Psychiatric Diagnoses In Developmentally Disabled Persons

Transcription

1 Agenda Psychiatric Diagnoses In Developmentally Disabled Persons Kari L. Kennedy, PsyD, HSPP Dana Lasek, PhD, HSPP Wednesday, 10/26/2011 History and challenges Dementia Mood disorders Anxiety disorders Personality disorders Q/A 1 2 Historical Perspective Challenges in Diagnosing Common belief used to be that mental health issues did not exist within Developmentally Disabled (DD) population More recent research actually indicates a higher risk for psychiatric disorders Diagnoses exist within 15% - 50% of the population (vs. ~10% non-dd) DD individuals may already display restricted behaviors that are different from same-age, non-dd peers Concrete thinking Poor memory Poor vocabulary/communication skills Poor/inappropriate social skills and behaviors may resemble diagnosable symptoms Immature behavior (giggling, acting silly, talking to self) Over-responses to environmental changes 3 4

2 Outcomes of Misinterpretation Dementia Defined Practitioners unfamiliar with DD issues may Incorrectly diagnose on norms for chronological age, rather than considering the mental age Erroneously ascribe behavior changes to DD causes rather than diagnosable psychiatric causes Third parties making mental health referrals may Report in an overly-subjective manner, based upon higher/lower tolerance for behaviors Refer/report with inadequate baseline understanding of behaviors due to brief/limited initial exposure Overlook other contributing factors (e.g., physical illness, environmental changes, etc.) Progressive decline in cognition or behavior from a prior level of functioning in one or more of: memory, reasoning, language, visual processes, executive functions, social interpersonal, behaviors, personality Interferes with customary activities of daily life and social relationships, causing dependence, alienation 5 6 Dementia in the DD Key Considerations - General Prevalence is considerably higher in DD population (esp. those with Downs Syndrome) than same-age, non-dd peers. ~ 4 times more likely Onset of symptoms occurs significantly earlier ~ 15 years earlier for most DD population ~ 30 years earlier for Downs Syndrome Dementia generally presents similarly in DD and same-age, non-dd populations Short-term forgetfulness Paired with intact long-term memory and confusion Above present early in progression Frontal-lobe symptom manifest significantly earlier 7 8

3 Mood Disorders Major Depressive Disorder Dysthymic Disorder Depressive Disorder NOS Bipolar I Disorder Bipolar II Disorder Kari L. Kennedy, Mood Disorders in ID Higher incidence among individuals with Intellectual Disabilities Severe and profound ID, difficult to diagnose due to limited non-verbal communication skills and difficulty with expressing subjective feelings Underdiagnosed problem Causes Biological and Genetic Factors Stress Kari L. Kennedy, Mood Disorders in ID Mild ID Tearfulness Mood swings Loss of energy Loss of interest Low self-esteem Mood Disorders in ID Moderate ID Social isolation Self injurious behavior Weight loss Severe ID Screaming Aggression Self injurious behavior Kari L. Kennedy, Kari L. Kennedy,

4 Mood Disorders in the PDD Study with children dx with PDD Higher rate of depression than among non- PDD No difference between types of PDD often present the same as non- PDD population Difficult to diagnose, look for CHANGES in behavior (sleep, appetite, energy) Mood Disorders in the PDD Adults and adolescents dx with PDD Problems with Diagnosis Overlook co-morbid diagnoses Do symptoms meet diagnostic criteria? DSM vs. ICD Asperger s-higher risk for Depression and Bipolar Disorder Autism-higher risk for Depression Kari L. Kennedy, Kari L. Kennedy, Mood Disorders in the PDD Higher functioning Lower functioning Vegetative symptoms-changes in weight, appetite, irritability, behavior Causes of Depression Biological-medical problems Genetic Environmental stressors Anxiety Disorders Social Phobia Obsessive Compulsive Disorder PTSD Generalized Anxiety Disorder Kari L. Kennedy, Kari L. Kennedy,

5 Anxiety Disorders in ID Higher Incidence of Anxiety Disorders among Individuals with ID (2-3 times more common) Difficult to assess due to lack of ability to report and rate the anxiety Most common symptoms include aggression, agitation, and obsessive-compulsive symptoms Causes include underlying pathology of disorder, environmental factors, and history of abuse Kari L. Kennedy, Anxiety Disorders in PDD Higher rates of anxiety among PDD population Most common diagnoses are Generalized Anxiety Disorder and OCD Kari L. Kennedy, Anxiety Disorders in PDD Classic OCD vs. Obsessive Compulsive Spectrum Disorder Obsessions Repetitive behaviors Negative vs. Positive Reinforcement Anxiety Disorders in PDD Causes Concomitant feature of disorder Temperamental disposition Environmental factors Kari L. Kennedy, Kari L. Kennedy,

6 Personality Disorders Defined Personality Disorders in the DD Criteria per DSM-IV TR enduring pattern of inner experience and behavior deviates markedly from the expectation of the individual s culture is pervasive and inflexible has an onset in adolescence or early adulthood is stable over time and leads to distress or impairment Prevalence of personality disorders in mild to moderate DD population Anywhere between 20% - 25% Vs. 11% - 22% in same-age, non-dd peer group Diagnoses occur only with mild to moderate individuals Individuals with severe to profound DD may Have language/communication difficulties that make accurate diagnosis impossible Lack understanding of laws and societal mores Be so profoundly developmentally delayed that diagnosis of a psychiatric disorder is inappropriate Disorder Clusters Cluster B - Antisocial DSM IV-TR identifies three clusters Cluster A Odd or eccentric Paranoid Schizoid Schizotypal Cluster B Dramatic, emotional or erratic Antisocial Borderline Histrionic Narcissistic Cluster C Anxious or fearful Avoidant Dependent Obsessive Compulsive Pervasive pattern of disregard for, violation of rights of others, rules of society Repeated violations of law Pervasive lying and deception Lack of remorse Physical aggressiveness Irresponsibility Reckless disregard for safety of self and others 23 24

7 Cluster B - Borderline Cluster B - Histrionic Pervasive pattern of unstable and intense Interpersonal relationships Self perception Moods Impulse control often markedly impaired Chronic feelings of emptiness Fear of abandonment Poor affect modulation Transient paranoia or dissociation Excessive displays of Emotion (lability) Attention seeking behavior Sexually provocative or seductive Vague and impressionistic speech Cluster B - Narcissistic Summary Sense of entitlement Grandiose Exaggeration of own talents/accomplishments Arrogant Exploitive Lack of empathy Excessive envy Top 4 Classes of Disorders Changes in Behavior Treatment 27 Kari L. Kennedy,

8 QUESTIONS???? 29