Interviewing Techniques

Communication is the foundation of every relationship. How individuals perceive theirconnection with their mental healthcare providers significantly influences the success oftheir treatment relationships (Finlay & Lyons, 2002). Many mental health professionals lackspecialized training in the field of intellectual disabilities (ID), including a lack of training incommunicating with patients who have limited expressive language skills. Although, inmost educational programs, the mental health assessment of patients focuses on history-taking, the mental status examination and the interview process, if an individual is nonverbalor has limited communication abilities, then the clinician may lack confidence in inter-viewing him or her

Toward Impacting Medical and Psychiatric Comorbidities in Persons With Intellectual/Developmental Disabilities: An Initial Prospective Analysis

Objective: The purpose of this study was to determine the effectiveness of psychiatric medical services, counseling, and behavioral treatments for adult patients with intellectual disabilities plus behavioral disorders and/or emotional distress. Methods: Behavioral and medical data were collected at six and 12 months for a consecutive series of 141 adult patients with mild, moderate, or severe/profound intellectual disabilities who had been referred to a dual diagnosis mental health clinic, and treatment outcomes were compared. Results: Most improvement in behavioral problem severity occurred at six months, then plateaued. Treatment improvement for subjects with anxiety disorders was statistically significant across all interventions. In this sample, as expected, patients with intellectual disability had higher incidences of medical illnesses than the general population. Conclusions: Subjects with more behavioral (overt) symptoms tended to receive referrals for behavioral support, and subjects with less overt symptoms were referred to counseling. In a follow-up study, similar individuals with moderate intellectual disabilities will be seen psychiatrically, but then randomly assigned to either supportive counseling or behavior support, or both. They will be followed prospectively, to determine the relative benefits of supportive psychotherapy, behavior support, or a combination, and for what duration of time the treatment should be continued

Psychiatry of Intellectual Disability : A Practical Manual

Patients with intellectual disability (ID) can benefit from the full range of mental health services. To ensure that psychiatric assessment, diagnosis and treatment interventions are relevant and effective; individuals with ID should be evaluated and treated within the context of their developmental framework. Behavior should be viewed as a form of communication. Individuals with ID often present with behavioral symptoms complicated by limited expressive language skills and undiagnosed medical conditions. Many training programs do not include focused study of individuals with ID, despite the fact that patients with ID will be seen by virtually every mental health practitioner. In this book, the authors present a framework for competent assessment and treatment of psychiatric disorders in individuals with ID.https://corescholar.libraries.wright.edu/books/1231/thumbnail.jp

Psychiatry of Intellectual Disability : A Practical Manual

Patients with intellectual disability (ID) can benefit from the full range of mental health services. To ensure that psychiatric assessment, diagnosis and treatment interventions are relevant and effective; individuals with ID should be evaluated and treated within the context of their developmental framework. Behavior should be viewed as a form of communication. Individuals with ID often present with behavioral symptoms complicated by limited expressive language skills and undiagnosed medical conditions. Many training programs do not include focused study of individuals with ID, despite the fact that patients with ID will be seen by virtually every mental health practitioner. In this book, the authors present a framework for competent assessment and treatment of psychiatric disorders in individuals with ID

Aggression

Aggression in its various forms (verbal, physical, property destruction and auto-aggressionor self-injurious behavior) is the most frequent cause for mental health appointmentsand assessments in patients with intellectual disabilities (ID) (Tenneijet al., 2009;Hurleyet al., 2007; Rueve & Welton, 2008; Silka & Hauser, 1997). Patients with IDexperience psychiatric and behavioral problems at three to six times the frequency of thegeneral population (Hardan & Sahl, 1997; Larsonet al., 2001). “Problem behavior” occursin approximately 50–60% of individuals with ID, and reported prevalence rates foraggression range widely from 2–40%, according to various reports (Clarket al., 1990;Deb & Fraser, 1994)

Aggression

Aggression in its various forms (verbal, physical, property destruction and auto-aggressionor self-injurious behavior) is the most frequent cause for mental health appointmentsand assessments in patients with intellectual disabilities (ID) (Tenneijet al., 2009;Hurleyet al., 2007; Rueve & Welton, 2008; Silka & Hauser, 1997). Patients with IDexperience psychiatric and behavioral problems at three to six times the frequency of thegeneral population (Hardan & Sahl, 1997; Larsonet al., 2001). “Problem behavior” occursin approximately 50–60% of individuals with ID, and reported prevalence rates foraggression range widely from 2–40%, according to various reports (Clarket al., 1990;Deb & Fraser, 1994)

Mandated Psychotherapy with the Impaired Physician

Physicians and other prescribers of medication are in a unique position with regard to substance misuse. Each physician must abide by the licensing guidelines of the state medical board in their geographical location of practice. When a physician has legal charges regarding substance use, he or she must report to the medical board and undergo monitoring for several years. The recommendations of the board may include mandatory psychotherapy. The following composite cases are illustrative of the implications of one physician treating another physician under the auspices of a mandate