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The purpose of this paper is to report on the success of an initiative involving the transformation of a group of small substance use treatment only or mental health treatment only provider agencies serving uninsured adults into providers of co-occurring disorder treatment.

The paper uses a case study narrative to describe the initiative and the transformation of the participant agencies from being providers of mental health or substance use treatment to providers of co-occurring disorders.

Six agencies serving uninsured adults expanded their scope of patient treatment services to include the capacity to treat adults with co-occurring disorders. This was achieved with modest support funding from a local foundation. The initiative has been ongoing for five years.

The outcome of this initiative demonstrates the financial and practical feasibility of improving and expanding treatment services to low-resourced patient populations. The participating agencies were able to improve their capacity to treat patients with substance use or mental health issues that previously they were not prepared to treat and thus increased their ability to provide integrated care.

The initiative described here shows that the treatment of concomitant substance use and mental health disorders is within the range of many small-scale treatment providers, if provided the leadership and support. Delivery of effective treatments to populations experiencing co-occurring disorders that are underserved and undertreated are achievable in community-based clinical practices. This has implications for developing treatment capacity outside of hospital settings to enable treatment of co-occurring disorders to become more accessible.

Psychopathy and antisocial personality are controversial disorders with alternate behavioral and dynamic formulations. As such, diagnostic approaches are often fragmentary and inconsistent. The purpose of this paper is to delineate the various conceptual parameters and to propose a comprehensive diagnostic approach.

A model is presented based on the congruence and differences among various categories of psychopathic and antisocial personality disorders and their clinical manifestations. Diagnostic approaches are critiqued and evaluated. Specific assessment tools and measures are recommended based on referrals and symptomatology.

Key factors of low frustration tolerance, poor social intelligence, aggression-driven psychopathy, sadism, and superego impairment are shown as central in the differential diagnostics of antisocial individuals.

The model enables the differentiation of problematic behaviors which may appear similar but require different forensic, legal, diagnostic, and intervention strategies.

Studies on psychiatric comorbidity in individuals with borderline intellectual functioning (BIF) are scarce, particularly with respect to certain diseases frequently observed in clinical practice. The purpose of this paper is to discuss the relevance of epidemiological research to psychiatric comorbidity in people with BIF.

Systematic searches of MEDLINE, EMBASE and Cochrane databases. Inclusion criteria: publications about BIF appearing between 1995 and 2017; epidemiological findings about comorbid mental disorders in individuals with BIF; and studies comparing BIF, mild intellectual disability (ID) and normal intellectual functioning. The discussion covers 24 of the 224 studies initially considered.

The most frequent psychiatric comorbidity reported was personality, post-traumatic as well as psychotic disorders, followed by psychosis, attention deficit and hyperactivity disorder, bipolar and sleep disorders. Individuals with BIF exhibit psychiatric comorbidity more frequently than individuals with normal intellectual functioning. Some psychiatric comorbidities were similarly prevalent in patients with BIF and those with mild or moderate ID; however, the prevalence was always higher in people with severe ID. Environmental factors, especially psychosocial adversity, seem to play an important mediating role. Pharmacotherapy is the most common treatment approach, including behavioural disorders.

This review of literature on mental disorders in people with BIF demonstrates the epidemiological relevance of psychiatric comorbidity, especially personality and post-traumatic disorders. Mental health professionals, general practitioners and other workers in outpatient settings have to be aware about the vulnerability and even fragility of people with BIF.

The purpose of this paper is to explore the different clinical features of pathological demand avoidance (PDA) and antisocial personality disorder (ASPD) presented in the form of a single case study. The study highlights the potential of misdiagnosis and conceptual confusions to practitioners in forensic settings between the two conditions when working with offenders with personality disorders.

A case formulation using the “five Ps” method based on the personal history of an incarcerated male is presented and the clinical similarities and differences between PDA and ASPD are delineated. These differences and similarities are evaluated and applied to offender management including intervention options.

