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NADD U.S. Policy Update (from the NADD Bulletin Volume X1 Number 5)
Complete listing
Preventable and treatable medical comorbidities and adverse drug
events in people with ID/MH
Laurie Charlot, PhD
Few studies report the prevalence or nature of medical problems
experienced by persons with intellectual disabilities (ID) treated
for psychiatric illness (Charlot, Abend, Ravin, Mastis, Hunt &
Deustch, manuscript in preparation). This, despite the fact that for
people with ID physical distress is often associated with changes in
mood, mental status and behavior, as a significant "setting
event" (Gardner & Whalken, 1996, Gunsett, Mulick, Fernald
& Martin, 1989; Carr, Smith, Giacin, Whelan, & Pancari,
2003). Medical causes for agitated behavior are frequently
missed (Abend & Silka, 1999, Ryan & Sunada, 1997) because
people with ID are poor reporters of their own health problems.
Also, individuals with limited expressive language often show the
same externalizing behaviors at different times, for different
reasons. These behaviors act as a "final common
pathway" for distress (Charlot, Doucette & Mezzacappa, 1993).
The potential cost for poor outcomes related to missing or
underestimating the impact of medical problems on behavior, both in
suffering and in health care dollars, is likely quite high.
People with ID are known to have high rates of medical problems when
compared to people without disabilities. Having a mental health
disorder may elevate risk for other health problems in persons with
ID (Kwok, 2007). Most estimates suggest about 40% of people with ID
have a psychiatric disorder, and as many as 60% are treated with
psychoactive medications. It is important to know if some of these
individuals have treatable or preventable health problems or adverse
drug events (ADEs). Recent investigations have emerged highlighting
the enormous impact of health problems suffered by persons with
serious mental illness, often associated with morbidity and mortality
rates many times greater than those reported for people without
psychiatric disorder (Connolly & Kelly, 2005).
In addition to many lifestyle factors associated with chronic mental
illness that appear to adversely affect health outcomes, recent
research points to a rise in risk for specific medical problems
related to psychopharmacologic treatment including obesity,
hypertension and diabetes. It is unclear to what extent these
same problems or different ones affect people with ID/MH (Mackin,
Bishop, Watkinson, Gallagher & Ferrier, 2007). At least
some differences in health related morbidity are likely to be
identified related to associations between ID and an array of
genetically determined risk factors. In some cases, people with
ID share common concerns with older individuals without ID, who also
have high rates of medical problems, and frequent treatment with
psychoactive medications in non-specific ways (eg to reduce
"agitation"). In light of recent findings from
the Tyrer et al. (2008) study, it seems timely to learn more about
side effects, as well as health issues we may routinely miss in our
patients with ID/MH.
We recently conducted a retrospective review of 198 consecutive
admissions to an inpatient psychiatric service for people with ID and
found high rates of medical comorbidity (Charlot, Abend, Ravin,
Mastis, Hunt & Deustch, manuscript in preparation). In many
cases, inpatients with ID were agitated or experienced significant
mental status changes that were primarily a product of a
non-psychiatric medical problem. A variety of health problems
were seen to provoke changes in behavior and mood, including
constipation, GERD, UTIs, ear infections, dental pain, skin
infections, neuroleptic induced movement problems such as akathsia
and dsytonias, excessive sedation, delirium, sleep apnea,
hypothyroidism and diabetes. For many individuals, improvement
in medical problems was a critical component of subsequent behavioral
improvements. Though the inpatients appeared to have fairly low
rates of psychosis, 73% received treatment with at least one
antipsychotic drug. Many inpatients were treated with
multi-drug regimens and had recently experienced multiple drug changes.
More systematic and focused research is needed to examine types and
rates of preventable and treatable medical problems and ADEs in
people with ID/MH.
