Pub Date : 2020-08-12DOI: 10.1108/amhid-09-2019-0028
F. Williams, M. Warwick, C. Mckay, C. Macleod, M. Connolly
This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA.,All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use.,Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%).,The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.
{"title":"Learning disability, autism and the Criminal Procedure (Scotland) Act","authors":"F. Williams, M. Warwick, C. Mckay, C. Macleod, M. Connolly","doi":"10.1108/amhid-09-2019-0028","DOIUrl":"https://doi.org/10.1108/amhid-09-2019-0028","url":null,"abstract":"This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA.,All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use.,Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%).,The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":"14 1","pages":"149-167"},"PeriodicalIF":1.1,"publicationDate":"2020-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-09-2019-0028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49156411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-06DOI: 10.1108/amhid-11-2019-0034
S. Cameron, James Swanton, D. Dagnan
This study aims to explore the applicability of Bordin’s model of therapeutic alliance in talking therapies for people with intellectual disabilities.,People with intellectual disabilities and therapists in six therapy dyads were interviewed using a qualitative methodology. Data were analysed using thematic analysis to explore how people with learning disabilities constructed the dimensions of therapeutic alliance. Content analysis was then used to focus on therapy bond, therapy tasks and goals to explore the agreement on these dimensions between the therapist and client.,People with intellectual disabilities reported their experience of therapy in a way that initially validates the alliance dimensions of Bordin’s model. There was clear overlap within most dyads in the description of the characteristics of the bond, the tasks undertaken and the goals of therapy. Some therapists described additional goals based on their therapeutic model that were not clearly described by the client working with them.,This study is limited by only including six therapy dyads; however, the results suggest further research on the impact of therapy alliance and how goals and tasks are agreed would be valuable.,Very few studies have explicitly examined the client’s view of therapy alliance.
{"title":"Conceptualising the therapeutic alliance: exploring the relevance of Bordin’s model for adults with intellectual disabilities","authors":"S. Cameron, James Swanton, D. Dagnan","doi":"10.1108/amhid-11-2019-0034","DOIUrl":"https://doi.org/10.1108/amhid-11-2019-0034","url":null,"abstract":"This study aims to explore the applicability of Bordin’s model of therapeutic alliance in talking therapies for people with intellectual disabilities.,People with intellectual disabilities and therapists in six therapy dyads were interviewed using a qualitative methodology. Data were analysed using thematic analysis to explore how people with learning disabilities constructed the dimensions of therapeutic alliance. Content analysis was then used to focus on therapy bond, therapy tasks and goals to explore the agreement on these dimensions between the therapist and client.,People with intellectual disabilities reported their experience of therapy in a way that initially validates the alliance dimensions of Bordin’s model. There was clear overlap within most dyads in the description of the characteristics of the bond, the tasks undertaken and the goals of therapy. Some therapists described additional goals based on their therapeutic model that were not clearly described by the client working with them.,This study is limited by only including six therapy dyads; however, the results suggest further research on the impact of therapy alliance and how goals and tasks are agreed would be valuable.,Very few studies have explicitly examined the client’s view of therapy alliance.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":"14 1","pages":"169-179"},"PeriodicalIF":1.1,"publicationDate":"2020-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-11-2019-0034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48372309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.1108/amhid-01-2020-0002
R. Abdi, Elizabeth Metcalf
This paper aims to determine whether an inclusive teaching session changes student attitudes towards people with intellectual disabilities (ID). To investigate the impact of an inclusive teaching session in terms of student perceptions.,66 years 4 students at Cardiff University completed the attitudes towards disabled people form B questionnaire (ATDP-B) before and after a communication skills session on ID. Before and after scores were collated and compared using a paired t-test analysis. Common perceptions were identified using anonymised ATDP-B results to conduct five semi-structured interviews and one focus group with nine students. The common perceptions were discussed, alongside how the teaching session tackled them and suggestions for further improvements.,Mean ATDP-B score before the teaching session was 115 (SD = 14.5). Mean ATDP-B score after the teaching session was 122 (SD = 17.2). The teaching session improved scores in the ATDP-B by a mean of 6.92 (4.69, 9.16). A paired t-test found this to be a statistically significant difference, t(65) = 6.20, p < 0.001. Qualitative data was thematically analysed and three main themes were identified: Student identity, patient contact and curriculum content.,This is the first study to investigate the origin of the negative attitudes of medical students, and found they stem from a lack of confidence in their abilities and failure to develop a professional identity. The impact of the teaching session stems from its focus on meaningful patient contact and identifying and overcoming communication barriers.
