Strategies for Effective Management of Intellectually Disabled Patients on the Psychiatric Inpatient Unit
Pages 87-90
Luisa Gonzalez, Ifeoma Nwugbana, Rahulkumar Patel, Marissa Lombardo and Panagiota Korenis

DOI: http://dx.doi.org/10.6000/2292-2598.2015.03.02.7

Published: 07 August 2015

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.

Weight Loss Intervention in Young Adults with Severe Learning Disabilities:The Additive Effect of Cognitive Behavioral Treatment (a Pilot Study)
Pages 91-96
Nachum Vaisman, Rachel Regev, Lior Katalan and Yael Duani

DOI: http://dx.doi.org/10.6000/2292-2598.2015.03.02.8

Published: 07 August 2015

Abstract: The prevalence of obesity is reported to be higher among people with intellectual disabilities compared to the general population. Factors which were suggested to contribute to this increased prevalence include: low adherence to healthy diets, poor level of physical activity, intellectual disabilities and the lack of residential settings supporting independence. This study was designed to evaluate the additive effect of an intervention in the form of cognitive behavioral treatment (CBT) in a multi-strategy weight loss program for young adults with severe learning disabilities living in group residences in the community. The study population included 28 subjects (12 males) who were randomly assigned to one of two groups. Both groups had a weekly meeting with a dietician and were invited to take part in walking groups. One group (intervention group) had on top a weekly session of CBT. The results of our study indicate that adding a CBT component to a conventional program aiming at improved nutritional understanding (prudent diet, physical activity) of subjects with LD may improve the success for change in life habits, yet, in our study this effect was noticeable only on follow up few months after study termination. Neither group differences at baseline nor differences in the scoring for the locus of control questionnaire at baseline could predict this outcome. This delayed impact warrants further investigation.

Medical Evaluation of Children with Intellectual Disability: Clinician Compliance with Published Guidelines
Pages 97-109
Alexis Tchaconas and Andrew Adesman

DOI: http://dx.doi.org/10.6000/2292-2598.2015.03.02.9

Published: 07 August 2015

Abstract: Background: Children with intellectual disability (CWID) in the USA are typically referred to child neurologists (CN) and developmental-behavioral pediatricians (DBP) for medical evaluation. Although the American Academy of Neurology/Child Neurology Society (AAN/CNS) and the American Academy of Pediatrics (AAP) have published evaluation guidelines, experience suggests CN and DBP do not consistently follow them. Our goal was to assess CN’s and DBP’s approach to evaluating CWID and overall compliance with published guidelines.

Methods: Questionnaires were mailed to CN and DBP in the U.S. (n=1897). Physicians were asked demographic information and which laboratory tests they would "routinely order" for the hypothetical case of a 3½ year old boy with Full Scale IQ=58 and unremarkable neurological history and exam. Chi-square tests were performed to compare sub-specialists’ ordering practices.

Results: 127 CN and 140 DBP responded. 7.1% CN (n=9) and 11.4% DBP (n=16) complied with AAN/CNS and AAP guidelines, respectively. Although routinely indicated, 36.2% CN and 31.4% DBP would not routinely order chromosomal microarray (CMA), and 42.5% CN and 26.4% DBP would not routinely order DNA for Fragile X (χ²=7.67, p=0.006). 7.9% CN and 7.1% DBP would order a karyotype without CMA. Although not indicated, 7.1% CN and 0.7% DBP noted they would routinely order an EEG (χ²=7.50, p=0.006). A brain MRI is only recommended by AAN/CNS guidelines; 49.6% CN and 12.9% DBP reported they would routinely order it (χ²=42.55, p<.0001).

Conclusion: Few CN and DBP follow published guidelines for laboratory evaluation of CWID. Relative to DBP, CN more frequently order EEGs and MRIs but less frequently order recommended genetic tests.

A Discussion of the Treatment of People with an Intellectual Disability Across Healthcare and the Modernization of Learning Disability Nursing
Pages 110-119
Pamela Inglis, Hazel Powell, Angela Ridley and Sheila McQueen

DOI: http://dx.doi.org/10.6000/2292-2598.2015.03.02.10

Published: 07 August 2015

Abstract: Aims: A discussion of the treatment of people with an intellectual disability across healthcare and the modernisation of learning disability nursing.

Background: Health inequalities are at the forefront of the collective mind of healthcare professionals and politicians, this paper explores why people with an intellectual disability have more health issues, die earlier and sometimes receive poor care, leading to unnecessary suffering and importantly, how this may change. Learning disability nursing has long been viewed as different and less valued, probably due to dual stigmatisation, or lack of understanding of specialist knowledge and skills required. This essential field of nursing is becoming a rare resource in our battle against health inequalities, yet internationally it is becoming recognised as crucial.

Design:Discussion Paper.

Data Sources:Literature and policy (1971 – 2012).

Implications for Nursing:All nurses need to recognise their role in meeting the health care needs of people with an intellectual disability. Health care managers and commissioners should value the unique contribution of learning disability nurse in addressing health inequalities.

Conclusion:Learning disabled people, their carers and professionals view the role of the learning disability nurse as central for effectively identifying and meeting health needs, reducing inequalities and barriers, supporting decisions around capacity, consent, best interests and advising and educating professionals. Recommendations for commissioning, nursing and services are made.

Summary Statement:

Why is this discussion paper needed?

People with an intellectual disability have shorter life-spans and receive poor healthcare because of the barriers to good health developed in societies constructed by and for people without a disability.

Internationally, the need for learning disability nurses, with their specific knowledge and skills, is being recognised in the battle against early and unnecessary deaths because of discrimination and health inequalities.

Learning disability nurses and ‘Strengthening the Commitment’ lead on improving healthcare for learning disabled people and this paper raises the profile of this important health issue.

What are the key findings?

This discussion paper explores how most of the poor health experienced by people with an intellectual disability is about discriminating healthcare provision and crucially, not because the person has a disability.

People with an intellectual disability have greater health needs than others and despite this, nonspecific health professionals often have scant understanding of their disability and health needs.

Learning disability nursing as a vital resource has in recent years seen posts reducing in the NHS, with actual and commissioned numbers of registered learning disability nurses dropping.

How should the findings be used to influence policy/practice/education/research?

People with an intellectual disability and nonspecific staff often feel they are inadequately educated and lack appropriate skills for quality healthcare provision for learning disabled people; this has to change.

Sir Johnathon Michael (2008) recommendation 1 advises that all health professionals be competent in supporting learning disabled people in a non-discriminatory way - universities and employers urgently need to adhere to this recommendation.

Professionals, learning disabled people and carers state learning disability nurses are vital to acquiring human rights - increased international commissioning for learning disability nurses to enable quality healthcare, education and advice to professionals is pressing.

Charles Dickens and Intellectual Disability
Pages 1-6
Edward A. Polloway, J. David Smith and James R. Patton

DOI: http://dx.doi.org/10.6000/2292-2598.2015.03.01.1

Published: 26 March 2015

Abstract: Throughout civilization, the power of the word has significantly influenced and shaped societies. The contributions of writers has been substantial and this is certainly true in the field of intellectual disability. The renowned author, Charles Dickens, spoke of the need for appropriate education and treatment for people with these disabilities. He is notable for his early and prophetic vision of their potential for growth. This paper reviews important examples that were included in his novels as well as in other writings on people with intellectual disabilities. The manuscript places his work in an historical perspective, highlights his contributions to the literature of disability advocacy, and references his relevance to the field of intellectual disability.