment enrichment reduces aggression and stereotypic behaviors in feedlot steers

2019 ◽  
Vol 97 (Supplement_1) ◽  
pp. 67-67
Author(s):  
Rachel M Park ◽  
Rachel Bova ◽  
Jenny S Jennings ◽  
Courtney L Daigle
Keyword(s):  
Environmental Enrichment ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Day Treatment ◽  
Feedlot Cattle ◽  
Behavioral Differences ◽  
Environmental Complexity ◽  
Feedlot Steers ◽  
Environment Enrichment ◽  
Species Specific

Abstract Feedlots provide limited environmental complexity to cattle-a highly curious and social species. In the absence of adequate stimulation, cattle may engage in aggressive or abnormal behaviors. Implementation of biologically appropriate and species specific environmental enrichment (EE) has the potential to enhance welfare of feedlot steers. The objective of this study was to identify behavioral differences between cattle exposed to EE compared to those without. Composite steers (n = 54) were assigned to one of two treatments 1) No enrichment (CON; n = 3 at 9 head/pen) and 2) BRUSH (cattle brush; n = 3 at 9 head/pen). Video recordings were decoded utilizing continuous observation for the frequency and duration of headbutting, mounting, kicking, bar licking, tongue rolling, allogrooming, and brush usage from 0800 to 1730 on d -2, -1, 0, 1, 2, 4, 8, 16, 32, and 64 relative to brush implementation. Impact of day, treatment and their interaction on cattle behavior was evaluated using a Generalized Linear Mixed Model (PROC MIXED) in SAS. (BRUSH) steers spent less time bar licking (P = 0.023) and engaged in bar licking less frequency (P = 0.005) than CON throughout the duration of the study. Compared to CON, BRUSH steers performed fewer headbutts across the duration of the study (P = 0.004). Brush usage frequency (P = 0.0002) and duration (P = 0.008) was greatest on d 0 compared to all other research days. The frequency (P = 0.0006) and duration (P = 0.0002) of tongue rolling increased with research day. Similarly, the frequency (P = 0.0001) and duration (P = 0.002) of allogrooming increased over time, however, there was a decrease in allogrooming on d 64. Mounting frequency was impacted by research day and peaked at d 8 (P = 0.002). BRUSH cattle performed less stereotypic and aggressive behaviors suggesting that EE is beneficial for feedlot cattle welfare.

Evaluation of the neutrophil-lymphocyte ratio (NLR) during neoadjuvant chemotherapy (NC) for muscle-invasive bladder cancer (MIBC) and correlation with pathologic response to treatment.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 351-351
Author(s):  
Jo-An Seah ◽  
Raya Leibowitz-Amit ◽  
Eshetu G. Atenafu ◽  
Nimira Alimohamed ◽  
Anthony Michael Joshua ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Clinical Stage ◽  
Continuous Variable ◽  
Response To Treatment ◽  
Neutrophil Lymphocyte Ratio ◽  
Significant Difference ◽  
Receiver Operator Curve Analysis ◽  
Muscle Invasive ◽  
Inflammatory Burden

351 Background: Cancer associated inflammation, as measured by markers such as NLR, appears to impact on outcome. In MIBC, an elevated NLR> 2.5 prior to radical cystectomy (RC) is associated with a poorer prognosis (Gondo, 2011). We evaluated the pattern of change in NLR before (pre-NC), during (mid-NC) and after NC (pre-RC) and correlated this with pathological outcomes, to determine if NLR is of predictive value in this setting. Methods: AllMIBC pts treated with NC and RC between Jan 2005 – April 2013 were evaluated. Standard demographic, disease-related and biochemical parameters (Hb, LDH, albumin) and NLR were analyzed with univariate and multivariable logistic regression. The continuous variable pre-RC NLR was dichotomized using a cut-off of 2.5 based on area under the receiver-operator-curve analysis. Generalized linear mixed model was used to account for the time trend and co-linearity when assessing NLR change between pts who achieved pathological response (pathR) and non-responders. Results: Twenty-three patients were evaluable. Age, gender, ECOG, smoking, clinical stage, and hydronephrosis did not significantly predict for pathR. Pre-NC and mid-NC NLR did not predict for pathR. Pre-RC NLR <2.5 showed a trend towards association with pathR (p=0.05). The pattern of NLR change between responders and non-responders was significantly different (p=0.039). Non-responders exhibited a transient decrease in NLR during NC, followed by an increase in NLR pre-RC above its baseline; responders exhibited a sustained decrease in NLR which remained suppressed until RC (Figure: http://bit.ly/1bYC2wR). Conclusions: While there was no significant difference in pre-NC NLR between responders and non-responders, there was a significant difference in the pattern of NLR change during NC. We speculate that a sustained decrease in inflammatory burden during NC, as manifested by NLR, is associated with pathR. Despite limitations of a small retrospective study, our results may have potential translational and clinical implications.

