Strategies for Effective Management of Intellectually Disabled Patients on the Psychiatric Inpatient Unit

Authors

  • Luisa Gonzalez Einstein College of Medicine
  • Ifeoma Nwugbana Einstein College of Medicine
  • Rahulkumar Patel Einstein College of Medicine
  • Marissa Lombardo Einstein College of Medicine
  • Panagiota Korenis Einstein College of Medicine

DOI:

https://doi.org/10.6000/2292-2598.2015.03.02.7

Keywords:

Intellectual Disability, Impulse control disorder, Agitation, Inpatient psychiatry

Abstract

The management of aggressive behavior remains a fundamental challenge when working on a psychiatric inpatient service. The task becomes far more daunting when the patient presents not only with mental illness but also has an intellectual disability (ID) or impulse control disorder (IC). Intellectual Disability is defined as “the impairment of general mental abilities that impact adaptive functioning in three domains: conceptual, social and practical.” Impulse control disorder, is defined as “a psychiatric disorder characterized by impulsivity- the failure to resist a temptation, urge or impulse that may harm oneself or others” [1]. Those with ID and or IC may present with varying degrees of impairment and social functioning. Numerous studies have identified an association with ID and psychiatric co-morbidities including: bipolar disorder, impulse control disorder, psychosis and depression. Due to budgetary cuts and the precipitous decline in available residential placements, inpatient psychiatric services are faced with the dilemma of managing these exceptionally complicated patients. While numerous studies have examined the utility of psychotropic medication to aid in the management of these patients, convincing evidence concerning the use of psychiatric medication in the management of this patient population remains elusive [2]. Therefore, this paper aims to explore the treatment strategies available to the multidisciplinary team on the inpatient service. Ultimately, future investigations will be necessary to better understand how to optimize the inpatient management of this complex patient population.

Author Biographies

Luisa Gonzalez, Einstein College of Medicine

Department of Psychiatry and Behavioral Sciences Albert, Bronx Lebanon Hospital Center

Ifeoma Nwugbana, Einstein College of Medicine

Department of Psychiatry and Behavioral Sciences Albert, Bronx Lebanon Hospital Center

Rahulkumar Patel, Einstein College of Medicine

Department of Psychiatry and Behavioral Sciences Albert, Bronx Lebanon Hospital Center

Marissa Lombardo, Einstein College of Medicine

Department of Psychiatry and Behavioral Sciences Albert, Bronx Lebanon Hospital Center

Panagiota Korenis, Einstein College of Medicine

Department of Psychiatry and Behavioral Sciences Albert, Bronx Lebanon Hospital Center

References

[1] American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders. 5th Edition. Washington, DC: APA Press 2013.
[2] Tyrer P, Oliver-Africano PC, Ahmed Z, Bouras N, Cooray S, Deb S, Murphy D, Hare M, Meade M, Reece B, Kramo K, Bhaumik S, Harley D, Regan A, Thomas D, Rao B, North B, Eliahoo J, Karatela S, Soni A, Crawford M. Risperidone, haloperidol and placebo in the treatment of aggressive challenging behavior in patients with intellectual disability: a randomized control trial. Lancet 2008; 371(9606): 57-63.
http://dx.doi.org/10.1016/S0140-6736(08)60072-0
[3] Maulik PK, Mascarenhas M, Mathers C, Dua T, Saxena S. Prevalence of intellectual disability: A meta-analysis of population-based studies. Res Dev Disabil 2011; 32: 419-36.
http://dx.doi.org/10.1016/j.ridd.2010.12.018
[4] Mohr C, Tonge BJ, Einfeld SL. The development of a new measure for the assessment of psychopathology in adults with intellectual disability. J Intellect Disabil Res 2005; 49: 469-80.
http://dx.doi.org/10.1111/j.1365-2788.2005.00701.x
[5] Cooper SA, Smiley E, Morrison J, Williamson A, Allan L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry 2007; 190: 27-35.
http://dx.doi.org/10.1192/bjp.bp.106.022483
[6] Cooper SA. An epidemiological investigation of affective disorders with a population-based cohort of 1023 adults with intellectual disabilities. Psychol Med 2007; 37: 873-82.
http://dx.doi.org/10.1017/S0033291707009968
[7] Reid KA, Smiley E, Cooper SA. Prevalence and associations of anxiety disorders in adults with intellectual disabilities. J Intellect Disabil Res 2011; 55: 172-81.
http://dx.doi.org/10.1111/j.1365-2788.2010.01360.x
[8] Cooper SA, Smiley E, Jackson A, Finlayson J, Allan L, Mantry D and Morrison J. Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors. J Intellect Disabil Res 2009; 53: 217-32.
http://dx.doi.org/10.1111/j.1365-2788.2008.01127.x
[9] Cooper SA, Elita S, Jillian M, Linda A, Andrew W, Janet F, Alison J, Dipali M. Psychosis and adults with intellectual disabilities. Prevalence, incidence, and related factors. Soc Psych Psych Epid 2007; 42: 530-6.
http://dx.doi.org/10.1007/s00127-007-0197-9
[10] Myrbakk E, von Tetzchner S: The Prevalence of Behavioral Problems among People with Intellectual Disability Living in Community Settings. J Mental Health Research in Intellectual Disabilities 2008; 1: 205-222.
http://dx.doi.org/10.1080/19315860802115607
[11] Serving Individuals with Co-occurring developmental disabilities and mental illnesses: Systems barriers and strategies for reform. National Association of State Mental Health Program Directors (NASMHPD) October 2004.

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Published

2015-08-07

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Section

General Articles