Case study: organizing outpatient pharmacological treatment of bipolar disorder in autism, intellectual disability and Phelan-McDermid syndrome (22q13.3 deletion syndrome)

Rysstad, Anne Langseth; Kildahl, Arvid Nikolai; Skavhaug, Jon Olav; Dønnum, Monica Stolen; Helverschou, Sissel Berge

doi:10.1080/20473869.2020.1756113

Cited by 15 publications

(12 citation statements)

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“…This may be particularly helpful in community settings, among general practitioners, and in ASD/ ID-specific services when considering referral to specialist mental health services. Furthermore, the PAC has demonstrated its value both for assessment and treatment monitoring in several case studies involving individuals with ASD and ID, including cases with a high degree of complexity (Bakken et al 2014, Kildahl et al 2017, 2019a, 2019b, Rysstad et al 2020.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings also concur with previous studies indicating that a reliable diagnosis of psychiatric disorder in individuals with ASD and ID should not rely on questionnaires or checklists alone but requires a multimodal diagnostic process, combining clinical expertise and a range of different assessment methods (Helverschou et al 2020b, MacNeil et al 2009. It is important, too, to work collaboratively with the family and others who know the person well, in order to obtain information on mental health and well-being, changes to typical patterns of behaviour and mood, and to provide information on idiosyncratic or atypical symptoms (Bakken and Høidal 2014, Helverschou et al 2011a, MacNeil et al 2009, Kildahl et al 2017, Rysstad et al 2020. Thus, for diagnosis in clinical services, more detailed and in depth clinical interviews and observations are recommended (Hollocks et al 2018, Oliver et al 2020.…”

Section: Discussionmentioning

confidence: 99%

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Psychometric properties of the Psychopathology in Autism Checklist (PAC)

Helverschou

Ludvigsen

Hove

et al. 2021

International Journal of Developmental Disabilities

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Psychiatric disorders in individuals with co-occurring autism spectrum disorders (ASD) and intellectual disability (ID) are common, but diagnosis presents many challenges. The Psychopathology in Autism checklist (PAC) is among the very few instruments specifically developed for this group of individuals. The psychometric properties of the PAC (i.e. criterion validity, specificity, sensitivity and predictive values) were explored by comparing scores with assessments on the Aberrant Behavior Checklist (ABC) and examining how well assessment by the PAC at referral predicts final clinical diagnoses. Results indicated a significant correlation with the ABC, further supporting the validity of the PAC. Sensitivity and Specificity for specific diagnoses were variable, although positive predictive value for "any diagnosis' was relatively high. The study confirms the potential value of the PAC as a screening checklist but highlights the need for clinical diagnosis to be based on a multimodal, multidisciplinary assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Psychometric properties of the Psychopathology in Autism Checklist (PAC)

Helverschou

Ludvigsen

Hove

et al. 2021

International Journal of Developmental Disabilities

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“…In line with previous suggestions (Appleton et al 2019, Valdovinos et al 2019, Helverschou et al 2011b, direct observation by mental health professionals with specific knowledge and experience concerning psychiatric disorder in ASD and ID may thus be particularly important as the diagnostic complexity increases, and was helpful also in the current study. Recent findings suggest that the challenges present in assessment of psychiatric disorder in this population are present also in evaluation of treatment effects (Rysstad et al 2020), and the use of similar, multimodal strategies proved helpful for evaluation in the current case. This included taking account of observations made by the patient's family, his professional caregivers and ward staff regarding his condition and development during the admission, as well as systematic monitoring of SIB and use of checklists.…”

Section: Discussionmentioning

confidence: 89%

“…Recent findings suggest that the challenges present in assessment of psychiatric disorder in this population are present also in evaluation of treatment effects (Rysstad et al. 2020 ), and the use of similar, multimodal strategies proved helpful for evaluation in the current case. This included taking account of observations made by the patient’s family, his professional caregivers and ward staff regarding his condition and development during the admission, as well as systematic monitoring of SIB and use of checklists.…”

Section: Discussionmentioning

confidence: 93%

Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour

Kildahl

Bakken

Matre

et al. 2020

International Journal of Developmental Disabilities

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Introduction : Anxiety disorders are highly prevalent in individuals with autism spectrum disorder (ASD), but knowledge is limited regarding identification and treatment of these disorders in individuals with ASD and more severe levels of intellectual disability (ID). The current case study aims to explore and describe the inpatient, psychiatric assessment in an adolescent male with ASD, severe ID and self-injurious behaviour (SIB) who was diagnosed with a co-occurring anxiety disorder. The study further aims to explore the implications of this diagnosis for subsequent intervention and care, including management of SIB. Materials and methods : Case study including multimodal, psychiatric assessment and subsequent intervention. Results : Following changes in care strategies attempting to incorporate the understanding of anxiety/trauma as contributing to SIB, a reduction of SIB was observed, and this reduced frequency was maintained when the patient was discharged from the inpatient setting. Conclusions : Though no causal inferences are possible, these experiences indicate that further research is needed regarding possible associations between SIB and anxiety in individuals with ASD, including implications for treatment. Experiences from the current case further indicate that it is possible to recognize and diagnose anxiety disorder in complex cases involving ASD, severe ID, limited verbal language skills, and severe SIB.

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“…Assessment and evaluation of treatment of mental illness in individuals with ID may be challenging (Fletcher et al., 2016 , Rysstad et al. 2020 ): individuals with ID may have limited verbal language skills or related difficulties affecting verbal communication (WHO 2018 ). Hence, symptoms may not be reported or directly observable to others.…”

Section: Introductionmentioning

confidence: 99%

Experiences of ward atmosphere in inpatients with intellectual disability and mental illness: clinical implications for mental health nursing

Sommerstad¹,

Kildahl²,

Munkhaugen

et al. 2021

International Journal of Developmental Disabilities

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Background: Patients with intellectual disability in psychiatric services are rarely asked about their experiences when admitted to inpatient units. Aim: To enhance the understanding of ward atmosphere for inpatients with co-occurring intellectual disabilities (ID) and mental illness by exploring patients’ experiences from a specialised mental health inpatient unit. Methods: A selected sample of 10 adults with comorbid mental illness and ID were recruited for a qualitative interview study based on Gunderson’s conceptualisation of therapeutic components in mental health wards. The patients were interviewed by two experienced clinicians and interviews were analysed using directed content analysis. Results: Patients’ experience of their relationships with ward staff seemed central to their experiences of several aspects of mental health nursing. Feeling safe, contained, and validated, were further important aspects. However, the patients seemed to have little influence on treatment choices and did not report participating in shared decision-making. Conclusions: The patients’ answers in this study are in line with previous research on ward atmosphere for patients in the general population. However, more research is necessary to inform future mental health nursing for patients with ID, both in inpatient and ambulatory services.

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Case study: organizing outpatient pharmacological treatment of bipolar disorder in autism, intellectual disability and Phelan-McDermid syndrome (22q13.3 deletion syndrome)

Cited by 15 publications

References 50 publications

Psychometric properties of the Psychopathology in Autism Checklist (PAC)

Psychometric properties of the Psychopathology in Autism Checklist (PAC)

Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour

Experiences of ward atmosphere in inpatients with intellectual disability and mental illness: clinical implications for mental health nursing

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