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Badger S, Watkins LV, Bassett P, Roy A, Eyeoyibo M, Sawhney I, Purandare K, Wood L, Pugh A, Hammett J, Sheehan R, Tromans S, Shankar R. The relationship between clinical presentation and the nature of care in adults with intellectual disability and epilepsy - national comparative cohort study. BJPsych Open 2024; 10:e94. [PMID: 38686441 PMCID: PMC11060072 DOI: 10.1192/bjo.2024.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND A quarter of People with Intellectual Disabilities (PwID) have epilepsy compared with 1% of the general population. Epilepsy in PwID is a bellwether for premature mortality, multimorbidity and polypharmacy. This group depends on their care provider to give relevant information for management, especially epilepsy. There is no research on care status relationship and clinical characteristics of PwID and epilepsy. AIM Explore and compare the clinical characteristics of PwID with epilepsy across different care settings. METHOD A retrospective multicentre cohort study across England and Wales collected information on seizure characteristics, intellectual disability severity, neurodevelopmental/biological/psychiatric comorbidities, medication including psychotropics/anti-seizure medication, and care status. Clinical characteristics were compared across different care settings, and those aged over and younger than 40 years. RESULTS Of 618 adult PwID across six centres (male:female = 61%:39%), 338 (55%) received professional care whereas 258 (42%) lived with family. Significant differences between the care groups existed in intellectual disability severity (P = 0.01), autism presence (P < 0.001), challenging behaviour (P < 0.001) and comorbid physical conditions (P = 0.008). The two groups did not vary in intellectual disability severity/genetic conditions/seizure type and frequency/psychiatric disorders. The professional care cohort experienced increased polypharmacy (P < 0.001) and antipsychotic/psychotropic use (P < 0.001/P = 0.008).The over-40s cohort had lower autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) comorbidity (P < 0.001/P = 0.007), increased psychiatric comorbidity and challenging behaviour (P < 0.05), physical multimorbidity (P < 0.001), polypharmacy (P < 0.001) and antipsychotic use (P < 0.001) but reduced numbers of seizures (P = 0.007). CONCLUSION PwID and epilepsy over 40 years in professional care have more complex clinical characteristics, increased polypharmacy and antipsychotic prescribing but fewer seizures.
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Affiliation(s)
- Sarah Badger
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Lance V Watkins
- University of South Wales, Pontypridd, UK; Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK; and Swansea Bay University Health Board, Port Talbot, UK
| | | | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Kiran Purandare
- Central and Northwest London NHS Foundation Trust, London, UK
| | - Laurie Wood
- Swansea Bay University Health Board, Port Talbot, UK
| | - Andrea Pugh
- Swansea Bay University Health Board, Port Talbot, UK
| | | | - Rory Sheehan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuel Tromans
- SAPPHIRE Group, Department of Population Health Sciences, University of Leicester, Leicester, UK; and Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
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Watkins L, Kulkarni A, Webber E, Bassett P, Lamb K, Sawhney I, Laugharne R, Heslop P, Jones A, Napier G, Crocker A, Sivan M, Shankar R. People with Intellectual Disabilities, Dysphagia and Post-Covid Syndrome. Dysphagia 2024:10.1007/s00455-024-10679-1. [PMID: 38498202 DOI: 10.1007/s00455-024-10679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 02/01/2024] [Indexed: 03/20/2024]
Abstract
People with Intellectual Disability (ID) were more likely to contract COVID-19 infection and more likely to die from the consequences. However, there is no evidence on the long-term impact of COVID-19 infection in people with ID. Post-Covid Syndrome (PCS) is an established diagnosis that requires specialist clinical support. To date there is no data on how common PCS is in people with ID, or how symptoms present. Dysphagia is identified as a clinical marker because of the known association with PCS, and the clear objective diagnostic criteria applicable through specialist assessment. This investigation presents a cohort of people with ID, who developed dysphagia/worsening of dysphagia post diagnosis with COVID-19. Cases were identified through support from the Royal College of Speech and Language Therapists. Data was collected by electronic survey, including application of the COVID-19 Yorkshire Rehabilitation Scale-modified (C19-YRSm). The C19-YRSm is a validated assessment tool for PCS and it's impact upon functional disability. This case series identifies that symptoms consistent with PCS are present in people with ID, post-COVID-19 infection. The risk of diagnostic overshadowing or misdiagnosis is high due to the subjective nature and the quality of PCS symptoms. People with ID who develop PCS may not be readily identified by clinical services and therefore not be accessing the specialist medical support required. Furthermore, changes in behaviour secondary to PCS may lead to unnecessary increased prescribing of psychotropic medication which in itself risks worsening dysphagia. Dysphagia could be an important bellwether to identify PCS in people with ID.
