Psychopathology and mental retardation: an Italian epidemiological study using the PIMRA

Effect of Peer Victimization on the Long-Term Mental Health Status among Adults Users of Intellectual Disability Services: A Longitudinal Follow-Up Study

Caregiving for mental health among people with intellectual disabilities (IDs) in the ID services was reported as insufficient. The purposes of this study were to investigate five types of peer victimization (PV) experiences among adults with ID using ID services, and to gain a deeper understanding of the influence of PV experience on adults with ID’s long-term mental health status. A one-year longitudinal follow-up study was conducted from eight long-term care ID services (n = 176). Logistic regression analysis was applied to variables comprising personal characteristics, various types of PV experience and polyvictimization to predict period prevalence of psychiatric symptoms. The data indicated that nearly one-third of individuals with ID experienced at least one psychiatric symptom. The three most common psychiatric symptoms prevalent after one year were adjustment disorder, anxiety disorder, and somatoform disorder. Over the 1-year study period, approximately 40% of adults with ID reported experiencing PV. The most frequently reported types of PV were physical force (26%) and verbal victimization (22%). Polyvictimization was experienced by approximately a quarter of adults with ID. The findings suggest that PV is a common experience among adults in ID services. Thus, for a clearer understanding of mental health risks, caregivers should pay attention to adults with ID who experienced PV.

Self-Concept, Self-Esteem and Psychopathological Symptoms in Persons with Intellectual Disability

The purpose of this study is two-fold: (a) to analyze self-concept, self-esteem, and psychopathological symptoms in individuals with and without intellectual disability; and (b) to explore whether there were gender differences in these same variables in both groups. The sample is made up of 170 participants aged 19 to 40, 128 without disability and 42 with intellectual disability. The methodology is descriptive. To measure the variables, three assessment instruments were applied: the “Listado de adjetivos para la evaluación del autoconcepto en adolescentes y adultos” (LAEA; Garaigordobil, in press), the Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965), and the Revised Symptom Checklist-90 (SCL-90; Derogatis, 1983). The ANOVA showed that participants with intellectual disability scored significantly lower in self-concept and self-esteem, and higher in all the psychopathological symptoms except for somatization. The ANOVA did not reveal significant gender differences in any variables in either of the two groups.

The making of a field: the development of comorbid psychopathology research for persons with intellectual disabilities and autism

Knowledge in the area of developmental disabilities has been expanding rapidly. One area that has received particular attention is the topic of related comorbid conditions. This phenomenon is not exclusive to the field of developmental disabilities. However, research with this population is of recent origin. The purpose of this paper is to review the origins of this field including some of the notable developments and potential future trends.

Reliability and validity of the SPAID-G checklist for detecting psychiatric disorders in adults with intellectual disability

SPAID (Psychiatric Instrument for the Intellectually Disabled Adult) is the first Italian tool-package for carrying out psychiatric diagnosis in adults with Intellectual Disabilities (ID). It includes the "G" form, for general diagnostic orientation, and specific checklists for all groups of syndromes stated by the available classification systems. SPAID was established to provide an easy and quick tool for daily practice of the personnel working with ID. The present study was aimed at evaluating psychometric and psychodiagnostic characteristics of the SPAID-G and at supplying new data on the prevalence rate of psychiatric disorders in a multicentric Italian sample of people with ID living in different settings. The SPAID-G was randomly applied to 304 participants with ID attending residential facilities or assessment services across Italy. A part of the sample was also consecutively assessed through the use of DASH, PDD-MRS and by the clinical application of the DSM-IV TR criteria. The correlation between SPAID-G scores and those provided by other evaluation tools was over 60%. Additionally, the internal consistency and inter-rater reliability resulted to be good. Psychopathological symptoms were detected in approximately 40% of the sample. Respectively, autistic spectrum disorders, impulse control disorders, mood disorders, and dramatic personality disorders were the diagnostic orientations providing the most prevalent over-threshold scores. SPAID-G seems to be a valid diagnostic tool, quick and easy to use in psychiatric disorders assessment within the Italian population with ID.

Scaling methods to measure psychopathology in persons with intellectual disabilities

Psychopathology prior to the last four decades was generally viewed as a set of problems and disorders that did not occur in persons with intellectual disabilities (ID). That notion now seems very antiquated. In no small part, a revolutionary development of scales worldwide has occurred for the assessment of emotional problems in persons with ID. The first standardized test to emerge was the Psychopathology Instrument for Mentally Retarded Adults (PIMRA) in 1984. Since that time, an impressive number of measures of general psychopathology have emerged for adults and children as well as for persons across the full range of levels of ID. The purpose of this review was to provide a description of available measures, to review papers published on these measures, and to discuss emerging trends in test development. The trends in this body of information for enhancing differential diagnosis of psychopathology in persons with ID are discussed.

