Background It has often been stated that the prevalence of psychiatric disorders in people with intellectual disabilities is greater than it is in the population as a whole.Method The epidemiological studies on psychiatric disorders in people with intellectual disabilities were reviewed.Results There is evidence that the prevalence of psychiatric disorder is greater in children with intellectual disabilities, compared with children with normal IQs, that it is higher in both adults and children with severe intel-lectual disabilities compared with people with mild or no intellectual disability and that the rate of problematic behaviour is higher in both adults and children having intellectual disabilities, than in their non-disabled peers. Conclusions There is no sound evidence that the prevalence of psychiatric disorders in adults with mild intellectual disability is greater than in the population as a whole.

Risperidone is efficacious and well tolerated in managing disruptive behavior disorders in adults with intellectual disability.

Background and Purpose: Conditions associated with frailty are common in people experiencing stroke and may explain differences in outcomes. We assessed associations between a published, generic frailty risk score, derived from administrative data, and patient outcomes following stroke/transient ischemic attack; and its accuracy for stroke in predicting mortality compared with other measures of clinical status using coded data. Methods: Patient-level data from the Australian Stroke Clinical Registry (2009–2013) were linked with hospital admissions data. We used International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes with a 5-year look-back period to calculate the Hospital Frailty Risk Score (termed Frailty Score hereafter) and summarized results into 4 groups: no-risk (0), low-risk (1–5), intermediate-risk (5–15), and high-risk (>15). Multilevel models, accounting for hospital clustering, were used to assess associations between the Frailty Score and outcomes, including mortality (Cox regression) and readmissions up to 90 days, prolonged acute length of stay (>20 days; logistic regression), and health-related quality of life at 90 to 180 days (quantile regression). The performance of the Frailty Score was then compared with the Charlson and Elixhauser Indices using multiple tests (eg, C statistics) for predicting 30-day mortality. Models were adjusted for covariates including sociodemographics and stroke-related factors. Results: Among 15 468 adult patients, 15% died ≤90 days. The frailty scores were 9% no risk; 23% low, 45% intermediate, and 22% high. A 1-point increase in frailty (continuous variable) was associated with greater length of stay (OR adjusted , 1.05 [95% CI, 1.04 to 1.06), 90-day mortality (HR adjusted , 1.04 [95% CI, 1.03 to 1.05]), readmissions (OR adjusted , 1.02 [95% CI, 1.02 to 1.03]; and worse health-related quality of life (median difference, −0.010 [95% CI −0.012 to −0.010]). Adjusting for the Frailty Score provided a slightly better explanation of 30-day mortality (eg, larger C statistics) compared with other indices. Conclusions: Greater frailty was associated with worse outcomes following stroke/transient ischemic attack. The Frailty Score provides equivalent precision compared with the Charlson and Elixhauser indices for assessing risk-adjusted outcomes following stroke/transient ischemic attack.

Background It has often been stated that the prevalence of psychiatric disorders in people with intellectual disabilities is greater than it is in the population as a whole.Method The epidemiological studies on psychiatric disorders in people with intellectual disabilities were reviewed. Results There is evidence that the prevalence of psychiatric disorder is greater in children with intellectual disabilities, compared with children with normal IQs, that it is higher in both adults and children with severe intel-lectual disabilities compared with people with mild or no intellectual disability and that the rate of problematic behaviour is higher in both adults and children having intellectual disabilities, than in their non-disabled peers. Conclusions There is no sound evidence that the prevalence of psychiatric disorders in adults with mild intellectual disability is greater than in the population as a whole.

Chromosomal copy-number variations (CNVs) are a class of genetic variants highly implicated in the aetiology of neurodevelopmental disorders, including intellectual disabilities (ID), schizophrenia and autism spectrum disorders (ASD). Yet the majority of adults with idiopathic ID presenting to psychiatric services have not been tested for CNVs. We undertook genome-wide chromosomal microarray analysis (CMA) of 202 adults with idiopathic ID recruited from community and in-patient ID psychiatry services across England. CNV pathogenicity was assessed using standard clinical diagnostic methods and participants underwent comprehensive medical and psychiatric phenotyping. We found an 11% yield of likely pathogenic CNVs (22/202). CNVs at recurrent loci, including the 15q11-q13 and 16p11.2-p13.11 regions were most frequently observed. We observed an increased frequency of 16p11.2 duplications compared with those reported in single-disorder cohorts. CNVs were also identified in genes known to effect neurodevelopment, namely NRXN1 and GRIN2B. Furthermore deletions at 2q13, 12q21.2-21.31 and 19q13.32, and duplications at 4p16.3, 13q32.3-33.3 and Xq24-25 were observed. Routine CMA in ID psychiatry could uncover ~11% new genetic diagnoses with potential implications for patient management. We advocate greater consideration of CMA in the assessment of adults with idiopathic ID presenting to psychiatry services.

No abstract

Despite an increasingt rend of serviceu seri nvolvement in psychiatric research, few studies involvingt he recipientso fs ecurec are, or individualsw ithl earning disability, were identified. It wasa rgued that service usersw ithl earning disabilitiesd etainedi nas ecureh ospital setting were an important source of information about the care theyr eceived. It wasp redicted that thisg roup would provideav alid and useful account of theire xperiences and that concerns would be raisedi ns imilar areas to thoset hat haveb een reported in other groups of service users. Thesei ncluded concerns relating to environmental conditions, therapeutica ctivities, qualityo fa vailablei nformation about care,a nd concerns relating to livingwithothers.Seven service usersc ompleted as emi-structured interviewa bout their experiences of the care thatt heyr eceived. Data were analysed usingc ontent analysis in order to deriveaseries of keyt hemes whilst acknowledging the individualityofparticipants'experiences.Themes were identified relating to twoa reas:D etention and Treatment. Findings supported predictions that individuals with learning disabilityc ouldg ive valid views about theirt reatment. Therew as overlapb etween the findings of this research and previous studies consideringv iews of mentalh ealth/forensic and learning disabled service users.

This report is the result of quantitative and qualitative inquiry into the workings of community learning disability teams with particular reference to the handling of caseloads and specifically discharge procedures. The study focused on four teams in the West Yorkshire area. Quantitative data to represent professionals within the teams, their caseload sizes and waiting lists were analysed. Qualitative information with respect to caseload management strategies was gathered via semi-structured interviews and the findings were validated by a focus group. The professionals identified the decision-making processes they employed regarding maintaining service users or discharging service users from their caseload. The management and structures within each of the teams were found to be complex and varied. The implications of these findings and recommendations for further investigations into the nature of caseload management practices in community learning disability services are discussed.