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Affiliation(s)
- Lance Watkins
- University of South Wales, Pontypridd, UK
- Swansea Bay University Health Board, Port Talbot, UK
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Amit Kulkarni
- Royal College of Speech & Language Therapists, London, UK
- University of Central Lancashire, Preston, UK
| | - Emma Webber
- Royal College of Speech & Language Therapists, London, UK
| | | | - Kirsten Lamb
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Richard Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, TR 4 9LD, UK
| | - Pauline Heslop
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Angela Jones
- Swansea Bay University Health Board, Port Talbot, UK
- Royal College of Speech & Language Therapists, London, UK
| | - Geraldine Napier
- Royal College of Speech & Language Therapists, London, UK
- South Eastern Health and Social Care Trust, Belfast, UK
| | - Angela Crocker
- Royal College of Speech & Language Therapists, London, UK
| | - Manoj Sivan
- School of Medicine, University of Leeds, Leeds, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK.
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK.
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3
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Tromans S, Robinson G, Gabrielsson A, Bassett P, Sawhney I, Triantafyllopoulou P, Hassiotis A, Shankar R. The views of psychiatrists on proposed changes to the England and Wales Mental Health Act 1983 legislation for people with intellectual disability: A national study. Int J Soc Psychiatry 2024; 70:388-401. [PMID: 38001564 PMCID: PMC10913297 DOI: 10.1177/00207640231212112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/or autism could not be detained beyond 28 days, in the absence of diagnosed co-occurring mental illness. AIM To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID. METHODS A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher's exact tests. Thematic analysis was conducted on free text responses. RESULTS A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process. CONCLUSION Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised.
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Affiliation(s)
- Samuel Tromans
- Department of Population Health Sciences, University of Leicester, UK
- Adult Learning Disability Service, Leicestershire Partnership NHS Trust, UK
| | - Gemma Robinson
- Forensic Community Learning Disability Team, Southern Health NHS Foundation Trust, Calmore, UK
| | | | | | | | | | | | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
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4
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Laugharne R, Sawhney I, Perera B, Wainwright D, Bassett P, Caffrey B, O'Dwyer M, Lamb K, Wilcock M, Roy A, Oak K, Eustice S, Newton N, Sterritt J, Bishop R, Shankar R. Chronic constipation in people with intellectual disabilities in the community: cross-sectional study. BJPsych Open 2024; 10:e55. [PMID: 38425039 PMCID: PMC10951845 DOI: 10.1192/bjo.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND One-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited. AIMS To enumerate risk factors associated with constipation in this population. METHOD A questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation. RESULTS Of the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender. CONCLUSIONS People with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.
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Affiliation(s)
- Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Bhathika Perera
- Department of Psychiatry, University College London, London, UK
| | | | | | | | - Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Republic of Ireland
| | - Kirsten Lamb
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | | | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, Birmingham, UK
| | - Katy Oak
- Royal Cornwall Hospitals Trust, Truro, UK
| | | | - Nick Newton
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | | | - Ruth Bishop
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
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5
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Gabrielsson A, Moghaddassian M, Sawhney I, Shardlow S, Tromans S, Bassett P, Shankar R. The long-term psycho-social impact of the pandemic on people with intellectual disability and their carers. Int J Soc Psychiatry 2023; 69:1781-1789. [PMID: 37191298 PMCID: PMC10191827 DOI: 10.1177/00207640231174373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND People with intellectual disabilities (PWID) are at six times higher risk of death due to COVID-19. To mitigate harm, as a high-risk group, significant social changes were imposed on PWID in the UK. Alongside these changes, the uncertainty of the pandemic influence, caused PWID and their carers to encounter significant stress. The evidence of the pandemic's psycho-social impact on PWID originates mainly from cross-sectional surveys conducted with professionals and carers. There is little research on the longitudinal psycho-social impact of the pandemic from PWID themselves. AIMS To examine the long-term psycho-social impact of the pandemic on PWID. METHODS A cross-sectional survey, following STROBE guidance, of 17 Likert scale statements (12 to PWID and 5 to their carers) to ascertain the pandemic's psychosocial impact was conducted. Every other PWID open to a specialist Intellectual Disability service serving half a UK County (pop:500,000) was selected. The same survey was re-run with the same cohort a year later. Descriptive statistics, Mann-Whitney, Chi-square and unpaired-t tests were used to compare responses. Significance is taken at p < .05. Comments were analysed using Clarke and Braun's approach. RESULTS Of 250 PWID contacted, 100 (40%) responded in 2020 and 127 (51%) in 2021. 69% (2020) and 58% (2021) reported seeking medical support. Carers, (88%, 2020 and 90%, 2021) noticed emotional changes in PWID they cared for. 13% (2020) and 20% (2021) of PWID had their regular psychotropics increased. 21% (2020) and 24% (2021) had their pro re nata (PRN) medication adjusted. PWID or carers demonstrated no statistically significant variation in responses between themselves from 2020 to 2021. PWID were more likely to report being upset/distressed compared to their carers' perceptions of them in both years (p < .001). Four themes were identified. CONCLUSION This longitudinal study highlights the diverse psycho-social impact of the pandemic on PWID in the UK. The Pandemic's psycho-social impact has been significantly underestimated.
