Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-07-07T07:29:54.527Z Has data issue: false hasContentIssue false

5 - The interface between medical and psychiatric disorders in people with intellectual disabilities

from Part I - Assessment and diagnosis

Published online by Cambridge University Press:  15 December 2009

By
Nick Lennox
Edited by
Nick Bouras  and
Geraldine Holt
Nick Lennox
Affiliation:
Associate Professor, Queensland Centre for Intellectual & Developmental Disability School of Population Health The University of Queensland
Nick Bouras
Affiliation:
King's College London
Geraldine Holt
Affiliation:
King's College London
Get access

Summary

Introduction

This chapter will discuss the interface between medical and psychiatric disorders in people with intellectual disabilities (ID). The Oxford Modern Australian Dictionary, 1998, defines interface as ‘a place where interaction occurs between two processes’. To fully understand this interaction we will need a broad framework that accounts for the underlying influences on the clinical presentation of medical and psychiatric conditions. A proposed framework, which can assist in understanding the individual and the nature of the influences on health, will be presented and discussed. Then the evidence for the poor health status of people with ID will be presented along with reasons why this situation may currently exist. The high levels of morbidity and psychosocial neglect experienced by this population highlight the importance of this interface. Finally, commonly encountered conditions, and an approach to their clinical features, are discussed.

Conceptual framework

A conceptual framework is helpful in describing the complex interaction between psychiatric and physical disorders. This framework may also be useful for the broader conceptualization of the constructs and also during the consultative process.

The framework in Table 5.1, adapted from Professor Tony Holland's model (personal communication), and extended to incorporate more recent findings and trends, is a simple four-by-four table. According to this model, each dimension along the x-axis, from biological to spiritual, can contribute to our understanding of an individual's current presentation. These dimensions can have varying degrees of influence on the person's health and well-being.

