The symptoms of 36 people with varying degrees of intellectual disability (ID) who had had an ICD-10 depressive syndrome in the preceding year were compared with 46 non-depressed people with comparable degrees of ID. Throughout the spectrum of ID, symptoms of depressed affect and sleep disturbance were significantly different between the groups. While symptoms in people with mild ID were reflected in the standard diagnostic criteria, this was not the case in people with moderate and severe ID. With increasing disability there was a move towards 'behavioural depressive equivalents' such as aggression, screaming and self-injurious behaviour. Diagnostic criteria for depression among people with severe ID, should place more emphasis on behavioural 'depressive equivalents'.

Caregivers of persons with Angelman syndrome completed the Aberrant Behavior Checklist and Reiss Screen for Maladaptive Behavior. Seventy-three replies were received, and comparisons were made with other published data. Responses indicated that 15q- Angelman syndrome is associated with such problems as lack of speech, overactivity, restlessness, and eating and sleep problems. Episodes of inappropriate laughter were only reported for 57%, despite being considered a cardinal feature of the syndrome; eating problems (64%) and a fascination with water (68%) were reported more frequently. Overactivity was more of a problem for children; Aberrant Behavior Checklist Factor IV (Hyperactivity) was negatively correlated with age. Scores were mostly lower than for previously studied etiological groups. Therapeutic effort should be put into programs to address these problems.

People with autism may develop new behaviours in adolescence or early adult life, in addition to those associated with the primary disorder. Some of these behaviours have been postulated to be symptoms of depressive disorder. This article notes the methodological problems of investigating depression in people with autism. The authors also attempt to clarify the symptoms that may be significant in diagnosing depression in this group, by using treatment response methods.

The benefits of comprehensive assessments, the use of standardized assessment tools and trials of treatments are discussed in the context of making psychiatric diagnoses.

SummaryThere has been growing media and political awareness of forced marriage in recent years, and individuals in England, Wales and Northern Ireland are now protected by the Forced Marriage (Civil Protection) Act 2007. Victims of forced marriage can experience significant abuse, which may lead to mental health problems. People with severe mental illness or intellectual disability may be at increased risk of forced marriage and more vulnerable to its negative consequences. We review the current literature on forced marriage, focusing on the way it might affect these two groups, touch on its potential mental health consequences and give practical examples of how to manage situations in clinical practice.