Problem behaviours and symptom dimensions of psychiatric disorders in adults with intellectual disabilities: An exploratory and confirmatory factor analysis.

BACKGROUND: The limited evidence on the relationship between problem behaviours and symptoms of psychiatric disorders experienced by adults with intellectual disabilities leads to conflict about diagnostic criteria and confused treatment. This study examined the relationship between problem behaviours and other psychopathology, and compared the predictive validity of dimensional and categorical models experienced by adults with intellectual disabilities. METHODS: Exploratory and confirmatory factor analyses appropriate for non-continuous data were used to derive, and validate, symptom dimensions using two clinical datasets (n=457; n=274). Categorical diagnoses were derived using DC-LD. Severity and 5-year longitudinal outcome was measured using a battery of instruments. RESULTS: Five factors/dimensions were identified and confirmed. Problem behaviours were included in an emotion dysregulation-problem behaviour dimension that was distinct from the depressive, anxiety, organic and psychosis dimensions. The dimensional model had better predictive validity than categorical diagnosis. CONCLUSIONS: International classification systems should not include problem behaviours as behavioural equivalents in diagnostic criteria for depression or other psychiatric disorders. Investigating the relevance of emotional regulation to psychopathology may provide an important pathway for development of improved interventions. WHAT THIS PAPER ADDS: There is uncertainty whether new onset problem behaviours or a change in longstanding problem behaviours should be considered as symptoms of depression or other types of psychiatric disorders in adults with intellectual disabilities. The validity of previous studies was limited by the use of pre-defined, categorical diagnoses or unreliable statistical methods. This study used robust statistical modelling to examine problem behaviours within a dimensional model of symptoms. We found that problem behaviours were included in an emotional dysregulation dimension and not in the dimension that included symptoms that are typical of depression. The dimensional model of symptoms had greater predictive validity than categorical diagnoses of psychiatric disorders. Our findings suggest that problem behaviours are a final common pathway for emotional distress in adults with intellectual disabilities so clinicians should not use a change in problem behaviours as a diagnostic criterion for depression, or other psychiatric disorders.

A survey of learning disability inpatient services in Scotland in 2007.

A national review of learning disability services in Scotland, The Same As You? recommended that Health Boards should close all long stay beds by 2005 and reduce assessment and treatment places to specified levels. A psychiatry-led service planning study was carried out in 2007 to find out whether these recommendations had been met. The extent of delayed discharges was also investigated. All 15 Health Boards in Scotland responded and supplied the requested information. There were 388 adults with learning disabilities within inpatient services, 91 of whom were within forensic learning disability services. The age, gender, reasons for admission and length of stay are reported for this inpatient population. Recommendations are made for future recording of delayed discharges and the adequacy of the number of assessment and treatment inpatient places in Scotland is discussed.

Delirium in adults with intellectual disabilities and DC-LD.

BACKGROUND: No systematic studies of delirium in adults with intellectual disabilities have been reported. Reasons for the absence of research are discussed. METHODS: Two cases of delirium are described which meet the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation [DC-LD]. CONCLUSIONS: DC-LD offers a diagnostic framework that permits comparison with premorbid cognitive function.