Intellectual disability (ID) or mental retardation or learning disability is a lifelong condition included in the group of mental disorders in all the international classification systems. It is a syndrome grouping (meta-syndrome) including a heterogeneous range of clinical conditions characterized by a deficit in cognitive functioning prior to the acquisition of skills through learning (1). Over 30% of people with ID have a comorbid psychiatric disorder, which often has its onset in childhood and persists through adolescence and adulthood (2,3).In spite of this evidence, ID and related conditions are still considered a marginal area of psychiatry. In many countries there is little or no training provision on ID during undergraduate medical training or psychiatric specialization. The World Health Organization (WHO) has recently highlighted the unmet care needs of persons with ID (4). Psychiatrists are the first health professionals in contact with this population group and there is a global gap in training and guidelines on mental health issues related to ID.Within the ID field, the assessment, differential diagnosis and treatment of problem behaviours (PBs) deserve special attention. The rate of PBs in people with ID is high (5) and their presentation is determined by many complex factors. The pathogenic contribution of organic conditions, psychiatric disorders, environmental influences, or a combination of these has to be carefully established for every single case.The prevalence of PBs in people with ID seems to be sufficiently high (5,6) to constitute a major concern in this population. Depending on the definition and methodology, rates have been reported to vary from 5.7 to 17% (7-10). Using the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities (DC-LD) (11), Cooper et al (12,13) aggression and self-injurious behaviour to be 9.8% and 4.9%, respectively, among adults (16 years and over) with ID in a community setting.It has been reported that 20-45% of people with ID are receiving psychotropic medication and 14-30% are receiving psychotropic medication to manage PBs such as aggression or self-injurious behaviours (14,15) in the absence of a diagnosed psychiatric disorder. Examples of psychotropic medications used for adults with ID are antipsychotics, antidepressants, anti-anxiety drugs (benzodiazepines, buspirone, beta-blockers), mood stabilizers (lithium, anticonvulsants), psychostimulants, and opioid antagonists. Spreat et al (16) reported that as many as two thirds of psychotropic medications prescribed to people with ID are antipsychotics.Studies suggest that PBs are not only prevalent but also persistent in people with . Totsika et al (20) found that serious physical attacks, self-injury and stereotypy were the most likely types of PBs to persist over time. It is therefore suggested that it may be necessary to start interventions as early as possible to prevent the behaviours from becoming more serious and to reduce the number of emergent behaviours. It has...
Although "intellectual disability" has widely replaced the term "mental retardation", the debate as to whether this entity should be conceptualized as a health condition or as a disability has intensified as the revision of the World Health Organization (WHO)'s International Classification of Diseases (ICD) advances. Defining intellectual disability as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. This paper presents the consensus reached to date by the WHO ICD Working Group on the Classification of Intellectual Disabilities. Literature reviews were conducted and a mixed qualitative approach was followed in a series of meetings to produce consensus-based recommendations combining prior expert knowledge and available evidence. The Working Group proposes replacing mental retardation with intellectual developmental disorders, defined as "a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills". The Working Group further advises that intellectual developmental disorders be incorporated in the larger grouping (parent category) of neurodevelopmental disorders, that current subcategories based on clinical severity (i.e., mild, moderate, severe, profound) be continued, and that problem behaviours be removed from the core classification structure of intellectual developmental disorders and instead described as associated features.
In view of the common interface of medical and mental-health problems in people with intellectual disabilities, and the disparity in health they often face, initiatives should be taken to enhance their healthcare. Family carers, social-care providers, primary-care practitioners and specialist psychiatric teams can all play an important role in recognizing ill health and navigating access to the appropriate health services that people with intellectual disabilities need.
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