[Psychotic symptoms in patients with mild intellectual disability: follow an integrative approach]. / Psychotische klachten bij patiënten met een lichte verstandelijke beperking.

In The Netherlands, approximately 1 in 8 citizens (2.2 million) have an IQ between 70 and 85. Together the combination of a low IQ (< 70) and low adaptive functioning is referred to as mild intellectual disability (ID). People with ID are vulnerable to stress and psychological problems. The diagnosis and treatment of psychotic symptoms in patients with mild ID can prove to be a challenge. In this clinical lesson we present two different cases. We encourage physicians to adhere to a holistic approach. Furthermore the AAIDD model may guide structuring the analysis of psychotic symptoms. This enables finding the right treatment which may include medical treatment or emphasis on context improvement or a combination of both. Upon treatment initiation with antipsychotics, it's important to start low and go slow regarding the dosage. And if the context is the main problem, it is important to taper off the use of antipsychotics.

Self-injurious behavior.

Self-injurious behavior (SIB) is a relatively common behavior in individuals with intellectual disabilities (ID). Severe SIB can be devastating and potentially life-threatening. There is increasing attention for somatic substrates of behavior in genetic syndromes, and growing evidence of an association between pain and discomfort with SIB in people with ID and genetic syndromes. In this review on SIB phenomenology in people with ID in general and in twelve genetic syndromes, we summarize different SIB characteristics across these etiologically distinct entities and identify influencing factors. We demonstrate that the prevalence of SIB in several well-known genetic intellectual disability syndromes is noticeably higher than in individuals with ID in general, and that characteristics such as age of onset and topographies differ widely across syndromes. Each syndrome is caused by a mutation in a different gene, and this allows detection of several pathways that lead to SIB. Studying these with the behavioral consequences as specific aim will be an important step toward targeted early interventions and prevention.