A Case of Treatment Resistant Depression and Alcohol Abuse in a Person with Mental Retardation: Response to Aripiprazole and Fluvoxamine Therapy upon Consideration of a Bipolar Diathesis after Repetitive Failure to Respond to Multiple Antidepressant Trials

Mental Retardation (MR) is a developmental disability characterized by impairments in adaptive daily life skills and difficulties in social and interpersonal functioning. Since multiple causes may contribute to MR, associated clinical pictures may vary accordingly. Nevertheless, when psychiatric disorders as Treatment Resistant Depression (TRD) and/or alcohol abuse co-exist, their proper detection and management is often troublesome, essentially due to a limited vocabulary MR people could use to describe their symptoms, feelings and concerns, and the lack of reliable screening tools. Furthermore, MR people are among the most medicated subjects, with (over) prescription of antidepressants and/or typical antipsychotics being the rule rather than exception. Thus, treatment resistance or even worsening of depression, constitute frequent occurrences. This report describes the case of a person with MR who failed to respond to repetitive trials of antidepressant monotherapies, finally recovering using aripiprazole to fluvoxamine augmentation upon consideration of a putative bipolar diathesis for “agitated” TRD. Although further controlled investigations are needed to assess a putative bipolar diathesis in some cases of MR associated to TRD, prudence is advised in the long-term prescription of antidepressant monotherapies in such conditions.

Impact of additional disabilities on adaptive behavior and support profiles for people with intellectual disabilities

Numerous researchers have reported a high incidence of additional disabilities coexisting with intellectual disabilities. Although an intuitive link can be made between the existence of multiple disabilities and greater need for support, little has been reported about this relationship. Using measures of adaptive functioning and support needs, we examined the extent to which adaptive and challenging behaviors and consequent support needs (including medical) were impacted by the presence and severity of additional disabilities for individuals with intellectual disabilities. Results show that adaptive behaviors and support needs were meaningfully related to the number and severity of additional disabilities present, whereas this was not so for challenging behaviors. Findings are discussed in terms of contemporary models of disability and functioning.

Risk of mental disorders in subjects with intellectual disability in the Lundby cohort 1947-97

The Lundby Study is a prospective cohort study, which has followed a Swedish unselected community sample between 1 July 1947 and 1 July 1997. The aim was to study the risks of mental morbidity and different DSM-IV disorders in subjects with intellectual disability (ID) in the Lundby cohort between 1 July 1947 to 30 June 1997. The diagnosis of ID was re-evaluated according to DSM-IV in subjects who had been considered to have ID between 1947 and 1997. Multiple sources of information were used to obtain best estimate consensus diagnoses of mental disorders. The relative risk of mental disorder was 1.34 in subjects with ID as compared with the reference group. Dual diagnosis was more prevalent in mild ID than in moderate ID. No subject with severe ID was diagnosed with mental disorder. The cumulative incidence of any mental disorder in subjects with ID was 44%. The most common DSM-IV diagnoses were: Mood Disorders (11.5%), Anxiety Disorders (11.5%), Schizophrenia and Other Psychotic Disorders (8%), Mental Disorder NOS Due to a General Medical Condition (8%), Dementia (3.8%) and Alcohol Abuse (1.9%). Mental disorders were more common in subjects with ID than in the reference group.

Diagnosis and treatment of mood disorders in adults with developmental disabilities

While the idea that individuals with developmental disabilities (DD) can suffer from mental illness has been largely accepted since the late 1980's, this is still an underserved and poorly studied population. In particular, mood disorders have traditionally been misdiagnosed, under-recognized and poorly treated. Through the years, reported rates of mood disorders in adults with DD have varied widely. Recent epidemiological studies have focused on community samples and find rates of mood disorders from 3 to 8.1%. Mood disorders are found to be more prevalent than psychotic disorders or anxiety disorders. The empirical literature on assessment of mood symptoms in adults with DD is limited, particularly in individuals with severe and profound DD. Several tools have been developed to assist in identification and diagnosis. However, the work on their psychometric properties and validity studies is still quite limited. The treatment literature is sparse and focused primarily on pharmacotherapy. This review considers the epidemiology and diagnosis of mood disorders in individuals with DD. Recent developments in assessment are reviewed. The literature regarding pharmacological treatment with antidepressants, mood stabilizers, electroconvulsive therapy and antipsychotics is summarized and the current state of psychological treatments for mood disorders in persons with DD is presented. Implications for clinical care and future research are considered.