Such problems could be better appreciated and reduced by:
·Increased government support for research exploring the
relationship between health and mental health in people with ID
·Development of screening tools and assessment guidelines to
increase early detection
·Initiatives addressing the prevention of common medical
problems and preventable ADEs, i.e. educational programs aimed at
caregivers, case managers, various clinicians, inpatient psychiatric
programs, ER programs, and especially MDs to alert care providers to
unique issues affecting people with ID/MH
·Collaborations with payors and governmental agencies to explore
the need for individuals with severe psychiatric problems and ID to
have access to multidisciplinary medical care, longer medical
appointments and clinician reimbursement for additional work required
to provide adequate care to individuals with highly complex needs.
(Targeting people treated with multiple psychoactive medications or
who have frequent "psychiatric" relapses, emergencies and
inpatient stays.)
·Initiatives aimed at promoting wellness, addressing the unique
needs of people with ID/MH including programs that promote use of
art, music, sports, exercise, and healthy diets. Education to promote
recognition of the key role of meaningful engagement in wellness.
Contact: Lauren Charlot, Ph.D.
CharlotL@UMMHC.org
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Upcoming Conferences:
September
Ohio State 10th Annual MI/DD Conference , Mental Health Aspects
–Treatment & Support (September 18 & September 19, 2012)
Columbus, Ohio
October
NADD 29th Conference & Exhibit Show, (October 17 - 19, 2012)
Denver, Colorado
October 2013
NADD 30th Conference & Exhibit Show, Baltimore MD (October 23 -
October 25, 2013)
Complete Calendar |
New Educational Products:
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 Intellectual
Disability and Mental Health: A Training Manual in Dual Diagnosis
Sharon McGilvery, Ph.D. and Darlene Sweetland, Ph.D.
With the release of this book, Drs. McGilvery and Sweetland share
decades of experience working with individuals diagnosed with an
intellectual disability and co-occurring psychiatric disorders. Their
well-practiced approach takes into account the extremely complex
nature of working with dual-diagnosis. The authors provide
in-depth information about the diagnostic process, hands-on treatment
considerations, and their experience training thousands of people to
work passionately with these individuals. An important
contribution is their approach to addressing complicating factors in
identifying appropriate psychiatric diagnoses, as well as the problem
of the underreporting of psychiatric symptoms and disorders. Finally,
those working in a variety of contexts with these individuals will
benefit from the innovative approaches of looking at treatment and
intervention strategies that can be immediately implemented. 264 pages
Details:
ST11-053B
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 A
PRACTICAL GUIDE to Assessing Medical Issues Associated with
Behavior/ Psychiatric Problems in Persons with Intellectual
Disability – Revised in 2011
Ann R. Poindexter, M.D.
This book discusses medical/medication issues which may present as
behavioral/ psychiatric problems in individuals with intellectual
disability. Three self-directed instructional courses and
several illustrative case histories are included. 110 pages\
Details:
DA05-021BR
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Psychotherapy for Individuals with Intellectual Disability
Edited by: Robert J. Fletcher, DSW, ACSW
This book provides the reader with insightful and useful ways to
provide psychotherapy treatment for individuals who have intellectual
disability (ID). It brings together all three modalities
(individual, couple, and group), and a variety of theoretical models
and techniques are discussed. The first section, Individual
Therapy, offers a variety of approaches and techniques including
dialectical behavioral therapy, positive psychology,
mindfulness-based practice, and relaxation training. Also included in
this section are chapters on specialty populations including victims
of abuse, people who have Autism Spectrum Disorder, and people in
mourning. The second section is a chapter on group therapy addressing
trauma issues. The third section is on family and couple therapy. The
fourth section covers chapters on research, ethics, and
training. The individual authors are respected authorities in
the field of providing psychotherapy treatment for persons with ID
and all have contributed to the professional literature.
This book is a major contribution to the effort to make psychotherapy
available to individuals who have ID and should serve to further
stimulate interest in the provision of psychotherapy treatment for
individuals who have ID co-occurring with significant mental health problems.
NADD # CT11-051B Details
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 Comprehensive
Competence-Based Parenting Assessment for Parents with Learning
Dificulties and Their Children
Maurice Feldman, PhD, Marjorie Aunos, PhD
This book presents an innovative, empirically-supported approach to
assessing parenting capacity of parents with learning difficulties
that can lead to more humane, fair and accurate child custody
decisions. The authors are leading researchers and
practitioners in this field haing worked with hundred of these
families. Many professionals working with these families
recognize that the current parenting capacity assessment approaches
are based on outdatd and invalid assumptions and methods. This
book addresses the unique assessment needs of these families and
includes detailed background information, rationales and methods.
