Psychiatric manifestationsof Medical Problems in Adults with Intellectual Disability
Shirley Portuguese MD MHA
BINA Clinic, Beer Yaakov Psychiatric center
Content
BINA Clinic Psychiatric Comorbidities in ID Physical Comorbidities in ID Psychiatric Manifestations of medical problems – case
studies How to Prepare for the Psychiatrist ?
BINA Clinic
Beer Yaakov outpatient clinic Multidisciplinary model by a joining psychiatrist References including: Welfare municipal Units,
service suppliers, child and adolescent psychiatric clinics, special Education facilities, etc.
ID Psychiatric Comorbidities
Up to 2/3 of ID adults have comorbid psychiatric disorder
Prevalent - Mood disorders, Autism, ADHD, Schizophrenia and Conduct disorder
The more severe the disability the higher the rate of psychiatric disorders.
Common Medical Manifestations in ID
Physical maintenance
Hygiene, vision, hearing, dental problems
Genetically related
Down syndrome - heart, ear, eye, thyroid, blood, GI etc
Tuberous sclerosis - brain, kidney, etc
Fragile X - ear, sinus, eye, seizures, ADHD etc
Common Medical Manifestations in ID
Stress related - Peptic ulcer, Myocardial infarction etc
Sedentary Lifestyle - metabolic syndrome, sleep apnea etc
Iatrogenic – including medication side effects :
- Antipsychotic (eg Risperidone) akathisia, dystonia etc
- Benzodiazepine (eg Clonex) drowsiness, coordination etc
Abstract
Up to two thirds of adults with intellectual disability have a comorbid psychiatric disorder, including mood disorders, autism, ADHD, schizophrenia and conduct disorder. The more severe the disability the higher the rate of psychiatric disorders. The presentation of medical problems can mimic psychiatric signs and symptoms thus hinder proper diagnosis and treatment. Medical causes can include medication side effects (such as antipsychotic medications causing dystonia or akathisia), metabolic deficits (such as diabetes and vitamin deficiencies), sleep disorders (such as sleep apnea syndrome) and many more. Medical problems might be masked by language and communication thus not addressed by the general practitioner. A psychiatrist specializing in adults inflicted by intellectual disability should be aware of possible physical diseases that might mimic psychiatric disorders allow for a better medical care.
Patient A
50 y female with ID (moderate) from hostel Primary Complaint- Anxiety 3 months not improved
by SSRI History- Picky eater, vegetarian, severe
menstruation Interview – Anxious, irritable, fatigue, refuses to
work Physical examination – warm clothes, pale, pulse
90/min
Patient A Diagnosis - Anemia
Treatment- Food supplements (iron, B12), stop bleeding
Patient B
42 y female ID (severe) from hostel Primary Complaint- Eating problems 1 mo, food cut
for her Interview - Slowness, back aches, Odd gait Physical- muscles spasms of lower back and jaw
Patient B Diagnosis –Dystonia
Risperidone started 1 mo due to behavioral disturbances
Antipsychotic side effects include Dystonia Treatment- stop Risperidone if possible
Try Anticholinergic medications
Patient C
35y Male with Down’s syndrome Complains- Cognitive decline inc. memory and
concentration Family crisis 3 years ago -> depressive symptoms and
behavioral disorders. Received SSRI -> Zyprexa. Gained 20 kg in 2 years. Interview- sleepiness, low concentration Mother says he snores
Patient C diagnosis - Sleep Apnea syndrome
Obstruction of larynx causing decline in oxygen delivery to the brain
Results- sleepiness, decline of concentration & attention, depression, anxiety etc
Childhood – Large Adenoids, Adulthood – Obesity
Treatment – CPAP (mask during sleep)
Patient D
27y Female with ID Complains- Irritability, Anger outbursts,
preoccupation with toilet, wet herself for 2 weeks Received Benzo -> worsening of wetting. Interview- has an new boyfriend in hostel,
abdominal pain especially during urination
Patient D diagnosis
Urine sample- Urinary Tract infection Symptoms – persistent urge to urinate, burning
sensation while urinating, frequent urination, pelvic/ rectal pain
Treatment- Oral antibiotics
Medical issues to address Before attending a Psychiatrist
Vision & Hearing Pain and discomfort (inc. teeth, ears, abdomen) Blood pressure, pulse Blood Tests – blood count, liver and kidney function,
TSH, B12, Folic acid, Glucose Complete medical history including medications and
family history, preferably GP visit
QUESTIONS?