[Psychotherapy in disorders of intellectual development-Current evidence and practical implementation]. / Psychotherapie bei Störungen der Intelligenzentwicklung ­ aktuelle Evidenz und praktische Umsetzung.

People with a disorder of intellectual development (German draft of the ICD-11, which came into force on 1 January 2022) suffer more frequently from mental illnesses. According to the international treatment guidelines multimodal approaches should include not only psychopharmacological treatment, but also disorder-specific psychotherapeutic methods. These psychotherapeutic interventions have to be adapted to the communicative and cognitive abilities (performance diagnostics with IQ tests) as well as the emotional developmental stage (developmental diagnostics, e.g., with the scale of emotional development, short version, SED-S 2; [1]). To ensure this, the rules of simple language should be observed and when appropriate relatives or caregivers should be involved in the therapeutic process. The effectiveness of cognitive behavioral therapy has received most scientific attention, especially for affective disorders. Posttraumatic stress disorders can be validly treated with eye movement desensitization and reprocessing (EMDR). There is also good evidence for exposure therapy with reinforcement in the treatment of anxiety disorders.

International clinician perspectives on pandemic-associated stress in supporting people with intellectual and developmental disabilities.

BACKGROUND: People living with intellectual and developmental disabilities (IDD) have suffered disproportionately in health outcomes and general well-being during the COVID-19 pandemic. There is emerging evidence of increased psychological distress. Increased strain has also fallen on clinicians managing the psychological needs of people with IDD, in the context of learning new technologies, staff shortages, reduced services and paused training opportunities. AIMS: To examine clinicians' experiences of patient care, clinical management and the impact of care delivery. METHOD: A mixed fixed-response and free-text survey comprising 28 questions covering four areas (responder demographics, clinical practice, changes to local services and clinician experiences) was developed, using the STROBE guidance. It was disseminated through an exponential snowballing technique to clinicians in seven high-income countries. Quantitative data were analysed and presented with Microsoft Excel. Qualitative data were coded and thematically analysed, and presented with in-text quotations. RESULTS: There were 139 respondents, mostly senior physicians (71%). Two-thirds reported over 10 years working in the field. Quantitative findings include increased clinician stress (77%), referrals (53%), patient distress presentations (>70%), patient isolation (73%) and carer burden (89%), and reduced patient participation in daily activities (86%). A third reported increased psychotropic prescribing. Qualitative analysis outlined changes to clinical practice, particularly the emergence and impact of telehealth. CONCLUSIONS: In the countries surveyed, the pandemic has not only had a significant impact on people with IDD, but also their carers and clinicians. A proactive, holistic international response is needed in preparedness for future public health emergencies.

The eloquence of silent cortex: analysis of afferent input to deafferented cortex in arm amputees.

Cortical reorganisation after limb amputation includes topographic displacements of body representation areas and changes of areal extent. Remarkably, truncated nerves, which had innervated amputated limb parts and remained in the residual limbs, can retain access to the deafferented somatosensory cortex. Using somatosensory evoked potentials (SEP) we characterized afferences from electrically stimulated truncated nerves to the brachial plexus and cortex in 12 arm amputees. While peripheral responses were highly variable, thalamocortical input to S-1, as reflected by the primary cortical SEP component, was present in 11 of 12 patients. Despite long-term deafferentation, macroscopic phenomena of inhibition/refractoriness, as assessed by stimulus rate variations, appeared to be changed only marginally. Thus, deafferented cortex remains responsive when given artificial phantom input and could provide a neuronal substrate for spontaneous phantom limb sensations, including phantom pain.