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People with an intellectual disability (ID) are likely to experience traumatic events and more vulnerable to its disruptive effects and thus to post traumatic stress disorders (PTSD). Little is known about how these PTSDs present themselves in patients with ID and whether this presentation differs from patients without an ID.
The aim of the present study was to compare PTSD symptomatology in psychiatric outpatients with borderline to mild ID and outpatients without ID in naturalistic out-patient samples from psychiatric secondary care.
Subjects and methods
From June 1th 2010 to March 15th 2012, 56 patients were diagnosed with PTSD. Using Routine Outcome Monitoring (ROM), 45 patients (80.4%) had complete data on both the Impact of Events Scale Revised (IES-R) and the Brief Symptom Inventory (BSI). They were compared to 45 gender- and age-matched non-ID patients diagnosed with PTSD in the same period.
Preliminary results show that there are some small differences in general psychological symptom patterns between ID and non-ID patients with PTSD as shown on the subscales obsession-compulsion, psychoticism and depression of the BSI. On the IES-R, there was no difference between ID and non-ID patients. There was no difference in symptomatology between patients with borderline or mild ID.
PTSD symptomatology does not differ in ID patients compared to non-ID patients. Consequently, ID patients deserve the same evidence based care.
Mild psychotic experiences are common in the general population. Although transient and benign in most cases, these experiences are predictive of later mental health problems for a significant minority. The goal of the present study was to perform examinations of the dimensional and discrete variations in individuals’ reporting of subclinical positive and negative psychotic experiences in a unique Dutch internet-based sample from the general population.
Positive and negative subclinical psychotic experiences were measured with the Community Assessment of Psychic Experiences in 2870 individuals. First, the prevalence of these experiences and their associations with demographics, affect, psychopathology and quality of life were investigated. Next, latent class analysis was used to identify data-driven subgroups with different symptom patterns, which were subsequently compared on aforementioned variables.
Subclinical psychotic experiences were commonly reported. Both positive and negative psychotic experiences were associated with younger age, more negative affect, anxiety and depression as well as less positive affect and poorer quality of life. Seven latent classes (‘Low psychotic experiences’, ‘Lethargic’, ‘Blunted’, ‘Distressed’, ‘Paranormal’, ‘Distressed_grandiose’ and ‘Distressed/positive psychotic experiences’) were identified that demonstrated both dimensional differences in the number/severity of psychotic experiences and discrete differences in the patterns of reported experiences.
Subclinical psychotic experiences show both dimensional severity variations and discrete symptom-pattern variations across individuals. To understand and capture all interindividual variations in subclinical psychotic experiences, their number, nature and context (co-occurrence patterns) should be considered at the same time. Only some psychotic experiences may lay on a true psychopathological psychosis continuum.
Data-driven techniques are frequently applied to identify subtypes of depression and anxiety. Although they are highly comorbid and often grouped under a single internalizing banner, most subtyping studies have focused on either depression or anxiety. Furthermore, most previous subtyping studies have not taken into account experienced disability.
To incorporate disability into a data-driven cross-diagnostic subtyping model.
To capture heterogeneity of depression and anxiety symptomatology and investigate the importance of domain-specific disability-levels to distinguish between homogeneous subtypes.
Sixteen symptoms were assessed without skips using the MINI-interview in a population sample (LifeLines; n = 73403). Disability was measured with the RAND-36. To identify the best-fitting subtyping model, different nested latent variable models (latent class analysis, factor analysis and mixed-measurement item response theory [MM-IRT]) with and without disability covariates were compared. External variables were compared between the best model's classes.
A five-class MM-IRT model incorporating disability showed the best fit (Fig. 1). Accounting for disability improved the differentiation between classes reporting isolated non-specific symptoms (“Somatic” [13.0%], and “Worried” [14.0%]) and those reporting more psychopathological symptoms (“Subclinical” [8.8%], and “Clinical” [3.3%]). A “Subclinical” class reported symptomatology at subthreshold levels. No pure depression or anxiety, but only mixed classes were observed.
An overarching subtyping model incorporating both symptoms and disability identified distinct cross-diagnostic subtypes. Diagnostic nets should be cast wider than current phenomenology-based categorical systems.
Figure not available.
Disclosure of interest
The authors have not supplied their declaration of competing interest.