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Affiliation(s)
| | | | | | - Sophie Shardlow
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - Samuel Tromans
- University of Leicester, UK
- Leicestershire Partnership NHS Trust, UK
| | | | - Rohit Shankar
- Peninsula School of Medicine, University of Plymouth, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
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6
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Gabrielsson A, Tromans S, Newman H, Triantafyllopoulou P, Hassiotis A, Bassett P, Watkins L, Sawhney I, Cooper M, Griffiths L, Pullen A, Roy A, Angus-Leppan H, Rh T, Kinney M, Tittensor P, Shankar R. Awareness of social care needs in people with epilepsy and intellectual disability. Epilepsy Behav 2023; 145:109296. [PMID: 37336133 DOI: 10.1016/j.yebeh.2023.109296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Nearly a quarter of people with intellectual disability (ID) have epilepsy with large numbers experiencing drug-resistant epilepsy, and premature mortality. To mitigate epilepsy risks the environment and social care needs, particularly in professional care settings, need to be met. PURPOSE To compare professional care groups as regards their subjective confidence and perceived responsibility when managing the need of people with ID and epilepsy. METHOD A multi-agency expert panel developed a questionnaire with embedded case vignettes with quantitative and qualitative elements to understand training and confidence in the health and social determinants of people with ID and epilepsy. The cross-sectional survey was disseminated amongst health and social care professionals working with people with ID in the UK using an exponential non-discriminative snow-balling methodology. Group comparisons were undertaken using suitable statistical tests including Fisher's exact, Kruskal-Wallis, and Mann-Whitney. Bonferroni correction was applied to significant (p < 0.05) results. Content analysis was conducted and relevant categories and themes were identified. RESULTS Social and health professionals (n = 54) rated their confidence to manage the needs of people with ID and epilepsy equally. Health professionals showed better awareness (p < 0.001) of the findings/recommendations of the latest evidence on premature deaths and identifying and managing epilepsy-related risks, including the relevance of nocturnal monitoring. The content analysis highlighted the need for clearer roles, improved care pathways, better epilepsy-specific knowledge, increased resources, and better multi-disciplinary work. CONCLUSIONS A gap exists between health and social care professionals in awareness of epilepsy needs for people with ID, requiring essential training and national pathways.
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Affiliation(s)
- A Gabrielsson
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - S Tromans
- University of Leicester, Leicester, UK; Leicestershire Partnership NHS Trust, Leicester, UK
| | - H Newman
- University of Plymouth Peninsula School of Medicine, Plymouth, UK
| | | | | | | | - L Watkins
- University of South Wales, Pontypridd, UK; Swansea Bay University Health Board, Port Talbot, UK
| | - I Sawhney
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - M Cooper
- National Development Team for Inclusion Bath, UK
| | - L Griffiths
- National Development Team for Inclusion Bath, UK
| | | | - A Roy
- Coventry and Warwickshire Partnership Trust, Birmingham, UK
| | | | | | - M Kinney
- Belfast Health and Social Trust, Belfast, UK
| | - P Tittensor
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - R Shankar
- University of Plymouth Peninsula School of Medicine, Plymouth, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK.
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7
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Sun JJ, Watkins L, Henley W, Laugharne R, Angus-Leppan H, Sawhney I, Shahidi MM, Purandare K, Eyeoyibo M, Scheepers M, Lines G, Winterhalder R, Perera B, Hyams B, Ashby S, Shankar R. Mortality risk in adults with intellectual disabilities and epilepsy: an England and Wales case-control study. J Neurol 2023:10.1007/s00415-023-11701-6. [PMID: 37022478 PMCID: PMC10078066 DOI: 10.1007/s00415-023-11701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND People with epilepsy (PWE) and people with intellectual disabilities (ID) both live shorter lives than the general population and both conditions increase the risk of death further. We aimed to measure associations between certain risk factors for death in PWE and ID. METHODS A retrospective case-control study was conducted in ten regions in England and Wales. Data were collected on PWE registered with secondary care ID and neurology services between 2017 and 2021. Prevalence rates of neurodevelopmental, psychiatric and medical diagnoses, seizure frequency, psychotropic and antiseizure medications (ASM) prescribed, and health activity (epilepsy reviews/risk assessments/care plans/compliance etc.) recorded were compared between the two groups. RESULTS 190 PWE and ID who died were compared with 910 living controls. People who died were less likely to have had an epilepsy risk assessment but had a greater prevalence of genetic conditions, older age, poor physical health, generalized tonic-clonic seizures, polypharmacy (not ASMs) and antipsychotic use. The multivariable logistic regression for risk of epilepsy-related death identified that age over 50, medical condition prevalence, antipsychotic medication use and the lack of an epilepsy review in the last 12 months as associated with increased risk of death. Reviews by psychiatrists in ID services was associated with a 72% reduction in the odds of death compared neurology services. CONCLUSIONS Polypharmacy and use of antipsychotics may be associated with death but not ASMs. Greater and closer monitoring by creating capable health communities may reduce the risk of death. ID services maybe more likely to provide this holistic approach.
