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Article
Publication date: 4 January 2016

Marco O. Bertelli, Kerim Munir, James Harris and Luis Salvador-Carulla

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 10 no. 1
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 5 January 2015

Sherva Elizabeth Cooray, Sab Bhaumik, Ashok Roy, John Devapriam, Rahul Rai and Regi Alexander

The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The…

Abstract

Purpose

The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The International Classification of Diseases (ICD) underpinning principle of clinical utility is currently poor for persons with Disorders of Intellectual Development (DID) and mental disorders. This impedes access to healthcare resources; services and social inclusion thereby further aggravating their vulnerability. The purpose of this paper is to present a critical overview and evidence informed recommendations within the context of an international collaborative programme, undertaken by the Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists, UK with support from the World Health Organisation (WHO).

Design/methodology/approach

The authors carried out: first, a systematic review (SR) of literature, using PRISMA guidelines regarding the reliability, validity and utility of the ICD-10/Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria in people with DID (PWDID); second, a national and international consultation exercise with partners, stakeholders and experts; third, a multicentric survey of problem behaviours in PWDID; and finally, information dissemination/dialogues including presentations and workshops at key scientific events, consultation networking, data gathering and consensus building.

Findings

The SR revealed a dearth of robust studies – most consisting of weak research methodologies. Significant difficulties were highlighted regarding the application of diagnostic criteria in the current classificatory systems – particularly in people with severe/moderate DID. Recommendations supported the introduction WHERE APPROPRIATE of modifications based on observed phenomena (signs) in PWDID in lieu of reported symptoms to facilitate DIAGNOSIS AND better access to healthcare and the community. Heterogeneity precluded quantitative pooling and meta-analysis. The consensus building exercise globally revealed that problem behaviours were the commonest reasons for referral to healthcare services with significant numbers without a diagnosed mental disorder being prescribed psychoactive medication.

Research limitations/implications

The consensus gathering exercise WAS SELECTIVE AND did not cover all of the 194 member states of WHO due to resource and time constraints and this constitutes the main limitation of our study. Based on the SR and expert consensus, the authors submitted evidence informed pragmatic proposals to the WHO aimed at addressing the shortcomings of the ICD-10. The key recommendations focused on improving clinical utility within the context of epistemic iteration which would consolidate and strengthen the future evidence base. It was also recommended that self-injurious behaviour should form a standalone sub category in view of its relevance for healthcare services and resources which underpin clinical utility.

Practical implications

The ICD-11 is a global, multidisciplinary and multilingual development for public health benefit with 70 per cent of the world's health expenditures assigned using this system for resource allocation. Currently mental disorders in PWDID can be misinterpreted, unrecognised and under reported resulting in barriers to access to treatment and healthcare resources. Conversely disorders may be over diagnosed when the inherent discrepancies between the chronological age and the developmental level of functioning are not considered. Conclusions and recommendations from this study will result in better diagnosis of mental disorders and healthcare resources in this population.

Social implications

PWDID are a vulnerable sector of the population with an increased prevalence of mental health problems who are marginalised and discriminated by society. Early detection, treatment and management of these conditions will prevent further decompensation and stigmatisation.

Originality/value

To the best of the authors knowledge this is the first comprehensive, large-scale study which evaluates the ICD classificatory system within the context of clinical utility for PWDID, including experts and stakeholders from both lower/middle- and high-income countries. The international consultation/consensus building process culminating in the formulation of evidence informed recommendations, aimed at improving the clinical utility of the ICD-11 for this population, has the potential to improve access to appropriate healthcare and treatment and consequent enhancement of their quality of life.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 9 no. 1
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 10 June 2014

David B. Menkes and Gillian A. Bendelow

Police in England and Wales are empowered, under Section 136 of the Mental Health Act 1983 (s136), to detain individuals thought to be a danger to themselves or to others…

Abstract

Purpose

Police in England and Wales are empowered, under Section 136 of the Mental Health Act 1983 (s136), to detain individuals thought to be a danger to themselves or to others. Use of this authority is widespread, but varies across districts and attracts controversy because of inconsistent application and the fact that it requires police to make judgements about mental health. The purpose of this paper is to examine police attitudes to and criteria for using s136.

Design/methodology/approach

The authors conducted focus groups with 30 officers in urban and rural areas of three different regions across England and Wales. Group interviews were audio-recorded, transcribed, and analysed using open and axial coding.

Findings

Use of s136 authority has major implications for police work; liaison with mental health services is seen as desirable but often ineffective due to resource constraints and the latter's lack of availability. The decision to invoke s136 depends on social context and other particulars of individual cases.

Research limitations/implications

Although the findings have limitations with respect to generalisability across the whole of the UK, there are patterns of responses which have major implications for policy recommendations.

Practical implications

Police decisions to apply s136 reflect an implicit values-based classification of and response to emotionally disturbed behaviour, in light of available institutional and social supports.

Social implications

Tasked primarily with protecting the public and keeping the peace, police “diagnoses” of risk often contrast with that of mental health professionals.

Originality/value

A highly original piece of research which has attracted further funding from BA/Leverhulme.