Harm avoidance, anxiety, and response to novelty in the adolescent S-100beta transgenic mouse: role of serotonin and relevance to Down syndrome

S-100beta is an astroglial-derived protein, which plays a role in brain development and maintenance, and is known to play a specific role in the regulation of growth of the serotonergic neuronal system. In humans, the gene for S-100beta is found on chromosome 21, within the region that is considered important for the phenotype of Down syndrome (DS). Thus, we have been studying a model of DS, the S-100beta transgenic mouse. In the current study, we have examined anxiety and responses to novelty in adolescent (60-90 days) animals, at a time when we have shown the animals to be relatively lacking in serotonin innervation, compared to their CD-1 nontransgenic controls. In a test for approach/avoidance, the light/dark test, the S-100beta transgenic mice animals showed no differences from control CD-1 mice. However, in the hole-board test for exploratory behavior, the S-100beta animals were found to be less responsive to the inhibiting effects of the serotonin receptor 5-HT1A agonist, buspirone. Three tests were used to measure response to novelty. In the open field, the S-100beta animals showed greater activity longer than the control animals, and in the Y-maze test, the S-100beta animals spent more time in the novel arm. In a test for novelty-induced gnawing, the S-100beta animals were also more active than control animals. All of these suggest that the S-100beta transgenic mice are slower to habituate to novelty than control animals. Finally, we tested the animals in a new procedure that we are proposing as a test for harm avoidance. In this apparatus, the S-100beta animals showed more approaches to a novel and potentially harmful object than the control mice did. These results are discussed in reference to the known lack of serotonin in the animals, and to the behavioral phenotype of DS.

Maladaptive behaviour in children and adolescents with Down's syndrome

BACKGROUND

Although children with Down's syndrome (DS) are at lower risk for psychopathology than others with intellectual disability, they do show more problems than typically developing children. However, age-related trends in these problems remain unclear.

METHODS

The present authors examined age-related changes in the maladaptive behaviours of 211 children and adolescents with DS aged between 4 and 19 years (mean = 9.74 years). Most participants (n = 180) were recruited from families residing in the greater Los Angeles area, California, USA, while a minority (n = 31) were patients from a clinic specializing in the psychiatric management of people with DS. The participants were divided into four age groups: (1) 4-6 years, (2) 7-9 years, (3) 10-13 years and (4) 14-19 years.

RESULTS

Externalizing behaviours were lower across both the community and clinic samples, while internalizing behaviours were significantly higher in older adolescents aged between 14 and 19 years. Increases were found in withdrawal, seen in 63% of community-based adolescents, and 75% of clinic adolescents.

CONCLUSIONS

Older adolescents with DS may show decreased externalizing symptoms and subtle increases in withdrawal. Possible relationships are discussed between these shifts and increased risks of later-onset depression and Alzheimer's disease in adults with DS.

Adjunctive gabapentin in patients with intellectual disability and bipolar spectrum disorders

The aim of the present study was to assess the efficacy of adjunctive gabapentin (GBP) in the treatment of patients with intellectual disability (ID) and bipolar spectrum disorders. Ten affected subjects with demonstrable increases in symptomatology during 'significant' life events which had interfered with or induced the interruption of their rehabilitation programmes were chosen for this study. The meaning of 'significant' was defined for each patient as a frequently repeated life event which had elicited a marked increase in symptoms on at least two occasions. Gabapentin (300-900 mg day-1) was added to the standard therapy. The subjects' psychopathological conditions during the significant life event were assessed by means of standardized tools both before and after adjunctive therapy with GBP. A positive response to therapy was observed, with subsequent improvement of psychopathological conditions, particularly for anxiety and depressive symptoms. The promising results obtained with GBP suggest the need for further trials. Adjunctive GBP may become an alternative treatment approach for patients with ID in whom traditional mood-stabilizing agents have frequent contraindications.

The psychopathology inventory for mentally retarded adults: factor structure and comparisons between subjects with or without dual diagnosis

Whether the Psychopathology Inventory for Mentally Retarded Adults (PIMRA) could detect specific psychopathological disorders was investigated in 652 subjects with different levels of mental retardation living in the community or in residential facilities. An exploratory factor analysis was carried out to check the scale organization of PIMRA. The Anxiety, Adjustment Disorder, Somatoform Disorder, and Soundness Scales were confirmed by 4 corresponding factors; the Psychosexual Disorder Scale was replaced by a factor specific to gender identity problems, and the Schizophrenia Scale by two factors concerning isolation and bizarre behaviors, respectively. The items of the Depression Scale were distributed over the three factors concerning anxiety, adjustment, and psychosomatic disorders, while the items of the Personality Disorder Scale were scattered over almost all the factors. Moreover, 55 subjects with anxiety disorders and 49 with depression were compared to 50 control subjects of the same age, intelligence level, and gender ratio but without dual diagnosis and obtained significantly higher factorial scores both on the overall scale and on the factors specifically related to their disorders. PIMRA has been found to show good construct validity. These results could be considered particularly valid as they were obtained from a large sample comprising different levels of mental retardation and thus showing all possible psychopathological behaviors.