Foot Health and Mobility in People With Intellectual Disabilities

Foot disorders affect people with intellectual disability and have an impact on their ability to mobilize; their prevalence appears to be higher than in the general population. Foot problems are recognized as part of certain syndromes associated with intellectual disabilities. Bony deformities of the foot, general health disorders, musculoskeletal disorders, and inappropriate footwear contribute to the development and aggravation of foot disorders. People with intellectual disability generally are disadvantaged as they do not have sufficient access to podiatric services even when foot problems are well known. Attention to people's foot health has important benefits to their health, social functioning, and mobility. Issues in the management of foot problems include awareness by carers and podiatrists of foot disorders in people with intellectual disabilities, effective communication with the person, and the assessment of mental capacity by podiatrists when proposing interventions to manage the problems. Maintaining people's mobility through active attention to their foot health has benefits not just for the persons but their access to community life and reduced costs in meeting their health needs

Mental health services for adults with mild intellectual disability

Meeting the mental health needs of people with mild intellectual disability (ID) can be a challenge to all mental health services. Not everyone with ID will be eligible to receive specialist ID services and therefore they rely on general mental health services to support them. The purpose of this College Report is to both inform readers on the complexities of providing care for this group of people, and how general and specialist services can co-operate to meet their needs. It is aimed it at psychiatrists and clinical staff working at the frontline of psychiatric services, and general practitioners providing services for people with ID. It includes: A review of service provision for people with mild ID across the four countries of the UK An oversight of the current evidenced-based thinking on what constitutes mild ID from an operational diagnostic perspective. The role, challenges and ambiguities of cognitive testing in this population. The Report’s conclusions are reinforced by the systematic review of current evidence on how care for this population is delivered that was undertaken and the review of all relevant NICE guidance on mental health applicable to people with ID that is provided. Drawing on the evidence, the Report also makes available a broad good-practice framework to enable psychiatrists, other practitioners, and services to self-measure and provide high quality care for people with mild ID and mental health problems

Reference evapotranspiration from coarse-scale and dynamically downscaled data in complex terrain: Sensitivity to interpolation and resolution

The main objective of this study was to investigate whether dynamically downscaled high resolution (4-km) climate data from the Weather Research and Forecasting (WRF) model provide physically meaningful additional information for reference evapotranspiration (E) calculation compared to the recently published GridET framework that uses interpolation from coarser-scale simulations run at 32-km resolution. The analysis focuses on complex terrain of Utah in the western United States for years 1985–2010, and comparisons were made statewide with supplemental analyses specifically for regions with irrigated agriculture. E was calculated using the standardized equation and procedures proposed by the American Society of Civil Engineers from hourly data, and climate inputs from WRF and GridET were debiased relative to the same set of observations. For annual mean values, E from WRF (EW) and E from GridET (EG) both agreed well with E derived from observations (r2 = 0.95, bias \u3c 2 mm). Domain-wide, EW and EG were well correlated spatially (r2 = 0.89), however local differences ΔE=EW-EG were as large as +439 mm year−1 (+26%) in some locations, and ΔE averaged +36 mm year−1. After linearly removing the effects of contrasts in solar radiation and wind speed, which are characteristically less reliable under downscaling in complex terrain, approximately half the residual variance was accounted for by contrasts in temperature and humidity between GridET and WRF. These contrasts stemmed from GridET interpolating using an assumed lapse rate of Γ = 6.5K km−1, whereas WRF produced a thermodynamically-driven lapse rate closer to 5K km−1 as observed in mountainous terrain. The primary conclusions are that observed lapse rates in complex terrain differ markedly from the commonly assumed Γ = 6.5K km−1, these lapse rates can be realistically resolved via dynamical downscaling, and use of constant Γ produces differences in E of order as large as 102 mm year−1

Characteristics of historical precipitation in high mountain asia based on a 15-year high resolution dynamical downscaling

The mountains of High Mountain Asia serve as an important source of water for roughly one billion people living downstream. This research uses 15 years of dynamically downscaled precipitation produced by the Weather Research and Forecasting (WRF) model to delineate contrasts in precipitation characteristics and events between regions dominated by the Indian Summer Monsoon (ISM) versus westerly disturbances during the cool season (December to March). Cluster analysis reveals a more complex spatial pattern than indicated by some previous studies and illustrates the increasing importance of westerly disturbances at higher elevations. Although prior research suggests that a small number of westerly disturbances dominate precipitation in the western Himalaya and Karakoram, the WRF-downscaled precipitation is less dominated by infrequent large events. Integrated vapor transport (IVT) and precipitation are tightly coupled in both regions during the cool season, with precipitation maximizing for IVT from the south-southwest over the Karakoram and southeast-southwest over the western Himalaya. During the ISM, Karakoram precipitation is not strongly related to IVT direction, whereas over the western Himalaya, primary and secondary precipitation maxima occur for flow from the west-southwest and northwest, respectively. These differences in the drivers and timing of precipitation have implications for hydrology, glacier mass balance, snow accumulation, and their sensitivity to climate variability and change

Pharmacological Management of Behavioral and Psychiatric Symptoms in Older Adults with Intellectual Disability

Given medical and social advances, the life expectancy of individuals with intellectual disability (ID) has increased dramatically, leading to a generation of older individuals with such disabilities. This review focuses on the pharmacological treatment of behavioral and psychiatric symptoms and disorders in older adults with ID. Older adults with ID often present with medical co-morbidities and mental health issues. Medication management of behavioral and psychiatric problems is complicated by a higher risk for adverse events, lack of decision-making capacity, and complex care networks. Some studies have shown that individuals with ID and co-morbid mental disorders are undertreated in comparison with those with similar disorders in the general population, resulting in poorer outcomes. However, older adults with ID are also at risk of polypharmacy, and older age is a risk factor for development of side effects. A general principle is that medication treatment for psychiatric disorders in older individuals with ID should be started at low dosages and increased cautiously while monitoring response and side effects. The use of psychotropic drugs for older individuals with ID and behavioral problems remains controversial, particularly in those with dementia

Patterns of comorbidity and psychopharmacology in adults with intellectual disability and attention deficit hyperactivity disorder: an UK national cross-sectional audit.

