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Minerva Psichiatrica 2012 March;53(1):29-38


language: English

Challenges and advances in mental health and intellectual disabilities

Wieland J. 1, Van Vliet J. P. M. 1, Zitman F. G. 2

1 Kristal, Center for Psychiatry and Intellectual Disabilities, Leiden, the Netherlands; 2 Leiden University Medical Center, Leiden, the Netherlands


People with intellectual disabilities suffer from the full range of psychiatric disorders and prevalence rates are high. Mental health care for people with intellectual disabilities however, is still in its infancy. Diagnosing psychiatric disorders is difficult because many professionals have little to no experience with this patient population and referral often depends on caretakers. The use of diagnostic criteria may be limited because of phenomena like intellectual distortion, cognitive disintegration, psychosocial masking, baseline exaggeration and answering in the affirmative. Challenging behavior is one of the main reasons for referral to psychiatric services, but it is not a formal psychiatric diagnosis and its relationship with psychiatric illness is unclear. Regarding treatment it can be said that in general, it is too early to speak about evidence based treatments in this patient group. Notwithstanding the lack of evidence people with intellectual disabilities are among the most medicated groups in society. Off label prescribing and polypharmacy are common. Psychotherapy has only recently taken root. But even though different forms of psychotherapy are now being used in clinical practice, there is little research based evidence of effectiveness. In the last decade or so there have been some important advances. Publications like the DM-ID and the DC-LD and the increasing availability of psychometrically sound instruments facilitate making accurate psychiatric diagnoses. The overuse of psychotropic medication, especially in challenging behavior, has become a focus of attention. And more and more studies, including RCT’s, are being conducted.
Still, compared to the general psychiatry, development is lagging far behind. Even though challenges have been thoroughly analysed, a gap remains between research and clinical practice. Focus should be on gaining more insight into the prevalence and course of psychopathology and the effectiveness of different kinds of treatments and translating this to everyday clinical practice.

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