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Affiliation(s)
- James J Sun
- Royal Free London NHS Foundation Trust, London, UK
| | - Lance Watkins
- Swansea Bay University Health Board, Port Talbot, UK
- University of South Wales, Pontypridd, UK
| | | | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK
- University of Plymouth Peninsula School of Medicine, Truro, UK
| | | | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | | | - Kiran Purandare
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Mark Scheepers
- Gloucestershire Health and Care NHS Foundation Trust, Gloucestershire Health and Care NHS Foundation Trust, Brockworth, UK
| | - Geraldine Lines
- Gloucestershire Health and Care NHS Foundation Trust, Gloucestershire Health and Care NHS Foundation Trust, Brockworth, UK
| | | | - Bhathika Perera
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | | | | | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK.
- University of Plymouth Peninsula School of Medicine, Truro, UK.
- Chy Govenek, Threemilestone Industrial Estate, Highertown, Truro, TR4 9LD, Cornwall, UK.
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8
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Sawhney I, Zia A, Gates B, Sharma A, Adeniji A. Clinical letters to patients with intellectual disabilities after psychiatric review: A quality improvement project. J Intellect Disabil 2023; 27:278-286. [PMID: 34937432 PMCID: PMC9940126 DOI: 10.1177/17446295211046478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 06/14/2023]
Abstract
AIM This Quality Improvement Project sought to improve communication between patients with intellectual disabilities and their psychiatrists by sharing medical information using an easy read letter format following psychiatric review. BACKGROUND Writing directly to patients is in keeping with good medical practice. Previous studies have shown patients with intellectual disabilities prefer letters tailored to meet their needs. METHOD An easy read letter was used by nine psychiatrists who handed them to 100 consecutive patients after review. Feedback of acceptability to patients was obtained using a three-item facial rating scale and the use of free text. Feedback of acceptability was obtained from participating psychiatrists. RESULTS Patients found the easy read letter helpful and felt it should be used routinely. Psychiatrists felt this approach was beneficial as well as aiding patient understanding of review. CONCLUSIONS The easy read letter was reported to improve communication following psychiatric review. Limitations are acknowledged but it is concluded that an easy read letter should be adopted as routine practice following psychiatric review, for people with intellectual disabilities.
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Affiliation(s)
| | - Asif Zia
- Hertfordshire Partnership University NHS
Foundation Trust, UK; University of West London, UK
| | - Bob Gates
- Bob Gates, University of West London, St.
Mary’s Road, Ealing, London W5 5RF, UK; University of Hertfordshire, De
Havilland Campus, Mosquito Way, Hatfield AL10 9EU, UK; University of Derby,
Kedleston Road, Derby DE22 1GB, UK.
| | - Anu Sharma
- Hertfordshire Partnership University NHS
Foundation Trust, UK
| | - Adetayo Adeniji
- Hertfordshire Partnership University NHS
Foundation Trust, UK
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9
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Tromans S, Bhui K, Sawhney I, Odiyoor M, Courtenay K, Roy A, Boer H, Alexander R, Biswas A, McCarthy J, Gulati G, Laugharne R, Shankar R. The potential unintended consequences of Mental Health Act reforms in England and Wales on people with intellectual disability and/or autism. Br J Psychiatry 2023; 222:188-190. [PMID: 36746616 DOI: 10.1192/bjp.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The draft Mental Health Bill, which amends the Mental Health Act 1983 for England and Wales, proposes protections for people with intellectual disability and/or autism (ID/A) to prevent detention in hospital in the absence of mental illness. This editorial critically appraises the positive impact and unintended consequences of the proposed reforms for people with ID/A.
