Dual diagnosis: an annotated bibliography of recent research

The assessment of mood in adults who have severe or profound mental retardation

Empirical literature examining the emotional lives of adults with severe and profound mental retardation is limited. One area to have received attention is mood. It is proposed that the utility of assessment of mood extends beyond psychiatric diagnosis to issues such as the appraisal of quality of life for individuals with limited or no expressive language. Two themes related to the assessment of mood are evident in contemporary literature. First, attempts have been made to clarify presentation of affective disorders, especially depression, and to improve assessment of depressive symptomatology in adults with mental retardation. A review of current methods for assessing depression indicates significant problems with reliability and validity. There is a need to develop appropriate assessment methods for use in relation to adults with severe and profound mental retardation who are unable to self-report and behavioral methodology might be useful in this respect. Second, there is an emerging argument that presentation of depression in adults with mental retardation, particularly in individuals with severe disabilities, includes challenging behaviors, referred to as "atypical symptoms." Methodological and conceptual issues related to this argument warrant closer examination. Finally, it is noted that research drawing on more rigorous methodology is required to interpret the emotional states of individuals with severe and profound mental retardation.

The relationship between levels of mood, interest and pleasure and 'challenging behaviour' in adults with severe and profound intellectual disability

BACKGROUND

Research on affective disorders in adults with intellectual disability (ID) suggests that depression may not present a 'classic picture' in individuals with severe and profound ID, but may include challenging behaviours, which are referred to as 'atypical symptoms', such as self-injury, aggression and irritability. The aim of the present study was to explore whether there is an association between constructs relating closely to the core symptoms of depression and challenging behaviours in adults with severe and profound ID.

METHOD

Mood and levels of interest and pleasure were measured in 53 adults with severe or pro-found ID using the Mood, Interest and Pleasure Questionnaire (MIPQ).

RESULTS

Two groups of adults were identified based on MIPQ scores: (1) a 'low mood' group (lowest score = 12); and (2) a comparison group (highest scoring = 12). The groups were clearly differentiated on the MIPQ (P < 0.0001), but were comparable on age, gender and medication use. The Challenging Behaviour Interview showed no difference between the two groups in self-injury, aggression or disrupting the environment. A secondary analysis revealed that participants who showed challenging behaviour scored significantly lower on the MIPQ than those who did not show challenging behaviour.

CONCLUSIONS

Possible reasons for these results and considerations for future studies are discussed.

The factor structure of the Reiss Screen for Maladaptive Behaviors in institutional and community populations

The Reiss Screen for Maladaptive Behavior was factor analyzed in two institutional samples and one community sample of persons with mental retardation. In Sample I a general factor was found. In Samples 2 and 3 a three-factor structure was found. These three factors were named Intra-personal Maladaptive Behavior, Psychotic Behavior, and Extra-personal Maladaptive Behavior. None of the factor solutions bore any close resemblance to a factor structure implied by the seven scales on the Reiss Screen. The implications for the future development of assessments of dual diagnosis are discussed.

Diagnostic-based pharmacological treatment of behavior disorders in persons with developmental disabilities: a review and a decision-making typology

This article reviews the diagnostic rationale for treatment of behavior disorders with psychotropic medication. After reviewing the concerns over the use of psychotropic medication and the use of diagnostic criteria with persons with developmental disabilities in the past, the variety of potential diagnoses that may underlie a behavior disorder are reviewed. A model to guide clinical decision making is then developed on the basis of this review, and areas for future research are suggested. The key questions are identified as making reliable differential diagnoses of behavior disorders and demonstrating that these differential diagnoses successfully identify more effective psychotropic medications for the treatment of behavior disorders in persons with developmental disabilities.