{"title":"Exploring attitudes of medical students towards intellectual disabilities","authors":"R. Abdi, Elizabeth Metcalf","doi":"10.1108/amhid-01-2020-0002","DOIUrl":"https://doi.org/10.1108/amhid-01-2020-0002","url":null,"abstract":"This paper aims to determine whether an inclusive teaching session changes student attitudes towards people with intellectual disabilities (ID). To investigate the impact of an inclusive teaching session in terms of student perceptions.,66 years 4 students at Cardiff University completed the attitudes towards disabled people form B questionnaire (ATDP-B) before and after a communication skills session on ID. Before and after scores were collated and compared using a paired t-test analysis. Common perceptions were identified using anonymised ATDP-B results to conduct five semi-structured interviews and one focus group with nine students. The common perceptions were discussed, alongside how the teaching session tackled them and suggestions for further improvements.,Mean ATDP-B score before the teaching session was 115 (SD = 14.5). Mean ATDP-B score after the teaching session was 122 (SD = 17.2). The teaching session improved scores in the ATDP-B by a mean of 6.92 (4.69, 9.16). A paired t-test found this to be a statistically significant difference, t(65) = 6.20, p < 0.001. Qualitative data was thematically analysed and three main themes were identified: Student identity, patient contact and curriculum content.,This is the first study to investigate the origin of the negative attitudes of medical students, and found they stem from a lack of confidence in their abilities and failure to develop a professional identity. The impact of the teaching session stems from its focus on meaningful patient contact and identifying and overcoming communication barriers.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":"14 1","pages":"125-136"},"PeriodicalIF":1.1,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-01-2020-0002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47767352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.1108/amhid-11-2019-0033
Hannah Iannelli, Camilla Tooley, G. Billon, S. Cross, J. Pathan, C. Attoe
Individuals health with intellectual disabilities (ID) experience comorbid physical and mental health needs and have poorer outcomes resulting in early mortality. Currently, many training provisions based on ID exist; however, limited research supports their effectiveness. High-fidelity simulation is an innovative training mechanism with promising preliminary results. This study aims to evaluate the longitudinal impact of simulation training on clinical practice in ID.,A mixed-method approach was used in this study. A one-day simulation course using actors who had ID was delivered to 39 health-care professionals from across London hospitals. Nine semi-structured interviews were conducted 12–18 months post training.,High-fidelity simulation training is an effective training modality, which has a sustainable impact on participants, their clinical practice and patients. Core features of the training including debriefing, the use and type of actors, scenario design and the facilitators are crucial learning mechanisms which impacts learning outcomes and changes to behaviour in clinical practice and settings.,To the best of the authors’ knowledge, this study is the first to longitudinally evaluate high-fidelity simulation training designed to improve the physical and mental health needs of those with ID. The research begins to bridge an important gap in the current literature, with a need for more research.
{"title":"Improving clinical practice through simulation training on intellectual disabilities: a longitudinal study","authors":"Hannah Iannelli, Camilla Tooley, G. Billon, S. Cross, J. Pathan, C. Attoe","doi":"10.1108/amhid-11-2019-0033","DOIUrl":"https://doi.org/10.1108/amhid-11-2019-0033","url":null,"abstract":"Individuals health with intellectual disabilities (ID) experience comorbid physical and mental health needs and have poorer outcomes resulting in early mortality. Currently, many training provisions based on ID exist; however, limited research supports their effectiveness. High-fidelity simulation is an innovative training mechanism with promising preliminary results. This study aims to evaluate the longitudinal impact of simulation training on clinical practice in ID.,A mixed-method approach was used in this study. A one-day simulation course using actors who had ID was delivered to 39 health-care professionals from across London hospitals. Nine semi-structured interviews were conducted 12–18 months post training.,High-fidelity simulation training is an effective training modality, which has a sustainable impact on participants, their clinical practice and patients. Core features of the training including debriefing, the use and type of actors, scenario design and the facilitators are crucial learning mechanisms which impacts learning outcomes and changes to behaviour in clinical practice and settings.,To the best of the authors’ knowledge, this study is the first to longitudinally evaluate high-fidelity simulation training designed to improve the physical and mental health needs of those with ID. The research begins to bridge an important gap in the current literature, with a need for more research.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":"11 6","pages":"137-148"},"PeriodicalIF":1.1,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-11-2019-0033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41303665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-18DOI: 10.1108/amhid-10-2019-0030
A. Clifford, Francesca Georgina Kemp
“Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in “case-complexity”, but had not tested this hypothesis against data. This study aims to investigate this question through a pragmatic mixed-methods approach as part of a wider service evaluation.,Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) scores were used (n = 1,766) to estimate average “case-complexity” of referrals over an eight-year sample period. Two focus groups for IST staff (n = 18) explored why “case-complexity” appears to be increasing. Participant perspectives were subjected to thematic analysis.,Average HoNOS-LD scores have steadily increased over the sample period, suggestive of increasing “case-complexity”. Focus groups identified three broad themes to potentially explain the increased complexity: effects of Transforming Care; people’s changing and unchanging support systems; and issues related to mild and borderline intellectual disability. Many perspectives are grounded in or supported by evidence.,Implications and limitations of findings are discussed, including areas for further consideration and research. The well-designed “short-cut” is promoted as a strategy for busy professionals in need of practice-based evidence but with limited research time and resources.,The findings and discussion will be of value to anyone involved in the design, commissioning and delivery of mental health and challenging behaviour services to people with intellectual and developmental disabilities (IDD) under Transforming Care. Study methodology is easily replicable to build broader picture about “case-complexity” among UK’s IDD population.