There are considerable similarities between ASPD and PDA making the two conditions difficult to separate. Both diagnostic criteria identify childhood behavioural problems, aggression, destructiveness, conduct disorder (CD), manipulation and non-compliance as indications of the disorder. For example, the criteria for later adult ASPD are the presence of childhood antisocial behaviour and CD. However, these behaviours may also be suggestive of the attention deficit hyperactivity disorder and non-compliance that are part of PDA. Violent behaviours and aggression can also be perceived in a similar way. Misdiagnosis of PDA as ASPD reduces the efficiency of treatment programmes.

The implications of these findings could prove useful in the successful risk management of offenders with PDA. Given the similar behavioural characteristics between PDA and ASPD, the prevalence of PDA among offenders may be higher than observed. The aim of this study is to raise awareness of potential conceptual complications and clinical confusions between the two conditions with a view to aid offender management through case formulation. A large scale study into offenders with PDA would draw attention to the prevalence of the condition as well as its association with offending behaviour.

The purpose of this article is to explore the current evidence base in understanding the relationship between mental health and challenging behaviour in people with intellectual disabilities.

The article discusses how challenging behaviour is associated with psychiatric disorders. Common aetiological factors between challenging behaviour and psychiatric disorders and diagnostic issues are considered. The article ends with a review of the assessment and management of challenging behaviour within the context of mental health.

Several studies have highlighted common aetiological factors that are responsible for challenging behaviour and psychiatric disorders in people with intellectual disabilities, and although there is an overlap in the symptoms, both are thought to be different phenomena. Treatment of the psychiatric disorder should ameliorate the challenging behaviour, although a functional analysis of the behaviour may still be required in order to understand the purpose of the behaviour. There is evidence for a range of different treatment approaches.

The article will assist professionals working with people with intellectual disabilities to understand the complex relationship between mental health and challenging behaviour. It also gives guidance on principles of management of people with complex mental health and behavioural needs.

Homicide is the most severe form of crime and one that imposes the greatest societal costs. The purpose of this paper is to introduce the homicide circumplex, a set of traits, behaviors, psychological and psychiatric features that are associated with greater homicidal ideation, homicidal social cognitive biases, homicide offending and victimization, and psychopathology that is facilitative of homicide.

Using the data from a near population of federal supervised release offenders from the Midwestern USA, ANOVA, multinomial logistic, Poisson and negative binomial regression models were developed.

Greater homicidal ideation is associated with homicide offending, attempted homicide offending and attempted homicide victimization and predicted by gang activity, alias usage, antisocial personality disorder and intermittent explosive disorder. These behavioral disorders, more extensive criminal careers, African American status and gang activity also exhibited significant associations with dimensions of the homicide circumplex.

Developing behavioral profiles of offenders that exhibit homicidal ideation and behaviors are critical for identifying clients at greatest risk for lethal violence. The homicide circumplex is an innovation toward the goal that requires additional empirical validation.

The debate as to whether intellectual disability (ID) should be conceptualized as a health condition or as a disability has intensified as the revision of World Health Organization’s (WHO’s) International Classification of Diseases (ICD) is being finalized. Defining ID as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. The purpose of this paper is to include some reflections on the consensus document produced by the first WHO Working Group on the Classification of MR (WHO WG-MR) and on the process that was followed to realize it. The consensus report was the basis for the development of official recommendations sent to the WHO Advisory Group for ICD-11.

A mixed qualitative approach was followed in a series of meetings leading to the final consensus report submitted to the WHO Advisory group. These recommendations combined prior expert knowledge with available evidence; a nominal approach was followed throughout with face-to-face conferences.

The WG recommended a synonym set (“synset”) ontological approach to the conceptualisation of this health condition underlying a clinical rationale for its diagnosis. It proposed replacing MR with Intellectual Developmental Disorders (IDD) in ICD-11, defined as “a group of developmental conditions characterized by a significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills”. The WG further advised that IDD be included under the parent category of neurodevelopmental disorders, that current distinctions (mild, moderate, severe and profound) be continued as severity qualifiers, and that problem behaviours removed from its core classification structure and instead described as associated features.

