8.4.4 Psychiatric Methods of Treatment
The Application of Psychiatric Methods of Treatment in Intellectual Disability Including Psychotherapy, Drug Treatments, Behaviour Therapy and Cognitive Therapy
The treatment of psychiatric disorders in individuals with intellectual disabilities requires a multidisciplinary approach, and psychiatrists play a crucial role in providing psychiatric methods of treatment. Psychotherapy, drug treatments, behaviour therapy, and cognitive therapy are among the common psychiatric methods of treatment used for intellectual disability:
- Psychotherapy is talking therapy that aims to alleviate emotional distress and mental health problems by encouraging individuals to explore their thoughts, emotions, and behaviours (McGilloway et al., 2012). Psychotherapy can be applied to individuals with intellectual disabilities, with adaptations made to accommodate their intellectual functioning and communication style.
- Pharmacotherapy, such as antipsychotics, antidepressants, and mood stabilizers, are commonly used to treat psychiatric disorders in individuals with intellectual disabilities (Sheehan & Hassiotis, 2017). However, the use of drugs in this population requires careful consideration, as individuals with intellectual disabilities may experience adverse effects or difficulties with medication compliance. Pharmacotherapy involves treating specific co-occurring conditions, such as ADHD with stimulants, OCD with SSRIs or antidepressants, tic disorders with antipsychotics, and epilepsy with anticonvulsants. Medications for challenging behaviours should only be administered if there is a high risk of harm to the patient or others, or if other interventions have proven unsuccessful. Where possible, other interventions should be continued and medications should be regularly reviewed. In some cases, a trial of antipsychotic treatment might be beneficial for severe aggression, hyperactivity, or stereotypies, though caution is needed in epilepsy cases due to the risk of extrapyramidal side effects. Alternative treatments for aggression, agitation, or self-injurious behaviours, mainly based on empirical evidence, include anticonvulsants, lithium, β-blockers, and buspirone. For self-injurious behaviours specifically, opiate antagonists like naltrexone show some promise.
- Behaviour therapy aims to modify maladaptive behaviours through the use of positive reinforcement, punishment, and extinction techniques (Dagnan & Sandhu, 2017). Cognitive therapy, on the other hand, aims to modify maladaptive thought patterns and beliefs that contribute to emotional distress and mental health problems (McGilloway et al., 2012).
| Management Approaches | Description |
| Educational interventions | For families/carers to improve understanding and for patients to ensure educational needs are met in a suitable setting. |
| Social interventions | Address unmet needs at home, with family/carers, or widen access to other services or facilities for social interaction and improved support networks. |
| Facilitating communication of needs | Address impairments of hearing, vision, and language, including the use of pictures, sign language, and electronic speech devices. |
| Behaviour support plan | Identify proactive strategies to improve quality of life, adaptions and strategies to change behaviour, preventative strategies to prevent distress, and reactive strategies to deal with challenging behaviour. |
| Cognitive approaches | Ranging from counselling on specific issues to simple imitation of relaxation/breathing techniques, based on the degree of cognitive impairment and language abilities. |
| Pharmacotherapy | Treatment for specific comorbid conditions (e.g. ADHD, OCD, tic disorders, epilepsy) and challenging behaviours only if other interventions have failed or the risk of harm is high. Regular medication review is necessary. Aggression, agitation, or self-injurious behaviours, can be managed with anticonvulsants, lithium, β-blockers, and buspirone. Self-injurious behaviours specifically, opiate antagonists like naltrexone can be used. |
| Physical interventions (i.e., restraint) | Use of splints, headgear, or isolation to protect the individual and others from injury/damage to property, only as a last resort. |
The application of psychiatric methods of treatment in individuals with intellectual disabilities requires careful consideration of their unique needs and abilities. In addition, a multidisciplinary approach that involves other healthcare professionals and caregivers is essential to ensure the best outcomes.
The Application of a Multidisciplinary Approach to the Management of Mental Health Problems in People with Intellectual Disability
A multidisciplinary approach is essential for the effective management of mental health problems in individuals with intellectual disabilities. This approach involves healthcare professionals from different disciplines working together to provide holistic care that addresses the complex needs of this population.
The multidisciplinary team typically includes psychiatrists, psychologists, nurses, social workers, occupational therapists, speech and language therapists, and other healthcare professionals as needed. The team works collaboratively to provide assessment, diagnosis, and treatment for mental health problems, as well as support for the individual’s social, emotional, and physical well-being.
The application of a multidisciplinary approach can result in improved outcomes for individuals with intellectual disabilities, including reduced symptom severity and increased social and occupational functioning (Munir et al., 2019). In addition, this approach can lead to improved communication and coordination among healthcare professionals, resulting in more efficient and effective care.
The importance of a multidisciplinary approach is also emphasized in UK healthcare policy, including the NHS Long Term Plan, which highlights the need for integrated care for individuals with intellectual disabilities and mental health problems (NHS, 2019).
In summary, the application of a multidisciplinary approach is crucial for the effective management of mental health problems in individuals with intellectual disabilities. This approach involves healthcare professionals from different disciplines working together to provide holistic care that addresses the complex needs of this population.
References:
- Dagnan, D., & Sandhu, S. (2017). Cognitive behavioural therapy and intellectual disabilities. In Oxford textbook of intellectual disability (pp. 811-819). Oxford University Press.
- McGilloway, S., Donnelly, M., & Mays, N. (2012). Psychological therapies for people with intellectual disabilities: A systematic review and meta-analysis. Research in Developmental Disabilities, 33(4), 1212-1228.
- Munir, K. M., Garlick, J., Azmi, S., & Johnson, B. (2019). The role of multidisciplinary teams in the management of mental health problems in adults with intellectual disabilities: A systematic review. Journal of Applied Research in Intellectual Disabilities, 32(6), 1386-1398.
- NHS. (2019). NHS Long Term Plan. Retrieved from https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf.
- Sheehan, R., & Hassiotis, A. (2017). Pharmacological treatments for mental health problems in people with intellectual disabilities: A systematic review. Journal of Intellectual Disability Research, 61(3), 219-234.