{"title":"A pragmatic mixed-methods review of changing “case-complexity” of referrals to an intensive support service","authors":"A. Clifford, Francesca Georgina Kemp","doi":"10.1108/amhid-10-2019-0030","DOIUrl":"https://doi.org/10.1108/amhid-10-2019-0030","url":null,"abstract":"“Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in “case-complexity”, but had not tested this hypothesis against data. This study aims to investigate this question through a pragmatic mixed-methods approach as part of a wider service evaluation.,Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) scores were used (n = 1,766) to estimate average “case-complexity” of referrals over an eight-year sample period. Two focus groups for IST staff (n = 18) explored why “case-complexity” appears to be increasing. Participant perspectives were subjected to thematic analysis.,Average HoNOS-LD scores have steadily increased over the sample period, suggestive of increasing “case-complexity”. Focus groups identified three broad themes to potentially explain the increased complexity: effects of Transforming Care; people’s changing and unchanging support systems; and issues related to mild and borderline intellectual disability. Many perspectives are grounded in or supported by evidence.,Implications and limitations of findings are discussed, including areas for further consideration and research. The well-designed “short-cut” is promoted as a strategy for busy professionals in need of practice-based evidence but with limited research time and resources.,The findings and discussion will be of value to anyone involved in the design, commissioning and delivery of mental health and challenging behaviour services to people with intellectual and developmental disabilities (IDD) under Transforming Care. Study methodology is easily replicable to build broader picture about “case-complexity” among UK’s IDD population.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":"14 1","pages":"111-124"},"PeriodicalIF":1.1,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-10-2019-0030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48776476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-11DOI: 10.1108/amhid-12-2019-0044
L. Thoms, A. Idowu, Arjun Nehra, A. Biswas
There is high incidence of dementia in individuals with Down’s syndrome. Much of the emphasis has been on Alzheimer’s disease as being most prevalent; however, it is apparent that other dementia types are also likely, to which this patient cohort may be predisposed. Specifically, this paper aims to highlight the potential for subcortical dementias in Down’s syndrome, suggesting a role for broader cognitive screening in aging individuals.,This paper describes a case of a female with Down’s syndrome and mild intellectual disability who presented with early signs of distinctive cognitive impairment and radiological calcification of the basal ganglia.,An active 42-year-old lady, who was mostly independent of activities of daily living and in part-time employment, presented with a three-year history of progressive cognitive deficit, characteristic of subcortical decline. She had no personal or known family history of mental illness, epilepsy or dementia. Routine blood tests showed chronic renal impairment, mild hypocalcaemia and vitamin D deficiency, managed by her GP. CT scan showed only bilateral basal ganglia calcification.,There is a widespread appreciation for the link between Down’s syndrome and Alzheimer’s disease but lesser consideration of the possibility of subcortical dementias. Given the differential nature and presentation of the two dementias, this case report highlights a need for clinicians to consider both to effectively manage these patients in the longer-term. Screening is discussed as a potential means of achieving this.
