Clinical usefulness of the diagnostic manual-intellectual disability for mental disorders in persons with intellectual disability: results from a brief field survey.

OBJECTIVE: The National Association for the Dually Diagnosed, in collaboration with the American Psychiatric Association, adapted the DSM-IV-TR for use with individuals with intellectual disability. This article presents the findings of a study to examine the utility of the Diagnostic Manual-Intellectual Disability (DM-ID) in clinical practice. METHOD: In a survey conducted during the summer of 2006, clinicians reported on the extent to which the DM-ID was user friendly, whether it allowed the clinician to arrive at an appropriate diagnosis of the patient, if the clinician was able to arrive at a more specific diagnosis than with the DSM-IV-TR, and if it helped avoid the use of "not otherwise specified" (NOS) diagnostic categories. Demographic information about the clinicians and the patients was obtained. RESULTS: Data from 63 clinicians and 845 patients with intellectual disability were included in the study. The patients' level of intellectual disability was approximately evenly divided among the categories of mild, moderate, and severe/profound. The DM-ID was rated as "easy" or "very easy" to use in over 68% of the 845 responses. The positive response to the DM-ID did not vary significantly across levels of intellectual functioning. Clinicians also indicated that the DM-ID helped them avoid the use of the "NOS" diagnosis category, resulting in a more specific diagnosis. CONCLUSIONS: The DM-ID is a useful adaptation of the DSM-IV-TR for persons with intellectual disability. Professionals indicated that it was easy to use, resulted in accurate diagnoses, and can reduce the use of the NOS category. Further research is needed to evaluate the reliability and validity of the DM-ID.

Consensus guidelines for primary health care of adults with developmental disabilities.

OBJECTIVE: To develop practical Canadian guidelines for primary health care providers based on the best available evidence for addressing health issues in adults with developmental disabilities (DD). QUALITY OF EVIDENCE: Authors of background papers synthesized information from their own clinical experience, from consultations with other experts, and from relevant professional publications. Based on discussions of these papers at a colloquium of knowledgeable health care providers, a consensus statement was developed. Standard criteria were used to select guidelines for consideration and to rank evidence supporting them. Most evidence was level III. MAIN MESSAGE: People with DD have complex health issues, some differing from those of the general population. Adequate primary health care is necessary to identify these issues and to prevent morbidity and premature death. Physical, behavioural, and mental health difficulties should be addressed, and primary health care providers should be particularly attentive to the interactions of biological, psychological, and social factors contributing to health, since these interactions can easily be overlooked in adults with DD. Attention must also be paid to such ethical issues as informed consent and avoidance of harm. Developmental disabilities are not grounds for care providers to withhold or to withdraw medically indicated interventions, and decisions concerning such interventions should be based on patients' best interests. CONCLUSION: Implementing the guidelines proposed here would improve the health of adults with DD and minimize disparities in health and health care.

Olanzapine in the treatment of pervasive developmental disorders: a case series analysis.

Controlling the symptoms that are characteristic of patients with pervasive developmental disorders is often challenging. We report on the safety and efficacy of olanzapine in the treatment of 7 patients with pervasive developmental disorders. The patients were all male and ranged in age from 8 to 52 years. They received olanzapine doses of 5-10 mg/d along with their various other drug regimens. Patients were monitored and evaluated for a mean duration of 17.7 (range 12-26) months while on olanzapine therapy. Very few side effects were observed during treatment. All patients showed clinically significant improvement on the Clinical Global Impressions scale, as well as an improved score as measured by the Global Assessment of Functioning scale. Our observations support the use of long-term olanzapine therapy for symptom control in patients with pervasive developmental disorders.