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Affiliation(s)
- Samuel Tromans
- Department of Psychiatry, University of Leicester, Leicester, UK; and Leicestershire Partnership NHS Trust, Leicester, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Indermeet Sawhney
- Faculty of the Psychiatry of Intellectual Disability, Royal College of Psychiatrists, London, UK; and Hertfordshire Partnership NHS Foundation Trust, Braintree, UK
| | - Mahesh Odiyoor
- Faculty of the Psychiatry of Intellectual Disability, Royal College of Psychiatrists, London, UK; Department of Psychiatry, University of Chester, Chester, UK; and Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Ken Courtenay
- Psychiatry of Intellectual Disability Services, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Ashok Roy
- Psychiatry of Intellectual Disability Services, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Harm Boer
- Learning Disabilities and Autism Services, West Midlands Partnership Alliance, Birmingham, UK
| | - Regi Alexander
- Intellectual Disability Forum, Royal Society of Medicine, London, UK
| | - Asit Biswas
- Leicestershire Partnership NHS Trust, Leicester, UK
| | - Jane McCarthy
- Learning/Intellectual Disability Service, Sussex Partnership NHS Foundation Trust, Worthing, UK; and Department of Psychiatry, King's College London, London, UK
| | - Gautam Gulati
- Department of Psychiatry, University of Limerick, Limerick, Ireland; and Faculty of Forensic Psychiatry, College of Psychiatrists of Ireland, Dublin, Ireland
| | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK; Peninsula Clinical Research Network, Exeter, UK; and Cornwall Intellectual Disability Equitable Research, University of Plymouth, Plymouth, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research, University of Plymouth, Plymouth, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK
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10
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Velani B, Sawhney I, Alexander RT, Shardlow S, Zia A. Implementing proposed reforms of the Mental Health Act for people with intellectual disability and autism: the perspective of multidisciplinary professionals in intellectual disability teams. BJPsych Open 2022; 8:e197. [PMID: 36373539 PMCID: PMC9707503 DOI: 10.1192/bjo.2022.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A recent government white paper sets out proposals for reforms to the Mental Health Act 1983 (MHA). Some of these proposals affect people with intellectual disabilities and/or autism. AIMS To explore both positive and unintended negative effects of the proposed reforms by gathering the perspectives of healthcare workers from multiple disciplines, working with intellectual disability and/or autism in community and in-patient settings. METHOD A 14-question electronic questionnaire, comprising free-text, multiple choice and five-point Likert scale responses, was sent out via email between April and July 2021, to all multidisciplinary team professionals working in specialist intellectual disability community and in-patient teams in Hertfordshire Partnership University NHS Foundation Trust. RESULTS There were 45 responders, of whom 53% worked in in-patient settings and 47% in out-patient teams. Respondents comprised healthcare professionals from multiple disciplines, 80% of which were non-medical. Most responders agreed with the general principles of the proposed reforms. However, 80% felt there would be potentially unintended consequences, and 76% thought that substantial investment in community services was required in advance of the proposed reforms. CONCLUSIONS The proposed MHA reforms may have unintended consequences for people with intellectual disabilities and/or autism. The findings of this study raised key concerns that need to be explored further and addressed before the MHA reforms are implemented. These include community provision, safeguards and use of the Mental Capacity Act, the potential for under or overdiagnosis of mental illness, and effects associated with the criminal justice system.
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Affiliation(s)
- Bharat Velani
- Adult Learning Disability Services, Hertfordshire Partnership University NHS Foundation Trust, UK
| | - Indermeet Sawhney
- Adult Learning Disability Services, Hertfordshire Partnership University NHS Foundation Trust, UK
| | - Regi T Alexander
- Adult Learning Disability Services, Hertfordshire Partnership University NHS Foundation Trust, UK.,School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Sophie Shardlow
- Adult Learning Disability Services, Hertfordshire Partnership University NHS Foundation Trust, UK
| | - Asif Zia
- Adult Learning Disability Services, Hertfordshire Partnership University NHS Foundation Trust, UK.,School of Life and Medical Sciences, University of Hertfordshire, UK.,School of Life and Medical Sciences, University of West London, UK
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Winterhalder R, McCabe J, Young C, Lamb K, Sawhney I, Jory C, O'Dwyer M, Shankar R. Bone health, intellectual disability and epilepsy: An observational community-based study. Acta Neurol Scand 2022; 145:753-761. [PMID: 35297524 PMCID: PMC9310839 DOI: 10.1111/ane.13612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/08/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
Abstract
Objectives Intellectual disability (ID) and epilepsy are independent risk factors for osteoporosis. Diverse predisposing factors influence this, for example in ID, genetics and poor nutrition and in epilepsy, anti‐seizure medication (ASM). Around 25% people with ID have epilepsy, majority treatment resistant. ASMs polypharmacy is common. However, little is known about the bone‐related characteristics of this vulnerable group. A prospective observational cohort study of bone profile across a community ID Epilepsy service was undertaken to understand this. Materials & Methods Participants were on minimum 2 years of ASMs. Baseline demographics, epilepsy data, bone metabolism biomarkers, bone mineral density (BMD) and vitamin D levels were collected. Doses needed to correct vitamin D insufficiency/deficiency were calculated. Results At baseline, of 104 participants, 92 (90.2%) were vitamin D insufficient/deficient. Seventy‐six (73.1%) had a DEXA scan, 50 of whom—in the osteopaenic/osteoporotic range. DEXA scores between ambulant and non‐ambulant patients were significantly different (p = .05) but not for ID severity. A high alkaline phosphatase (ALP) predicted lower vitamin D levels. Borderline significance (p = .06) in calcium levels between normal and high ALP was identified. There were no significant associations between parathyroid hormone, inorganic phosphate and magnesium levels, with vitamin D status or DEXA hip T‐scores. Normalizing vitamin D levels (mean 101.4 nmol/L) required an average of 1951IU cholecalciferol daily. Conclusions Vitamin D deficiency is highly prevalent in people with ID and epilepsy treated with ASMs impacting likely on their bone health. Screening with vitamin D levels, ALP and DEXA in this group should be pro‐actively and routinely considered.