{"title":"Significance of Basal ganglia calcification in Down's syndrome","authors":"L. Thoms, A. Idowu, Arjun Nehra, A. Biswas","doi":"10.1108/amhid-12-2019-0044","DOIUrl":"https://doi.org/10.1108/amhid-12-2019-0044","url":null,"abstract":"There is high incidence of dementia in individuals with Down’s syndrome. Much of the emphasis has been on Alzheimer’s disease as being most prevalent; however, it is apparent that other dementia types are also likely, to which this patient cohort may be predisposed. Specifically, this paper aims to highlight the potential for subcortical dementias in Down’s syndrome, suggesting a role for broader cognitive screening in aging individuals.,This paper describes a case of a female with Down’s syndrome and mild intellectual disability who presented with early signs of distinctive cognitive impairment and radiological calcification of the basal ganglia.,An active 42-year-old lady, who was mostly independent of activities of daily living and in part-time employment, presented with a three-year history of progressive cognitive deficit, characteristic of subcortical decline. She had no personal or known family history of mental illness, epilepsy or dementia. Routine blood tests showed chronic renal impairment, mild hypocalcaemia and vitamin D deficiency, managed by her GP. CT scan showed only bilateral basal ganglia calcification.,There is a widespread appreciation for the link between Down’s syndrome and Alzheimer’s disease but lesser consideration of the possibility of subcortical dementias. Given the differential nature and presentation of the two dementias, this case report highlights a need for clinicians to consider both to effectively manage these patients in the longer-term. Screening is discussed as a potential means of achieving this.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":"14 1","pages":"103-110"},"PeriodicalIF":1.1,"publicationDate":"2020-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-12-2019-0044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42400178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-09DOI: 10.1108/amhid-07-2018-0032
S. Mattock, K. Beard, A. Baddeley
Recent guidelines from the National Institute of Health and Care Excellence highlight that service users (SUs) with intellectual disabilities and co-occurring mental health problems rarely get the opportunity to share their experiences of mental health services. Over the past 20 years, policy documents have stated that these individuals (SUs) must be included in decisions about their care. Research suggests that often this is not the case. Therefore, this paper aims to create a space for SUs to share their experiences of mental health services, and what they found helpful.,A focus group was held with five SUs, two psychologists and two researchers. The audio recording of the discussion was transcribed and analysed using thematic analysis.,Three main themes were identified, namely, “relationships with others”, “inclusion and communication” and “challenges”. This focus group highlighted that although some SUs felt supported, they reported having little control in their lives and wanted to be listened to.,Including a SU in the planning and facilitation of the focus group would have made this research more inclusive.,The implications of this research suggest that by listening to and involving SUs and developing more person-centred services, recovery rates may increase as the services provided would be more targeted.,Very little research has previously been conducted to explore SUs’ experiences. This paper highlights the value of being heard and the knowledge that is often lost if the authors do not take the time to listen to the people for whom a service is designed.
{"title":"“When other people try to understand”: exploring the experiences of people with intellectual disabilities, who also have mental health problems","authors":"S. Mattock, K. Beard, A. Baddeley","doi":"10.1108/amhid-07-2018-0032","DOIUrl":"https://doi.org/10.1108/amhid-07-2018-0032","url":null,"abstract":"Recent guidelines from the National Institute of Health and Care Excellence highlight that service users (SUs) with intellectual disabilities and co-occurring mental health problems rarely get the opportunity to share their experiences of mental health services. Over the past 20 years, policy documents have stated that these individuals (SUs) must be included in decisions about their care. Research suggests that often this is not the case. Therefore, this paper aims to create a space for SUs to share their experiences of mental health services, and what they found helpful.,A focus group was held with five SUs, two psychologists and two researchers. The audio recording of the discussion was transcribed and analysed using thematic analysis.,Three main themes were identified, namely, “relationships with others”, “inclusion and communication” and “challenges”. This focus group highlighted that although some SUs felt supported, they reported having little control in their lives and wanted to be listened to.,Including a SU in the planning and facilitation of the focus group would have made this research more inclusive.,The implications of this research suggest that by listening to and involving SUs and developing more person-centred services, recovery rates may increase as the services provided would be more targeted.,Very little research has previously been conducted to explore SUs’ experiences. This paper highlights the value of being heard and the knowledge that is often lost if the authors do not take the time to listen to the people for whom a service is designed.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":"14 1","pages":"91-101"},"PeriodicalIF":1.1,"publicationDate":"2020-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-07-2018-0032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42881729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-08DOI: 10.1108/amhid-11-2019-0039
Raghavendar Baburaj, H. Dunstall, C. Bright, C. Lawthom
Epilepsy is a chronic illness affecting around 50 million people worldwide. Levetiracetam is an effective novel antiepileptic drug but can cause behavioural adverse events. A total of 10-15 per cent people with intellectual disability (ID) already present with Behaviour that Challenges (BtC). Brivaracetam is postulated to have a distinct pharmacological profile compared with levetiracetam which may result in fewer behavioural adverse events.,This paper presents two cases of people with epilepsy and ID being switched from levetiracetam to brivaracetam for reported behaviour adverse events.,The cases support that people with epilepsy and ID who are experiencing behavioural adverse events from levetiracetam can safely be switched to brivaracetam, resulting in significant reductions in BtC and potentially improved seizure control. Nevertheless, these results must be interpreted with caution, as aetiology for BtC in people with ID is often multifactorial.,This is one of the first papers to date, according to the best of the authors’ knowledge, to describe improved behavioural profile in people with ID and epilepsy when switching from levetiracetam to brivaracetam.