Within the ID/IDD synset two different names combine distinct aspects under a single construct that describes its clinical as well as social, educational and policy utilities. The single construct incorporates IDD as a clinical meta-syndrome, and ID as its functioning and disability counterpart. IDD and ID are not synonymous or mirror concepts as they have different scientific, social and policy applications. New diagnostic criteria for IDD should be based on a developmental approach, which accounts for the complex causal factors known to impact the acquisition of specific cognitive abilities and adaptive behaviours. The paper focuses on a new clinical framework for the diagnosis of IDD that also includes and complements the existing social, educational and policy components inherent in ID.

The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC‐LD) was introduced in 2003 in an attempt to improve accuracy of diagnosis in the intellectual disability population. The paper aims to apply this system to a sample of a population with intellectual disability to further investigate its usefulness in the clinical setting.

A sample of 50 patients within an intellectual disability service was identified. Each individual was interviewed by a registrar in psychiatry of intellectual disability in the presence of their key worker or a carer that knew the individual well. Chart notes were extensively reviewed for clearly documented history of psychiatric symptoms and behavioural difficulties. The information gathered was applied as per the DC‐LD criteria to identify appropriate diagnoses. Previously documented diagnoses were also recorded for comparison purposes.

There was considerable discrepancy between the rates of psychiatric diagnoses after application of DC‐LD and rates of previously documented diagnoses within the sample. Use of DC‐LD led to the reclassification of many previously documented diagnoses, mainly as behavioural disorders. There were also discrepancies between rates of diagnosis of pervasive developmental disorders and Alzheimer's disease before and after use of DC‐LD.

This study adds to the evidence regarding the usefulness of DC‐LD in the intellectual disability population and also highlights the shortcomings of non‐systematic methods of diagnosis. It was agreed that DC‐LD criteria be applied to all service users in this population in the future.

This article examines the prevalence of mental disorders in a community and clinic population of adolescents with learning disabilities in one catchment area (in the UK). A two stage cross‐sectional survey was used. Measures included screening by parental report (Developmental Behaviour Checklist), adaptive behaviour (Vineland Survey Scale) and clinical interview (ICD 10 childhood disorders).Seventy‐five adolescents aged 12‐19 years old participated in the study. 50.7% screened positive for mental disorders, mainly in the disruptive and anti‐social domains. Almost all of those were found to have an identifiable ICD10 mental disorder. The most common diagnoses included pervasive developmental disorders, hyperkinetic disorder and emotional disorders. Male participants as well as those with autism were more likely to be reported as cases. Caseness was associated with lower adaptive level, presence of autism and family history of mental disorder.Rates of psychopathology are high in adolescents with learning disabilities. There are continuing difficulties in diagnostic ascertainment primarily due to mediation by developmental factors. Further research is necessary in order to clarify continuities of mental disorders in this population and to develop effective interventions.

The purpose of this paper is to identify the severity of certain communication disorders (CD) in a sample of Syrian refugee children. There are a limited number of studies about CD among refugee children.

Over a period of 22 months, 161 cases of CD – not caused by motor or structural disorders – were seen at a Mental Health Clinic in Beqaa, Lebanon. The authors calculated descriptive statistics (frequencies and percentages) and bivariate statistics to identify relationships between CD, demographics and school enrollment among cases.

Ages ranged between 3 and 16 years with a mean of 6.91. Male to female ratio was 1.6:1. The most prevalent category of CD was speech, followed by expressive language, then receptive language. Parents reported behavioral or emotional problems in 38 percent of the cases; emotional problems, mainly anxiety, were much more common than behavioral problems. Enrollment in school was associated with a lower number of impairments and less severe speech and language impairments.

The results highlight the importance of early detection and intervention among Syrian refugee children. Schools can alleviate some psychological issues that compound CD by enhancing resilient behaviors and providing social support. They can also implement measures for detection and intervention.