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Affiliation(s)
| | | | | | - Kirsten Lamb
- Cornwall Intellectual Disability Epilepsy Research (CIDER) University of Plymouth Peninsula School of Medicine Truro UK
| | | | - Caryn Jory
- Cornwall Partnership NHS Foundation Trust Truro UK
| | - Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin 2 Ireland
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust Truro UK
- Cornwall Intellectual Disability Epilepsy Research (CIDER) University of Plymouth Peninsula School of Medicine Truro UK
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Watkins LV, Henley W, Sun JJ, Perera B, Angus-Leppan H, Sawhney I, Purandare K, Eyeoyibo M, Scheepers M, Lines G, Winterhalder R, Shankar R. Tackling increased risks in older adults with intellectual disability and epilepsy: data from a national multicentre cohort study. Seizure 2022; 101:15-21. [DOI: 10.1016/j.seizure.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022] Open
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13
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Sun JJ, Perera B, Henley W, Angus-Leppan H, Sawhney I, Watkins L, Purandare KN, Eyeoyibo M, Scheepers M, Lines G, Winterhalder R, Ashby S, De Silva R, Miller J, Philpott DE, Ashwin C, Howkins J, Slater H, Medhurst D, Shankar R. Correction to: Epilepsy related multimorbidity, polypharmacy and risks in adults with intellectual disabilities: a national study. J Neurol 2022; 269:2761. [PMID: 35247093 DOI: 10.1007/s00415-022-11012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- James J Sun
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Bhathika Perera
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | | | | | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | | | | | | | - Mark Scheepers
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | | | | | | | - Ravindu De Silva
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Jonjo Miller
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | | | - Chris Ashwin
- Cornwall Partnership NHS Foundation Trust, Truro, TR4 9LD, UK
| | - Joshua Howkins
- Cornwall Partnership NHS Foundation Trust, Truro, TR4 9LD, UK
| | | | | | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, TR4 9LD, UK. .,University of Plymouth Peninsula School of Medicine, Plymouth, UK. .,Cornwall Intellectual Disability Equitable Research (CIDER), Threemilestone Industrial Estate, Cornwall, TR4 9LD, Truro, UK.
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14
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Sawhney I, Perera B, Bassett P, Zia A, Alexander RT, Shankar R. Attention-deficit hyperactivity disorder in people with intellectual disability: statistical approach to developing a bespoke screening tool. BJPsych Open 2021; 7:e187. [PMID: 34602112 PMCID: PMC8503915 DOI: 10.1192/bjo.2021.1023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is common among people with intellectual disability. Diagnosing ADHD in this clinically and cognitively complex and diverse group is difficult, given the overlapping psychiatric and behavioural presentations. Underdiagnoses and misdiagnoses leading to irrational polypharmacy and worse health and social outcomes are common. Diagnostic interviews exist, but are cumbersome and not in regular clinical use. AIMS We aimed to develop a screening tool to help identify people with intellectual disability and ADHD. METHOD A prospective cross-sectional study, using STROBE guidance, invited all carers of people with intellectual disability aged 18-50 years open to the review of the psychiatric team in a single UK intellectual disability service (catchment population: 150 000). A ten-item questionnaire based on the DSM-V ADHD criteria was circulated. All respondents' baseline clinical characteristics were recorded, and the DIVA-5-ID was administered blinded to the individual questionnaire result. Fisher exact and multiple logistic regressions were conducted to identify relevant questionnaire items and the combinations that afforded best sensitivity and specificity for predicting ADHD. RESULTS Of 78 people invited, 39 responded (26 men, 13 women), of whom 30 had moderate-to-profound intellectual disability and 38 had associated comorbidities and on were medication, including 22 on psychotropics. Thirty-six screened positive for ADHD, and 24 were diagnosed (16 men, eight women). Analysis showed two positive responses on three specific questions to have 88% sensitivity and 87% specificity, and be the best predictor of ADHD. CONCLUSIONS The three-question screening is an important development for identifying ADHD in people with intellectual disability. It needs larger-scale replication to generate generalisable results.