Type
Chapter
Information
Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities , pp. 76 - 90
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beange, H., McElduff, A. & Baker, W. (1995). Medical disorders of adults with mental retardation: a population study. American Journal of Mental Retardation, 99, 595–604.Google Scholar
Bittles, A. H., Petterson, B. A., Sullivan, S. G.et al. (2002). The influence of intellectual disability on life expectancy. Journals of Gerontology, 57A, 470–2.Google Scholar
Boer, H., Holland, A., Whittington, J.et al. (2002). Psychotic illness in people with Prader–Willi syndrome due to chromosome 15 maternal uniparental disomy. Lancet, 359, 135–6.Google Scholar
Bohmer, C., Klinkenberg Knol, E., Kuipers, E.et al. (1997b). The prevalence of Helicobacter pylori infection among inhabitants and healthy employees of institutes for the intellectually disabled. American Joural of Gastroenterology, 92, 1000–4.Google Scholar
Bohmer, C., Klinkenberg Knol, E., Niezen de Boer, R.et al. (1997a). The prevalence of gastro-oesophageal reflux disease based on non-specific symptoms in institutionalized, intellectually disabled individuals. European Journal of Gastroenterology and Hepatology, 9, 187–90.Google Scholar
Bohmer, C. J., Taminiau, J. A., Klinkenberg Knol, E. C.et al. (2001). The prevalence of constipation in institutionalized people with intellectual disability. Journal of Intellectual Disability Research, 45, 212–18.Google Scholar
Bowley, C. & Kerr, M. (2000). Epilepsy and intellectual disability. Journal of Intellectual Disability Research, 44, 529–43.Google Scholar
Cathels, B. & Reddihough, D. (1993). The health care of young adults with cerebral palsy. The Medical Journal of Australia, 159, 444–6.Google Scholar
Centre, J., Beange, H. & McElduff, A. (1998). People with mental retardation have an increased prevalence of osteoporosis: A population study. American Journal of Mental Retardation, 103, 19–28.Google Scholar
Centre, J., McElduff, A. & Beange, H. (1994). Osteoporosis in groups with intellectual disability. Australia and New Zealand Journal of Developmental Disabilities, 19, 251–8.Google Scholar
Cumella, S., Ransford, N., Lyons, J. M. & Burnham, H. (2000). Needs for oral care among people with intellectual disability not in contact with community dental services. Journal of Intellectual Disability Research, 44, 45–52.Google Scholar
Cunningham, S., Cunningham, R., Izmeth, M.et al. (1994). Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped. Epidemiology and Infection, 112, 195–200.Google Scholar
Deb, S., Thomas, M. & Bright, C. (2001). Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years. Journal of Intellectual Disability Research, 45, 495–505.Google Scholar
Decker, H. A., Herberg, E. N., Haythornthwaite, M. S.et al. (1968). Provision of health care for institutionalized retarded children. American Journal of Mental Deficiency, 33, 283–93.Google Scholar
Durvasula, S., Beange, H. & Baker, W. (2002). Mortality of people with intellectual disability in northern Sydney. Journal of Intellectual & Developmental Disability, 27, 255–64.Google Scholar
Emerson, E. (2003). Mothers of children and adolescents with intellectual disability: social and economic situation, mental health status, and the self-assessed social and psychological impact of the child's difficulties. Journal of Intellectual Disability Research, 47, 385–99.Google Scholar
eTG complete. (2004). Therapeutic guidelines; see www.tg.com.au, accessed 25 May 2006.
Evenhuis, H. (1995a). Medical aspects of ageing in a population with intellectual disability: I. Visual impairment. Journal of Intellectual Disability Research, 39, 19–25.Google Scholar
Evenhuis, H. (1995b). Medical aspects of ageing in a population with intellectual disability: II. Hearing impairment. Journal of Intellectual Disability Research, 39, 27–33.Google Scholar
Eyman, R. K., Borthwick Duffy, S. A., Call, T. L.et al. (1988). Prediction of mortality in community and institutional settings. Journal of Mental Deficency Research, 32, 203–13.Google Scholar
Eyman, R. K., Grossman, H. J., Chaney, R. H.et al. (1993). Survival of profoundly disabled people with severe mental retardation. American Journal of Diseases of Children, 147, 329–36.Google Scholar
Forsgren, L., Edvinsson, S. O., Nystrom, L.et al. (1996). Influence of epilepsy on mortality in mental retardation: an epidemiologic study. Epilepsia, 37, 956–63.Google Scholar
Gaventa, W. C. (2003). Journal of Intellectual Disability Research, 47, 565–7.
Gowdey, C. W., Zarfas, D. E. & Phipps, S. (1987). Audit psychoactive drug prescriptions in group homes. Mental Retardation, 25, 331–4.Google Scholar
Griffin, J. M., Fuhrer, R., Stansfeld, S. A. and Marmot, M. (2003). The importance of low control at work and home on depression and anxiety: Do these effects vary by gender and social class? In Social and Economic Patterning of Health among Women/Les Facteurs Sociaux et Économiques de la Santé des Femmes, Arber, S. and Khlat, M. (eds.), Paris: CICRED, 2003, pp. 297–330.
Hagerman, R. J. & Cronister, A. (eds.) (1996). Fragile X Syndrome: Diagnosis, Treatment, and Research (second edn). Baltimore & London: The Johns Hopkins University Press.
Hand, J. E. (1994). Report of a national survey of older people with lifelong intellectual handicap in New Zealand. Journal of Intellectual Disability Research, 38, 275–87.Google Scholar
Harrison's Principles of Internal Medicine (2005). The McGraw-Hill Companies; Electronic version, accessed 25 May 2006.
Howells, G. (1986). Are the medical needs of mentally handicapped adults being met?Journal of the Royal College of General Practitioners, 36, 449–53.Google Scholar
Jancar, C., Eastham, R. & Carter, G. (1984). Hypocholesterolaemia in cancer and other causes of death in mentally handicapped. British Journal of Psychiatry, 145, 59–61.Google Scholar
Janicki, M. & Dalton, A. (1998). Sensory impairments among older adults with intellectual disability. Journal of Intellectual and Developmental Disability, 23, 3–11.Google Scholar
Janicki, M., Dalton, A., Henderson, C.et al. (1999). Mortality and morbidity among older adults with intellectual disability: health services considerations. Disability and Rehabilitation, 21, 284–94.Google Scholar
