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Catatonia is increasingly recognised as a comorbid syndrome of Autism Spectrum Disorder (ASDs). The assessment and management of individuals with comorbid ASD and intellectual disability (ID) adds a further dimension to this already complex presentation, with few cases identified in the literature. The paper aims to discuss these issues.

This paper presents four cases of catatonia in individuals with comorbid ASD and ID. The diagnostic challenges, response to treatment and prognosis are discussed whilst comparing with the existing literature.

A high index of suspicion is required to recognise the subtle catatonic features seen in patients with ASD and ID. Clinicians should be particularly vigilant following stressful events in young adults. The assessment of catatonia in ASDs and ID requires a pragmatic approach given the lack of suitable diagnostic tools and difficulties completing investigations. Caution is advised when using rating scales as they are not validated in ID. The mainstay of treatment is lorazepam, although responses vary.

The discussion of these four cases strengthens the existing literature, and highlights the implications a comorbid diagnosis of ID has on the assessment and management of catatonia in ASDs.

Some patients with severe mental disorders are refractory to psychotherapeutic or psychopharmacological interventions. We present a patient who at the age of 19 developed several schizophrenia - suspect symptoms. Soon inexplicable general seizures where observed. He was treated with antipsychotics, but had two bouts of malignant neuroleptic syndrome. Electroconvulsive therapy (ECT) gave some symptom relief and he continued on maintenance ECT for years with weekly intervals. Interruption of this treatment pattern rapidly increased symptom load. After seven years a lorazepam provocation test was performed as he had a new relapse after 3 weeks without ECT. In the ensuing hours his aggressiveness and nonsense speaking rapidly diminished. Kahlbaums observation of seizures as part of a catatonia was not understood in this case. The publication of the new DSM-V diagnosis of catatonia may hopefully reduce the probability of treating a patient for schizophrenia for years without access to a more targeted medication and ECT plan.

Delirious mania is an understudied psychiatric disorder with a mortality rate as high as 75%. Previous case studies suggest that electroconvulsive therapy (ECT) may be an effective treatment for delirious mania, though this procedure may not always be a viable option. We describe the case of a 20-year old patient, with no previous psychiatric history, who developed delirious mania over the course of four months. ECT was not a viable option for this patient due to his religious beliefs, so alternative treatment modalities were explored. After failing trials of risperidone and olanzapine, significant improvements in symptoms were exhibited with a trial of clozapine. We propose that clozapine may be an effective option in cases of delirious mania, when ECT is not a viable option. Additional research is still necessary to understand the pathology of this condition and potential treatment modalities.

People with schizophrenia and related psychoses may be more likely to be ‘treatment‐resistant’ when dually diagnosed with intellectual disabilities. This case study highlights many of the difficulties which can occur in their assessment and management. Clozapine is currently the best available intervention for treatment‐resistant schizophrenia, and its use has increased in people with intellectual disabilities. However, it is not always effective, and a wide range of adjunctive strategies have been suggestive and tried. The evidence base for the specific use of these additional strategies in people with intellectual disabilities needs to be increased.

Adults with autism spectrum disorder (ASD) present with a range of psychiatric disorders. However, making an accurate diagnosis is challenging. It is important to follow a robust and informed process in the assessment of psychopathology that is centred on the individual and their neurodevelopmental difficulties. The purpose of this paper is to provide clinicians with an evidence-based approach to the assessment process for adults with ASD presenting with a possible co-occurrent psychiatric disorder.

A review of the recent literature was undertaken focusing on key papers that describe the assessment of mental health problems in adults with ASD.

The presentation of psychiatric symptoms is influenced by the underlying developmental disorder and it is often quite different from the one of the general population. Thus, it is essential to undertake a comprehensive psychopathological assessment including a diagnostic assessment of ASD. There is a very small evidence base on the use of diagnostic tools in the assessment of adults with ASD.

This is a practice review paper applying recent evidence from the literature.

Witchcraft in Honduras is an unprotected marginalized woman’s efforts to gain social, economic, and political power through an informal economy by utilizing the cultural belief in the witches’ supernatural power. The Honduran post-colonial Latin American culture allows for a persistent informal economy, in part, based on the commoditization of witchcraft and exorcism. The case study provides a specific example through ethnographic interviews of this under-researched informal economy driven by fear and economic desperation. Further research and analysis of these poorly understood and rarely recorded modern phenomena and the associated informal economy is needed.

The purpose of this paper is to critically reflect upon the place of rugby union in contemporary Wales where the game is used as an important tool to promote images of the nation. Using Benedict Anderson's conceptualisation of the nation as an “imagined community” the paper aims to locate and analyse the game within and around discourses of Cool Cymru, a term coined in the late twentieth century to promote images of a new vibrant Wales as popularised through its leading music bands.

A critical sociological approach analyses and problematises notions of Welshness as it relates to the national sport of rugby.

The nation is often (re)presented and conceptualised as a monolithic whole where rugby's assumed centrality is rarely questioned. This essay focuses upon the areas of language, geography and gender to demonstrate the situated limits of these (re)presentations. Rugby union and Cool Cymru are also located alongside devolution and are examined further with specific reference to the postmodern sporting celebrity.

This work highlights an increasing primacy afforded to the capital city of Cardiff within a re‐imagining of the nation and the national game.

Delirium, or acute confusional syndrome, is a set of symptoms whose care involves not only psychiatry, but also many other medical specialties. Being as how the syndrome is caused by multiple factors, it is important to recognize each risk factor affecting the patient in order to anticipate and prevent it. In case of diagnosis, identifying and treating the root cause that triggered is important, given that it has a high rate of comorbidity and an elevated cost of medical care. We describe a case where a patient with hypothyroidism began suffering from delirium due to an abrupt discontinuation of levothyroxine treatment. Previously, the patient was seemingly healthy. After the medical treatment was interrupted, sensory processing and behavior were altered, and symptoms fluctuated, for a short period of time, showing disorientation and memory and language impairment.

During the last few years the prevalence of autism and Autism Spectrum Disorder (ASD) has increased greatly. A recurring issue is the overlap and boundaries between Intellectual Developmental Disorder (IDD), ASD and Schizophrenia Spectrum Disorders (SSD). In clinical practice with people with IDD, the alternative or adjunctive diagnosis of ASD or SSD is particularly challenging. The purpose of this paper is to define the boundaries and overlapping clinical characteristics of IDD, ASD and SSD; highlight the most relevant differences in clinical presentation; and provide a clinical framework within which to recognize the impact of IDD and ASD in the diagnosis of SSD.

A systematic mapping of the international literature was conducted on the basis of the following questions: first, what are considered to be core and overlapping aspects of IDD, ASD and SSD; second, what are the main issues in clinical practice; and third, can key diagnostic flags be identified to assist in differentiating between the three diagnostic categories?

Crucial clinical aspects for the differentiation resulted to be age of onset, interest towards others, main positive symptoms, and anatomical anomalies of the central nervous system. More robust diagnostic criteria and semeiological references are desirable.

The present literature mapping provides a comprehensive description of the most relevant differences in the clinical presentation of ASD and SSD in persons with IDD.