NADD # DA10-050B Details
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 Working
with People with Challeging Behaviors: A Guide for Maintaining
Positive Relation
Nathan Ory
The material in this book introduces general practices
and specific solutions to behavior problems that will work with
people who display difficult and challenging behaviors regardless of
who they are. It is especially suitable for working with
individuals who have developmental or intellectual disabilities
coupled with a behavior disorder. The methods also apply to the
person with emotional or psychiatric disturbances, or another serious
mental health problem. Finally, they are helpful in providing
support to elderly individuals who display challenging behavior.
NADD # ST10-049B Details
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Human Needs and Intellectual Disabilities: Applications for Person
Centered Planning, Dual Diagnosis, and Crisis Intervention
Steven Reiss, Ph.D.
Human Needs and Intellectual Disabilities identifies the 12 human
needs most relevant to the lives of people with intellectual
disabilities, autism and related developmental disabilities. It
includes detailed, practical suggestions for caregivers or parents
interested in the happiness, quality of life, and self-determintion
of their loved ones or consumers. The book includes detailed,
practical suggestions for reducing episodes of challenging behavior
and psychiatric symptoms in people with a dual diagnosis
(intellectual disabilities and mental illness). It shows how to
substitute the language of individuality (e.g., "friendly
person") for the language of disability (e.g., "person with
disability"). It also reduces the tendency of planners to
confuse their own value system for that of the consumer. The
book includes scholarly reviews of dual diagnosis literature on
mental illness, prevalence, and assessment.
NADD # DA10-048B Details
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Positive Identity Development
Author: Karyn Harvey, PhD
Positive Identity Development is an exciting new approach to
treatment for individuals with intellectual disabilities. This
book provides a new theoretical perspective on treatment along with a
variety of innovative tools. It rejects reducing adults with
intellectual disabilities to a mere compilation of their behaviors
and promotes the use of a positive, therapeutic approach to each
unique individual. Psychologists, social workers and therapists
should be able to use the tools presented in this book to directly
enhance the effectiveness of the treatment they provide to adults
with intellectual disabilities. This book promotes well-being on
every level and explores a broad range of issues relevant to the life
and mental health of adults with intellectual disabilities
Mbr Price: $34.95
Non-Mbr: $39.95
NADD #CT09-047B Details |
 Down
Syndrome: When to Worry about Mental Health and What to Do About It
Robin Friedlander, M.D. & Peter Johnson, Ph.D.
NADD # FI09-044B Details |
 Working
with People who have Intellectual Disability and Behavioral
Problems: A Self-Study Guide for Interdisciplinary Team Members
Ann R. Poindexter, M.D. & Paul D. Kolstoe, Ph.D.
NADD # ST09-045B Details |
Multi-Media CDs of NADD 25th Annual Conference Presentations
Presentations recorded at NADD 25th Annual Conference are available
as multi-media CDs. These CDs contain the video and Power Point
from conference presentations and are a great tool for training
yourself and your staff. To order, or for additional
information, click here.
Community Networks of Specialized Care: Building Community
Capacity through Training and Education Lisa Holmes, Liz
Froese, MSW, Rosanne Stein, LLB, BSc, Sandi Bricker
NADD Competency-Based Dual Diagnosis Certification Program Robert
Fletcher, DSW, ACSW, FAAIDD; Donna McNelis, PhD; John McGonigle,
PhD; Kathleen Olson, PhD; Jarrett Barnhill, MD
Autism Spectrum Disorders: Separating the Data from the
Myths Ann R. Poindexter, MD
Diagnostic Systems for Use with People with ID Luis
Salvador-Carulla, MD, PhD, Robert J. Fletcher, DSW, ACSW, FAAIDD,
Sally-Ann Cooper, MD
The price for the above multimedia is: Member:
$49.95 Non-member: $59.95
To order, or for additional information, click
here.
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