Patients with and without intellectual disability seeking outpatient psychiatric services: diagnoses and prescribing pattern.
Adults with ID who show aggression often have depression, so screen for mood before reaching for antipsychotics.
01Research in Context
What this study did
Rutherford et al. (2003) looked at two groups of adults who came to the same outpatient psychiatric clinic. One group had intellectual disability. The other group did not.
The team wrote down every diagnosis and every medicine the doctor gave. They wanted to see if the two groups looked different.
What they found
Adults with ID were sent in for aggression, self-hitting, or body complaints. They left with prescriptions for antipsychotics or mood stabilizers.
Adults without ID came in for sadness or worry. They left with antidepressants or anti-anxiety pills.
Still, depression was the top diagnosis in both groups.
How this fits with other research
Lunsky et al. (2011) extends this picture. They compared ID adults in special ID clinics with ID adults in general psychiatry clinics. The special-clinic group looked a lot like the ID group in D et al.: more behavior problems and more mood meds.
Howlin et al. (2006) help explain why. Their survey of 214 adults with ID showed that self-injury or aggression usually points to an affective disorder, not just "behavior."
Chaplin (2004) seems to contradict the push for special clinics. The review found no clear win for either general or specialist services. The papers do not clash: D et al. describe what is happening, while Chaplin (2004) simply says we still lack outcome data to pick one service model over the other.
Why it matters
If a client with ID hits himself, ask about mood. The behavior may be depression talking, not "just ID." Screen with a simple depression checklist even when the referral only lists aggression. You might end up starting an antidepressant instead of jumping straight to an antipsychotic.
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02At a glance
03Original abstract
BACKGROUND: The present study examined the presenting problem of psychiatric outpatients, and resulting diagnostic and prescribing patterns, comparing patients with intellectual disability (ID) with non-ID (N-ID) patients seen in the same clinic. METHODS: This study was a retrospective medical chart review of information in the first psychiatric diagnostic evaluation for the most recent 100 adult patients with mild ID, 100 patients with moderate, severe or profound ID, and 100 matching N-ID patients. RESULTS: There were significant differences in rates of medical illness, disabilities, history of marriage, children, independent living, and family history of psychiatric and neurological disorders. Individuals with ID were more likely to present with aggression, self-injurious behaviour or physical complaints, whereas N-ID subjects presented more frequently with depression and anxiety complaints. For all groups, depressive disorders were the most frequent class of diagnoses. For those with ID, antipsychotics were used in 32% of subjects, with mood stabilizers in 28% and antidepressants in 27%. The N-ID subjects were most frequently prescribed antidepressants (40%) and anxiolytics (22%). Polypharmacy did not differ significantly among groups. CONCLUSIONS: Psychiatric practitioners relied on the diagnostic examination to formulate their diagnosis, whereas the chief complaint reflected the view of caregivers of the subjects with ID. In contrast to previous studies, outpatient providers frequently diagnosed depression, and the prescribing pattern showed increased usage of antidepressants and mood stabilizers.
Journal of intellectual disability research : JIDR, 2003 · doi:10.1046/j.1365-2788.2003.00463.x