Background: Attention-deficit hyperactivity disorder (ADHD) is higher in people with intellectual disability (ID) compared to the general population. Available limited evidence suggests this population has increased psychological problems, diagnostic overshadowing and psychotropic prescribing. This audit Identifies and analyzes real-world characteristics, diagnostic practices, treatment, and management of ADHD in adults with ID.Research Design and Methods: Pooled retrospective case note data for people with ID and ADHD, collected from 30 organizations across the UK, were analyzed. Patients were classified into mild and moderate-profound ID groups. Associated mental health and neurodevelopmental co-morbidity, Demographics, concomitant psychotropics, and mental and behavioral concerns were collected. Group differences were reported using logistic regression models.Results: Of 445 participants, 73% had co-occurring autism spectrum disorder (ASD) and 65% were prescribed ADHD medications. Those on ADHD medication were less likely to be prescribed antipsychotics (p < 0.001) and antidepressants (p < 0.001). Multiple significant differences were found in ADHD medication response between ID groups and those with/without co-morbid ASD but not associated with challenging behavior reduction.Conclusions: High levels of neurodevelopmental and psychiatric comorbidity were found. ID severity and the presence of ASD appear to influence the use of certain psychotropic medications. Appropriate use of ADHD medication appears to reduce psychotropic polypharmacy

Standardised patients with intellectual disabilities in training tomorrow's doctors

Aims and method: To develop a programme to help undergraduate medical students and postgraduate trainees to improve their skills in communicating with people with intellectual disabilities through teaching sessions that had input from simulated patients with intellectual disabilities. We conducted four sessions of training for 47 undergraduate 4th-year medical students. The training involved a multiprofessional taught session followed by a clinical scenario role-play with simulated patients who were people with intellectual disabilities. The training was assessed by completing the healthcare provider questionnaire before and after the training. / Results: There were improvements in the students' perceived skill, comfort and the type of clinical approach across all three scenarios. / Clinical implications: By involving people with intellectual disabilities in training medical students there has been a significant improvement in students' communication skills in areas of perceived skills, comfort and type of clinical approach which will raise the quality of care provided by them in the future

Attention deficit hyperactivity disorder (ADHD) in adults with intellectual disability

The field of neurodevelopmental disorders is an exciting one in clinical practice. People with intellectual disability are more likely to have associated neurodevelopmental disorders such as autism and attention hyperactivity disorder (ADHD). The current practice of diagnosis and management of ADHD in people with intellectual disability is based on findings from assessment and treatments in the general population. People with intellectual disability often have additional comorbid disorders that may conceal or exacerbate the signs of ADHD and, for this reason, treatments applicable in the general population may not always be appropriate in treating a person with intellectual disability. To fill this gap in knowledge and practice, this College Report on ADHD in adults with intellectual disability is very welcome and timely when so much more is understood about ADHD in general. The challenge for clinicians in supporting people with intellectual disability and ADHD is to deliver the best care based on good evidence on the effectiveness of assessment processes and treatments. This report brings together the current evidence as applied in people with intellectual disabilities and it benefits from the expertise and knowledge of clinicians, built over years of experience working with people with intellectual disabilities. The evidence base will grow from more original research on ADHD in intellectual disability to understand how the disorder manifests in people with intellectual disability. The report will prove to be a valuable resource to clinicians and services in applying evidence to support and treat ADHD in people with intellectual disability

UK psychiatrists' experience of withdrawal of antipsychotics prescribed for challenging behaviours in adults with intellectual disabilities and/or autism.

BACKGROUND: A high proportion of adults with intellectual disabilities are prescribed off-licence antipsychotics in the absence of a psychiatric illness. The National Health Service in England launched an initiative in 2016, 'Stopping over-medication of people with a learning disability [intellectual disability], autism or both' (STOMP), to address this major public health concern. AIMS: To gain understanding from UK psychiatrists working with adults with intellectual disabilities on the successes and challenges of withdrawing antipsychotics for challenging behaviours. METHOD: An online questionnaire was sent to all UK psychiatrists working in the field of intellectual disability (estimated 225). RESULTS: Half of the 88 respondents stated that they started withdrawing antipsychotics over 5 years ago and 52.3% stated that they are less likely to initiate an antipsychotic since the launch of STOMP. However, since then, 46.6% are prescribing other classes of psychotropic medication instead of antipsychotics for challenging behaviours, most frequently the antidepressants. Complete antipsychotic discontinuation in over 50% of patients treated with antipsychotics was achieved by only 4.5% of respondents (n = 4); 11.4% reported deterioration in challenging behaviours in over 50% of patients on withdrawal and the same proportion (11.4%) reported no deterioration. Only 32% of respondents made the diagnosis of psychiatric illness in all their patients themselves. Family and paid carers' concern, lack of multi-agency and multidisciplinary input and unavailability of non-medical psychosocial intervention are key reported factors hampering the withdrawal attempt. CONCLUSIONS: There is an urgent need to develop national guidelines to provide a framework for systematic psychotropic drug reviews and withdrawal where possible