Jurek, G. & Reid, W. (1994). Oral health of institutionalized individuals with mental retardation. American Journal of Mental Retardation, 98, 656–60.Google Scholar
Kaplan, B. & Sadock, V. (2003). Kaplan & Sadock's Synopsis of Psychiatry, Behavioural Sciences/Clinical Psychiatry (ninth edn). New York, NY: Lippincott Williams & Wilkins.
Lennox, N., Beange, H. & Edwards, N. (2000). The health needs of people with intellectual disability. Medical Journal of Australia., 173, 328–30.Google Scholar
Lennox, N. & Chaplin, R. (1996). The psychiatric care of people with intellectual disabilities: the perceptions of consultant psychiatrists in Victoria. The Australian and New Zealand Journal of Psychiatry, 30(6), 774–80.Google Scholar
Lennox, N. & Diggens, J. (1999). Medical education and intellectual disability: A survey of Australian medical schools. Journal of Intellectual & Developmental Disability, 24, 333–40.Google Scholar
Lennox, N., Diggens, J. & Ugoni, A. (1997). The general practice care of people with an intellectual disability: barriers and solutions. Journal of Intellectual Disability Research, 4, 380–90.Google Scholar
Lennox, N. & Eastgate, G. (2004). Adults with intellectual disability and the GP. Australian Family Physician, 33, 601–6.Google Scholar
Lennox, N. G., Rey-Conde, T., Bain, C.et al. (2004). The evidence for better health from health assessments: A large clustered randomised controlled trial. Journal of Intellectual Disability Research, 48, 342.Google Scholar
Marshall, D., McConkey, R. & Moore, G. (2003). Obesity in people with intellectual disabilities: the impact of nurse-led health screenings and health promotion activities. Journal of Advanced Nursing, 41, 147–53.Google Scholar
McDermott, S., Platt, T. & Krishnaswami, S. (1997). Are individuals with mental retardation at high risk for chronic disease?Family Medicine, 29, 429–34.Google Scholar
Morgan, C. L., Baxter, H. & Kerr, A. M. (2003). Prevelence of epilepsy and associated health service utilization and mortality among patients with intellectual disability. American Journal of Mental Retardation, 108, 293–300.Google Scholar
Nelson, R. & Crocker, A. (1978). The medical care of mentally retarded persons in public residential facilities. The New England Journal of Medicine, 299, 1039–44.Google Scholar
O'Brien, G. & Yule, W. (eds.) (1995). Behavioural Phenotypes (first edn). London: MacKeith Press.
Parker, G. (1991). Developmentally disabled, doubly disadvantaged. The Medical Journal of Australia, 155, 68–71.Google Scholar
Peach, H. G. (2003). Religion, spirituality and health. The Medical Journal of Australia, 178, 415–16.Google Scholar
Reiss, S., Levitan, G. & Szyszko, J. (1982). Emotional disturbance and mental retardation: diagnostic overshadowing. American Journal of Mental Deficiency, 87, 567–74.Google Scholar
Robertson, J., Emerson, E., Gregory, N.et al. (2000). Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilies. Research in Developmental Disabilities, 21(6): 469–86.Google Scholar
Sachdev, P. & Longragan, C. (1991). The present status of akathisia. The Journal of Nervous and Mental Disease, 179, 381–91.Google Scholar
Sherrard, J., Tonge, B. J. & Ozanne Smith, J. (2001). Injury in young people with intellectual disability: descriptive epidemiology. Injury Prevention Journal of the International Society for Child and Adolescent Injury Prevention, 7, 56–61.Google Scholar
Sobsey, D. (1994). Violence and Abuse in the Lives of People with Disabilities: The End of Silent Acceptance?Baltimore, MD: Paul H. Brookes Publishing Co.
Sobsey, D. & Doe, T. (1991). Patterns of sexual abuse and assault. Sexuality and Disability, 9, 243–59.Google Scholar
Stehr Green, P., Wilson, N., Miller, J.et al. (1991). Risk factors for hepatitis B at a residential institution for intellectually handicapped persons. New Zealand Medical Journal, 104, 514–16.Google Scholar
Tohill, C. (1997). A study into the possible link between anti-epileptic drugs and the risk of fractures in Muckamore Abbey Hospital. Journal of Intellectual and Developmental Disability, 22, 281–92.Google Scholar
Tyler, C. V. Jr. & Bourguet, C. (2000). Primary care of adults with mental retardation. Journal of Family Practice, 44, 487–94.Google Scholar
Schrojenstein Lantman-de Valk, H. M. J., Akker, M. ⅴ. d., Maaskant, M.et al. (1997). Prevalence and incidence of health problems in people with intellectual disability. Journal of Intellectual Disability Research, 41, 42–51.Google Scholar
Schrojenstein Lantman-de Valk, H. M., Metsemakers, J. F., Haveman, M. J.et al. (2000). Health problems in people with intellectual disability in general practice: a comparative study. Family Practice, 17, 405–7.Google Scholar
Wallace, R. A., Webb, P. M. & Schluter, P. J. (2002). Environmental, medical, behavioural and disability factors associated with Helicobacter pylori infection in adults with intellectual disability. Journal of Intellectual Disability Research, 46, 51–60.Google Scholar
Warburg, M. (1994). Visual impairment among people with developmental delay. Journal of Intellectual Disability Research, 38, 423–32.Google Scholar
Warburg, M. (2001). Visual impairment in adult people with intellectual disability: literature review. Journal of Intellectual Disability Research, 45, 424–38.Google Scholar
Wells, M. B., Turner, S., Martin, D. M.et al. (1997). Health gain through screening — a coronary heart disease and stroke: Developing primary health care services for people with intellectual disability. Journal of Intellectual and Developmental Disability, 22, 251–63.Google Scholar
White, M. J. N., Cassandra, N., Cook, R. S.et al. (1995). Diagnostic overshadowing and mental retardation: A meta-analysis. American Journal on Mental Retardation, 100, 293–8.Google Scholar
Wilson, D. & Haire, A. (1990). Health care screening for people with mental handicap living in the community. British Medical Journal, 301, 1379–81.Google Scholar
Yang, Q., Rasmussen, S. A. & Friedman, J. M. (2002). Mortality associated with Down's syndrome in the USA from 1983 to 1997: a population-based study. Lancet, 359, 1019–25.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×