Psychosocial experiences of chronic illness in individuals with an intellectual disability: A systematic review of the literature

The Intriguing Diagnosis of Lung Cancer in a Psychiatry Inpatient Unit: A Reflection Through a Case Report

People with intellectual developmental disorders are vulnerable to somatic and mental illnesses, often presenting with behavioural changes. Through an intriguing and uncommon case report, we aim to provide an overview of behavioural changes in patients with an intellectual developmental disorder, emphasizing the need for screening for non-psychiatric conditions. We present a clinical case of a 57-year-old man with a personal history of intellectual developmental disorder, epilepsy, and alcohol and tobacco abuse. He had a previous acute psychiatric admission in 2017 due to behaviour disorganization and irritability. In April 2019, he was readmitted with disorganized behaviour and caregiver exhaustion. On the 58th day of hospitalization, he fell off his bed and suffered a mild traumatic brain injury. A cerebral CT scan revealed two metastatic lesions in the brain. Further investigations discovered a primary neoplastic lung lesion with metastasis to pulmonary lymph nodes. This case emphasizes that despite a long follow-up with psychiatry services, physical illness should be considered when patients with intellectual developmental disorders present with behavioural changes as they can precede image and laboratory findings. Additionally, further studies are needed in order to provide guidelines and proper medical and psychosocial care for this particular population and the caregivers.

What Are the Psycho-Social and Information Needs of Adolescents and Young Adults Cancer Care Consumers with Intellectual Disability? A Systematic Review of Evidence with Recommendations for Future Research and Practice

People with intellectual disability have unmet health needs and experience health inequalities. There is limited literature regarding cancer care for children, adolescents, and young adults (AYA) with intellectual disability despite rising cancer incidence rates in this population. This systematic review aimed to identify the psycho-social and information support needs of AYA cancer care consumers with intellectual disability to generate recommendations for future research and cancer care service delivery enhancement. We searched eight databases yielding 798 articles. Following abstract and full-text review, we identified 12 articles meeting our inclusion criteria. Our three themes related to communication and accessible information; supports and system navigation, cancer service provider training, and reasonable adjustments. There was a lack of user-friendly, accessible information about cancer and screening programs available. Both paid and family carers are critical in accessing cancer supports, services, and screening programs for AYA with intellectual disability. Ongoing training should be provided to healthcare professionals regarding the importance of care screening for AYAs with intellectual disability. This review recommends that AYA with intellectual disability and their family carers be involved in developing tailored cancer services. This should focus on enabling inclusive screening programs, accessible consent, and challenging the enduring paternalism of support services via training and appropriate communication tools.

The palliative care needs of adults with intellectual disabilities and their access to palliative care services: A systematic review

BACKGROUND

There is evidence that people with intellectual disabilities experience healthcare inequalities, including access to specialist palliative care, but to date, there has not been a systematic review of empirical evidence.

AIM

To identify the palliative care needs of adults with intellectual disabilities and the barriers and facilitators they face in accessing palliative care.

DESIGN

Systematic review using a narrative synthesis approach (International prospective register of systematic reviews (PROSPERO) registration number: CRD42019138974).

DATA SOURCES

Five databases were searched in June 2019 (MEDLINE, Embase, PsycINFO, the Cochrane library and CINAHL) along with hand searches and a search of the grey literature. All study designs were included.

RESULTS

A total of 52 studies were identified, all of which were conducted in high-income countries, the majority in the United Kingdom (n = 28). From a total of 2970 participants across all studies, only 1% were people with intellectual disabilities and 1.3% were family members; the majority (97%) were health/social care professionals. Identified needs included physical needs, psychosocial and spiritual needs, and information and communication needs. Barriers and facilitators were associated with education (e.g. staff knowledge, training and experience), communication (e.g. staff skill in assessing and addressing needs of people with communication difficulties), collaboration (e.g. importance of sustained multidisciplinary approach) and health and social care delivery (e.g. staffing levels, funding and management support).

CONCLUSION

This review highlights the specific problems in providing equitable palliative care for adults with intellectual disabilities, but there is a lack of research into strategies to improve practice. This should be prioritised using methods that include people with intellectual disabilities and families.

Identification of emotions and physiological response in individuals with moderate intellectual disability

According to Ekman's model, the basic emotions are anger, disgust, fear, happiness, sadness, and surprise. These emotions are universal and have an adaptative function. However, studies on these emotions among individuals with moderate intellectual disability (MID) are limited, mainly owing to issues in sample size and sample homogeneity. The present study aimed to explore differences between a MID group (n = 10) and a non-MID control group (n = 10) in 1) the identification of basic emotions; and 2) the physiological response with images related to fear, happiness, sadness, anger, and disgust, as well as images with neutral and sexual content. A total of 29 images from The International Affective Picture System and a biofeedback measurement system were used. The results showed no statistically significant differences in the identification of the basic emotions of fear, sadness, and disgust. However, statistically significant differences were found for happiness (p = .008), anger (p = .02), and neutral images (p = .02), and minor statistically significant differences were found for images with sexual content (p < .01) in MID individuals with respect to the control group. The MID group's physiological response was lower compared with the control group, with statistically significant differences for all emotional visual stimuli. This preliminary study showed important and interesting results for the study of emotions and sexuality in MID. Future studies should consider the sample size, sex and age comparisons, and the different levels of intellectual disability.

Cognition and Behaviour in Sotos Syndrome: A Systematic Review

BACKGROUND

Research investigating cognition and behaviour in Sotos syndrome has been sporadic and to date, there is no published overview of study findings.

METHOD

A systematic review of all published literature (1964-2015) presenting empirical data on cognition and behaviour in Sotos syndrome. Thirty four journal articles met inclusion criteria. Within this literature, data relating to cognition and/or behaviour in 247 individuals with a diagnosis of Sotos syndrome were reported. Ten papers reported group data on cognition and/or behaviour. The remaining papers employed a case study design.

RESULTS

Intelligence quotient (IQ) scores were reported in twenty five studies. Intellectual disability (IQ < 70) or borderline intellectual functioning (IQ 70-84) was present in the vast majority of individuals with Sotos syndrome. Seven studies reported performance on subscales of intelligence tests. Data from these studies indicate that verbal IQ scores are consistently higher than performance IQ scores. Fourteen papers provided data on behavioural features of individuals with Sotos syndrome. Key themes that emerged in the behavioural literature were overlap with ASD, ADHD, anxiety and high prevalence of aggression/tantrums.

CONCLUSION

Although a range of studies have provided insight into cognition and behaviour in Sotos syndrome, specific profiles have not yet been fully specified. Recommendations for future research are provided.