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Affiliation(s)
- Indermeet Sawhney
- Adult learning disability services, Hertfordshire Partnership University NHS Foundation Trust, UK
| | - Bhathika Perera
- Adult learning disability services, Barnet Enfield and Haringey Mental Health NHS Trust, UK
| | | | - Asif Zia
- Adult learning disability services, Hertfordshire Partnership University NHS Foundation Trust, UK
| | - Regi T Alexander
- Adult learning disability services, Hertfordshire Partnership University NHS Foundation Trust, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Rohit Shankar
- Adult learning disabilities service, Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Medical School, UK
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15
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Perera B, Laugharne R, Henley W, Zabel A, Lamb K, Branford D, Courtanay K, Alexander R, Purandare K, Wijeratne A, Radhakrishnan V, McNamara E, Daureeawoo Y, Sawhney I, Scheepers M, Taylor G, Shankar R. COVID-19 deaths in people with intellectual disability in the UK and Ireland: descriptive study. BJPsych Open 2020; 6:e123. [PMID: 33059790 PMCID: PMC7562776 DOI: 10.1192/bjo.2020.102] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/14/2020] [Accepted: 09/03/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Rapid spread of coronavirus disease 2019 (COVID-19) has affected people with intellectual disability disproportionately. Existing data does not provide enough information to understand factors associated with increased deaths in those with intellectual disability. Establishing who is at high risk is important in developing prevention strategies, given risk factors or comorbidities in people with intellectual disability may be different to those in the general population. AIMS To identify comorbidities, demographic and clinical factors of those individuals with intellectual disability who have died from COVID-19. METHOD An observational descriptive case series looking at deaths because of COVID-19 in people with intellectual disability was conducted. Along with established risk factors observed in the general population, possible specific risk factors and comorbidities in people with intellectual disability for deaths related to COVID-19 were examined. Comparisons between mild and moderate-to-profound intellectual disability subcohorts were undertaken. RESULTS Data on 66 deaths in individuals with intellectual disability were analysed. This group was younger (mean age 64 years) compared with the age of death in the general population because of COVID-19. High rates of moderate-to-profound intellectual disability (n = 43), epilepsy (n = 29), mental illness (n = 29), dysphagia (n = 23), Down syndrome (n = 20) and dementia (n = 15) were observed. CONCLUSIONS This is the first study exploring associations between possible risk factors and comorbidities found in COVID-19 deaths in people with intellectual disability. Our data provides insight into possible factors for deaths in people with intellectual disability. Some of the factors varied between the mild and moderate-to-profound intellectual disability groups. This highlights an urgent need for further systemic inquiry and study of the possible cumulative impact of these factors and comorbidities given the possibility of COVID-19 resurgence.
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Affiliation(s)
| | - Richard Laugharne
- Cornwall Intellectual Disability and Epilepsy Research (CIDER) Centre, Cornwall Partnership Foundation NHS Trust, UK
| | | | - Abigail Zabel
- Cornwall Intellectual Disability and Epilepsy Research (CIDER) Centre, Cornwall Partnership Foundation NHS Trust, UK
| | - Kirsten Lamb
- Royal College General Practitioners special interest group for learning disability, UK
| | | | - Ken Courtanay
- Barnet Enfield and Haringey Mental Health NHS Trust, UK
| | - Regi Alexander
- Hertfordshire Partnership University NHS Foundation Trust, UK
| | | | | | | | - Eileen McNamara
- Barnet, Enfield and Haringey Mental Health trust, Barnet Learning Disability Team, UK
| | - Youshan Daureeawoo
- Barnet, Enfield and Haringey Mental Health trust, Barnet Learning Disability Team, UK
| | | | - Mark Scheepers
- Gloucestershire Health and Care NHS Foundation Trust, UK
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16
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Alexander R, Ravi A, Barclay H, Sawhney I, Chester V, Malcolm V, Brolly K, Mukherji K, Zia A, Tharian R, Howell A, Lane T, Cooper V, Langdon PE. Guidance for the Treatment and Management of COVID-19 Among People with Intellectual Disabilities. J Policy Pract Intellect Disabil 2020; 17:256-269. [PMID: 32837529 PMCID: PMC7307021 DOI: 10.1111/jppi.12352] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 01/19/2023]
Abstract
The current COVID‐19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID‐19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID‐19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS‐CoV‐2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID‐19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID‐19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.
