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7 results

  • Chapter 8 - Diagnosis of Co-occurrent Mental Health Problems in Persons with Intellectual Disability, Major Communication and Insight Difficulties, and Stressor-Related Disorders

  • Edited by Andrea Fiorillo, University of Campania “L. Vanvitelli”, Naples, Peter Falkai, Ludwig-Maximilians-Universität München, Philip Gorwood, Sainte-Anne Hospital, Paris
  • Book:
    Mental Health Research and Practice
    Published online:
    01 February 2024
    Print publication:
    08 February 2024, pp 122-134

  • Summary

    The prevalence of psychiatric disorders among patients with intellectual disability (ID) and low-functioning autism spectrum disorder (ASD) is higher than in the general population. The available reports on this comorbidity vary depending on the adopted methodologies, the size of the examined ID population, and the criteria used to diagnose mental disorders. Multiple factors contribute to the significantly different presentation of psychopathological symptoms and syndromes in people with ID and ASD compared to the general population, including cognitive and communicative impairments, developmental peculiarities, and neuro-autonomic vulnerability. Because they have a hard time conceptualizing and articulating their mental states, the diagnosis of their psychopathology must rely on firsthand observation of behaviors in the context of daily life as well as third-party accounts. As a result, diagnostic criteria designed for the general population are ineffective when used in these groups, so for them specific diagnostic procedures and instruments should be a significant determinant of psychiatric diagnosis validity.

  • Psychotropic medication for problem behaviours in intellectual disability and autism spectrum disorder: the need for caution

  • Marco O. Bertelli
  • Journal:
    BJPsych Advances / Volume 29 / Issue 5 / September 2023
    Published online by Cambridge University Press:
    15 May 2023, pp. 334-336
    Print publication:
    September 2023
    • Article
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  • Many persons with intellectual developmental disorders and/or autism spectrum disorder presenting problem behaviours undergo pharmacotherapy without receiving an appropriate psychiatric assessment and diagnosis. Instead, prescription of psychotropic medication should have specific aims and involve interdisciplinary assessment, personalisation and patient and family participation. Current knowledge about pharmacological management of problem behaviours in this population is limited, necessitating extreme caution in clinical practice and more research into the complex interrelated factors that affect presentation, course and treatment response.

  • Randomised controlled trials of antidepressant and anti-anxiety medications for people with autism spectrum disorder: systematic review and meta-analysis

  • Shoumitro Deb, Meera Roy, Rachel Lee, Madiha Majid, Bharati Limbu, Jacopo Santambrogio, Ashok Roy, Marco O. Bertelli
  • Journal:
    BJPsych Open / Volume 7 / Issue 6 / November 2021
    Published online by Cambridge University Press:
    01 October 2021, e179
    • Article
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      • Open access
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  • Background

    Although widely used, the current evidence for the efficacy of antidepressant and anti-anxiety medications for people with autism spectrum disorder (ASD) is limited and conflicting.

    Aims

    We carried out a systematic review and meta-analysis of randomised controlled trials that assessed the effectiveness of these medications in people with ASD.

    Method

    We searched the following databases: Cochrane Library, Medline, EMBASE, CINAHL, PsycINFO, ERIC, DARE and ClinicalTrials.gov. Additionally, we hand-searched 11 relevant journals. We used the Cochrane risk-of-bias tool and Jadad score to assess the quality of each included study. We carried out a meta-analysis using a random effects model.

    Results

    We included 15 randomised controlled trials (13 on antidepressants and two on anti-anxiety medications) for a total of 958 people with ASD. Data showed contradictory findings among the studies, with larger studies mostly showing a non-significant difference in outcomes between the treatment and the placebo groups. Meta-analysis of pooled Yale-Brown Obsessive Compulsive Scale and Clinical Global Impression Scale data from nine studies (60%) did not show any statistically significant inter-group difference on either of the outcome measures. The adverse effects reported were mild and, in most studies, their rates did not show any significant inter-group difference.

    Conclusions

    Given the methodological flaws in the most included studies and contradictory findings, it is difficult to draw any definitive conclusion about the effectiveness of either antidepressant or anti-anxiety medications to treat either ASD core symptoms or associated behaviours. Robust, large-scale, randomised controlled trials are needed to address this issue.

  • Chapter 24 - Mental health and intellectual disability: implications for global mental health

  • from Section 4 - Systems of development for special populations
  • Edited by Samuel O. Okpaku
  • Book:
    Essentials of Global Mental Health
    Published online:
    05 March 2014
    Print publication:
    27 February 2014, pp 222-230

  • Summary

    Management of the mental health patient is a concept that has gradually evolved in many countries and cultures. Traditional mental health care is critical in providing support to societies and communities that would otherwise have no one to attend to the coexisting physical and mental illnesses. Over the past few years there have been moves to facilitate collaboration between traditional practitioners and Western practitioners. The collaboration has taken place in countries such as South Africa and India, where national health policies have been amended to try and recognize the role of traditional practitioners. The complexity of mental health systems in some countries may be increased by the parallel operation of traditional healers and Western-style practitioners. One of the main obstacles hindering collaboration between Western-style practitioners and traditional practitioners concerns human rights abuses that can occur in prayer camps and traditional shrines.