{"title":"Case reports of improvement in behaviour following switching of patients with intellectual disability and epilepsy from levetiracetam to brivaracetam","authors":"Raghavendar Baburaj, H. Dunstall, C. Bright, C. Lawthom","doi":"10.1108/amhid-11-2019-0039","DOIUrl":"https://doi.org/10.1108/amhid-11-2019-0039","url":null,"abstract":"Epilepsy is a chronic illness affecting around 50 million people worldwide. Levetiracetam is an effective novel antiepileptic drug but can cause behavioural adverse events. A total of 10-15 per cent people with intellectual disability (ID) already present with Behaviour that Challenges (BtC). Brivaracetam is postulated to have a distinct pharmacological profile compared with levetiracetam which may result in fewer behavioural adverse events.,This paper presents two cases of people with epilepsy and ID being switched from levetiracetam to brivaracetam for reported behaviour adverse events.,The cases support that people with epilepsy and ID who are experiencing behavioural adverse events from levetiracetam can safely be switched to brivaracetam, resulting in significant reductions in BtC and potentially improved seizure control. Nevertheless, these results must be interpreted with caution, as aetiology for BtC in people with ID is often multifactorial.,This is one of the first papers to date, according to the best of the authors’ knowledge, to describe improved behavioural profile in people with ID and epilepsy when switching from levetiracetam to brivaracetam.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":"14 1","pages":"85-90"},"PeriodicalIF":1.1,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-11-2019-0039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43173105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1108/amhid-11-2019-0037
J. Himmerich
Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still small and largely based on case studies and small trials whose participants mainly have mild to moderate ID. This paper aims to review and critique the literature in regards to the adaptations; and the effectiveness of psychodynamic psychotherapy for those with severe and profound ID.,A systematic literature search of PsycINFO, Social Policy and Practice, Medline, Cumulative Index to nursing and allied health literature and applied social sciences index and abstracts was conducted. Six studies met inclusion criteria and underwent a quality evaluation and critical review.,Six papers (all case studies) met inclusion criteria and underwent a quality evaluation and critical review. Some adaptations to therapy were reported, such as a more flexible therapeutic frame and increased use of the physical environment as a therapeutic tool. Due to significant methodological weaknesses of the included studies, it is yet unclear whether psychodynamic psychotherapy is an effective intervention for individuals with severe and profound ID.,Only a small number of case studies met the inclusion criteria. Further research should use more robust outcome measures, larger samples and compare psychodynamic psychotherapy to alternative interventions.,This paper is the first to review the psychodynamic psychotherapy literature with regard to its effectiveness as a treatment specifically for individuals with severe and profound ID and mental health difficulties.
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Pub Date : 2020-03-09DOI: 10.1108/amhid-10-2019-0031
C. Patterson, Jonathan Williams, Robert Jones
There is growing literature on the application of Dialectical Behaviour Therapy (DBT) with adults with intellectual disabilities (IDs). To draw upon the evidence-base from mainstream approaches, adapted interventions must remain true to their theoretical foundations and retain key components. The purpose of this paper was to establish the extent to which DBT has been adapted for adults with ID, and whether existing adapted protocols can still be considered DBT.,The theoretical underpinnings and key components of DBT were identified. Six DBT studies were critiqued according to these criteria.,In terms of content, only one intervention comprised all necessary elements. All of the remaining interventions included a skills group; two included individual therapy and another two included group consultation. None of the remaining interventions provided 24-h telephone support. Furthermore, none of the studies explicitly described using dialectical strategies.,To the best of the authors’ knowledge, this is the first paper to critically examine the evidence-base for the use of DBT in ID, particularly its fidelity.
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