Writing in 2005, Ann Poindexter noted, “After forty years of working with individuals with mental retardation/intellectual disability and behavioral/psychiatric problems, I continue to be impressed with the importance of medical issues in the presentation of behavioral symptoms” (p. v). Although it may not be offering new information to say that physical distress caused by non-psychiatric medical problems can provoke changes in mood and behavior in people with ID, this is a concept that bears repeating. Often the root of a psychiatric referral of a person with ID will turn out to be an undiagnosed medical condition. People with ID may lack the verbal ability to communicate their discomfort or distress. They may even lack the cognitive ability to identify the source of their pain. Health problems that may cause or worsen behavior problems include ear infections, premenstrual pain, sleep disturbances, allergies, dental pain, seizures, constipation, and urinary tract infections.
Addressing the need to assess for medical factors in the context of a psychiatric assessment, Hurley et al. (2007) write in the DM-ID:
Medical problems are often the source of the chief complaint for the mental health interview for an individual with ID, in contrast with the typical interview for intellectually normal individuals (who can understand that they have a medical condition that could be associated with a mental disorder, such as chronic pain leading to Depressive Disorder). For persons with ID, the association of medical condition with mental disorder is not generally understood — not by family, not by direct support professionals, and not by clinicians. (p. 17).
A recent study (Charlot et al., 2011) finds that “individuals with ID admitted for inpatient psychiatric care exhibited high rates of medical problems, and these were associated with duration of inpatient stay.”
Improved assessment and treatment of medical conditions may prevent unnecessary psychiatric referrals and may improve the quality of life of many individuals with ID by relieving their prolonged distress caused by undiagnosed and untreated medical conditions.
Robert J. Fletcher, Founder & CEO, NADD
Charlot, L., Abend, S., Ravin, P.,, Mastis, K, Hunt, A, & Deustch, C. (2011). Non-psychiatric health problems among psychiatric inpatients with intellectual disabilitiese. Journal of Intellectual Disability Research, 55(2), 119-209.
Hurley, A.D., Levitas, A., Lecavalier, L., & Pary, R.J. (2007). Assessment and diagnostic procedures. In R. Fletcher, E. Loschen, C. Stavrakaki, & M. First (Eds.), Diagnostic manual – intellectual disability (DM-ID): A textbook of diagnosis of mental disorders in persons with intellectual disability. Kingston, NY: The NADD Press.
Poindexter, A.R. (2005). Assessing medical issues associated with behavioral/psychiatric problems in persons with intellectual disability. Kingston, NY: The NADD Press.
This is one reason why it is so critical to have medical and caregivers who are stable and understand the population which they serve. People with ID present issues very differently than those of us who are “typical” (whatever that is) .
The Medical Home Model, as researched and described in the report Medical Care Task Force Jan 2002 , is an example of how we
can achieve safe, quality and cost effective care for our most vulnerable populations. Please share this report with others.