The prevalence of obesity among forensic intellectual disability inpatients

2017 ◽  
Vol 41 (S1) ◽  
pp. S585-S585
Author(s):  
R. Denman ◽  
V. Chester ◽  
J. Watson ◽  
C. Nyakunuwa ◽  
R. Alexander
Keyword(s):  
Intellectual Disability ◽  
Length Of Stay ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Management Interventions ◽  
Increased Risk ◽  
Mental Health Settings ◽  
Prevalence Of Obesity ◽  
Competing Interest ◽  
The Impact

BackgroundInpatient mental health settings have been described as “obesogenic” environments, due to factors including psychotropic medication, high calorie food, restricted physical activity and sedentary lifestyles. No research has investigated obesity among forensic intellectual disability inpatients, despite this populations’ increased risk. Therefore, this paper aims to evaluate the prevalence and correlates of overweight and obesity on, and during admission.MethodThe weight and body mass index data of 46 inpatients (15 women and 31 men) within a specialist intellectual disability forensic service was examined for the study.ResultsOnly six patients (13%) were a normal weight at admission, whereas 40 (87%) were overweight or obese. During their admission, 28 (61%) gained weight (average 11.8 kg), and one (2%) maintained. However, 17 patients (37%) lost weight (average 6.2 kg), though 16 remained in overweight/obese categories. There was no correlation between length of stay and weight/BMI.ConclusionsThe majority of patients were overweight or obese on admission, and approximately 60% gained weight during their admission. Women appeared at greater risk of obesity. There was no relationship between length of stay and weight. This is potentially due to the high prevalence of obesity on admission and the impact of previous admissions on weight. The results highlight the need for effective weight management interventions with this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Contextualizing Distress

2021 ◽  
Vol 15 (3) ◽  
pp. 269-286
Author(s):  
Tessa-May Zirnsak
Keyword(s):  
Intellectual Disability ◽  
Liberal Democracy ◽  
Emotional Abuse ◽  
Political Discourse ◽  
Physical Violence ◽  
Specific Reference ◽  
Challenging Behaviour ◽  
Political Expression

The intellectual disability community faces ongoing emotional abuse, neglect, condescension, and removal of autonomy. By considering the instances of physical violence that are perpetuated by this community as the product of long-term experiences of cultural, structural, and physical violence, we are able to reconfigure the role of challenging behaviour. This reconfiguration has the capacity to revolutionize our understanding of how legitimate political discourse is presented. Rather than arguing for the legitimacy of violence, the article argues that acts of challenging behaviour from people with intellectual disability are acts of political expression. This argument is made by drawing from the context in which people with intellectual disability are situated in Western liberal democracy, with specific reference to evidence that this community experiences violence, emotional abuse, neglect, and high governance from non-disabled supporters over long periods of time, often across their lifetime.

Examining the Effects of Social Stories on Challenging Behavior and Prosocial Skills in Young Children: A Systematic Review and Meta-Analysis

2019 ◽  
Author(s):  
Charis Lauren Wahman ◽  
James E Pustejovsky ◽  
Michaelene M. Ostrosky ◽  
Rosa Milagros Santos
Keyword(s):  
Young Children ◽  
Challenging Behavior ◽  
Single Case ◽  
Meta Analysis ◽  
Social Stories ◽  
Evidence Base ◽  
Response To Treatment ◽  
Prosocial Skills ◽  
Primary Intervention ◽  
Size Measure

Social stories are a commonly used intervention practice in early childhood special education. Recent systematic reviews have documented the evidence-base for social stories, but findings are mixed. We examined the efficacy of social stories for young children (i.e., 3-5 years) with challenging behavior across 12 single-case studies, that included 30 participants. The What Works Clearinghouse standards for single case research design were used to evaluate the rigor of studies that included social stories as a primary intervention. For studies meeting standards, we synthesized findings on the efficacy of social stories using meta-analysis techniques and a recently developed parametric effect size measure, the log response ratio. Trends in participants’ response to treatment also were explored. Results indicate variability in rigor and efficacy for the use of social stories as an isolated intervention and in combination with other intervention approaches. Additional studies that investigate the efficacy of social stories as a primary intervention are warranted.

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