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Affiliation(s)
- Regi Alexander
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK.,University of Hertfordshire Hatfield United Kingdom
| | - Ambiga Ravi
- Bowlers Green, Hertfordshire Partnership University NHS Foundation Trust Hatfield UK
| | - Helene Barclay
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK
| | - Indermeet Sawhney
- Lexden Hospital, Hertfordshire Partnership University NHS Foundation Trust Colchester UK
| | - Verity Chester
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK
| | - Vicki Malcolm
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK
| | - Kate Brolly
- Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust Norwich UK
| | - Kamalika Mukherji
- Hertfordshire Partnership University NHS Foundation Trust Hatfield UK
| | - Asif Zia
- Hertfordshire Partnership University NHS Foundation Trust Hatfield UK
| | - Reena Tharian
- Hellesdon Hospital, Norfolk and Suffolk NHS Foundation Trust Norwich UK
| | - Andreana Howell
- ReseArch in DevelopmentAl NeuropsychiaTry (RADiANT) Norwich UK
| | - Tadhgh Lane
- ReseArch in DevelopmentAl NeuropsychiaTry (RADiANT) Norwich UK
| | | | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR) University of Warwick Coventry UK.,Worcestershire Health and Care NHS Trust Worcester UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry UK
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Sawhney I, Mukhopadhyay A, Karki C. Mental Capacity Act 2005: views and experiences of learning disability psychiatrists. Psychiatr bull 2018. [DOI: 10.1192/pb.bp.108.020479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodPostal questionnaires were sent out to 66 learning disability psychiatrists to assess their knowledge and experience of the Mental Capacity Act 2005.ResultsA response rate of 55% (n = 36) was achieved; 22 (61%) respondents felt that patient care had improved; 16 (44%) felt workload had increased. Despite 79% (n = 23) of the respondents feeling that the training for the Act was adequate, only 19% (n = 7) were aware of the situations where patients had to be referred to the Independent Mental Capacity Advocate (IMCA) service and only 53% (n = 19) were aware that the Act currently does not cover patients who fall in the ‘Bournewood gap’.Clinical ImplicationsLearning disability psychiatrists are still not conversant with significant parts of the Act and this raises questions about the adequacy of the training delivered. Implementing the Act should improve patient care but will have implications for the workload of professionals.
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Abstract
A 30-year-old man with learning disability, living in a residential home with no documented mental health diagnosis, on the autistic spectrum was prescribed carbamazepine, olanzapine and propranolol to manage behaviour on a long-term basis. He was able to successfully discontinue both of his psychotropic medicines. The reduction was carried out in the community under the supervision of the learning disability psychiatrist. He is less tired, more alert and better able to express himself. He has expanded his activities and increased his access to the community. He is able to cope better with changes to his routine. His behaviours are well managed by the behavioural strategies in place and he has now been discharged by the psychiatrist to the general practitioner.
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Affiliation(s)
- Danielle Adams
- Hertfordshire Partnership NHS Foundation Trust, St Albans, Hertfordshire, UK
| | - Indermeet Sawhney
- Department of Learning Disability, Hertfordshire Partnership NHS Foundation Trust, St Albans, Hertfordshire, UK
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Janka E, Töröcsik D, Gáspár K, Bodnár E, Sawhney I, Csordás A, Kovács Z, Herédi E, Szegedi A, Remenyik É. 041 The association between early-onset and late-onset psoriasis and co-morbidities in a case-control study. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sawhney I, Tajer A, Morgan J. Copying Clinical Letters to Patients: Views of People with Learning Disability and Their Carers. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979507799103432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Vatve M, Sharma VK, Sawhney I, Kumar B. Evaluation of patch test in identification of causative agent in drug rashes due to antiepileptics. Indian J Dermatol Venereol Leprol 2000; 66:132-135. [PMID: 20877054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Patch test was evaluated for the identification of causative agent in cutaneous eruptions due to antiepileptics. Patch tests were carried out in twenty patients and ten controls with carbamazepine, phenytoin sodium, phenobarbitone and sodium valproate. Sodium valproate was found tobe irritant in 1 and 5% concentration and further dilution is recommended for patch testing. Patch test was positive in 14 (70%) patients and in 7 with suspected drug alone, and remaining 7 were positive with more than one antiepileptic drug. We recommended patch test for identification of causative drug in rashes due to antiepileptics.
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Affiliation(s)
- M Vatve
- Department of Dermatology, Venereology and Leprology and Department of Neurology Postgraduate Institute of Medical Education and Research, Chandigarh, India
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