Details

Journal of Public Mental Health, vol. 13 no. 2
Type: Research Article
ISSN: 1746-5729

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Article
Publication date: 14 April 2010

Alan Leyin

This article explores the nature of the classifications of learning disabilities as promulgated in the diagnostic manuals. By leaving aside all doubts and controversies…

Abstract

This article explores the nature of the classifications of learning disabilities as promulgated in the diagnostic manuals. By leaving aside all doubts and controversies that surround the concept and measurement of intellectual functioning, weaknesses are exposed from within those manuals' own frames of reference. The difficulties arising from using the international sub‐classifications of learning disabilities when the national classifications should apply are discussed.

Details

Tizard Learning Disability Review, vol. 15 no. 2
Type: Research Article
ISSN: 1359-5474

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Article
Publication date: 2 January 2018

Carlos Peña-Salazar, Francesc Arrufat, Josep Manel Santos, Ramón Novell and Juan Valdés-Stauber

Studies on psychiatric comorbidity in individuals with borderline intellectual functioning (BIF) are scarce, particularly with respect to certain diseases frequently…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 12 no. 1
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 1 June 2004

Ellen Sexton

Libraries supporting a forensic psychology undergraduate and/or graduate level college program need to collect materials from a range of disciplines – psychology, law…

Abstract

Libraries supporting a forensic psychology undergraduate and/or graduate level college program need to collect materials from a range of disciplines – psychology, law, psychiatry and criminal justice. This guide identifies the major reference works, journals, databases and other resources that should be in a good forensic psychology collection.

Details

Reference Services Review, vol. 32 no. 2
Type: Research Article
ISSN: 0090-7324

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Book part
Publication date: 30 July 2014

Emily Boshkoff Johnson

This chapter is a comprehensive discussion of autism spectrum disorder (ASD) across the globe (e.g., United States, China, Brazil, Japan and Turkey). Topics that are…

Abstract

This chapter is a comprehensive discussion of autism spectrum disorder (ASD) across the globe (e.g., United States, China, Brazil, Japan and Turkey). Topics that are discussed include the following: diagnostic criteria and approaches; international perspectives of ASD; western and eastern assessment practices; cultural considerations of assessment of ASD; educational and medical interventions; behavioral and emotional interventions; complementary and alternative medical interventions; variations in educational services among countries; early intervention practices; adult services; national and international resources; and current needs and future directions.

Details

Special Education International Perspectives: Biopsychosocial, Cultural, and Disability Aspects
Type: Book
ISBN: 978-1-78441-045-2

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Article
Publication date: 1 March 2005

Giorgio Nardone and and Claudette Portelli

This paper develops from the constructivistic premise that our reality is a computation rather than a representation. Provides a constructive critique on the rigid…

Abstract

Purpose

This paper develops from the constructivistic premise that our reality is a computation rather than a representation. Provides a constructive critique on the rigid psychopathological classifications used in mental health that end up creating a conditioned self‐confirming reality.

Design/methodology/approach

Proposes to present an approach, which moves away from the traditional rigid categorizing definitions of mental disorders, to a constructivist perspective that considers human problems as dysfunctional systems of perception and reaction to reality.

Findings

Provides literature that demonstrates how humans use interpretative tools to give order and definition to the world around them, but most often, end up forgetting that all their classifications, theories, tests and so forth, are mere human inventions. Presents various distinctive scientific research which evidence how those who are invested with the power of diagnosing mental sanity or insanity, are often trapped in their own theories and resulting diagnostic practice.

Originality/value

This paper puts forward the need in replacing a rigid deterministic model by an elastic and self‐corrective constructive‐strategic model of knowledge and intervention that guarantees the real efficacy and effectiveness of therapy.

Details

Kybernetes, vol. 34 no. 3/4
Type: Research Article
ISSN: 0368-492X

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Article
Publication date: 16 September 2011

Angela Woods

Over 100 years ago, Emil Kraepelin revolutionised the classification of psychosis by identifying what he argued were two natural disease entities: manic depressive…

Abstract

Purpose

Over 100 years ago, Emil Kraepelin revolutionised the classification of psychosis by identifying what he argued were two natural disease entities: manic depressive psychosis (bipolar disorder) and dementia praecox (schizophrenia). Kraepelin's discoveries have since become the “twin pillars” of mainstream psychiatric thinking, practice, and research. Today, however, a growing number of researchers, clinicians, and mental health service users have rejected this model and call for a symptom‐led approach to prioritise subjective experience over diagnostic category. The purpose of this paper is to ask: how can the published first‐person accounts of experts by experience contribute to these debates?

Design/methodology/approach

This paper analyses the representation of psychiatric diagnosis in two prominent autobiographies: Kurt Snyder's Me, Myself, and Them: A Firsthand Account of One Young Person's Experience with Schizophrenia (2007) and Elyn Saks' The Center Cannot Hold: My Journey Through Madness (2007).

Findings

As well as providing a prognosis and a plan for treatment, the psychiatric diagnosis of schizophrenia gives shape and meaning to the illness experience and ultimately becomes the pivot or platform from which identity and memoir unfold.

Practical implications

The paper introduces two popular autobiographical accounts of schizophrenia which may be useful resources for mental health service users and clinicians.

Social implications

The paper highlights the complex ways in which people interpret and make meaning from their psychiatric diagnosis.

Originality/value

The paper demonstrates that first‐person accounts make an important, if frequently overlooked, contribution to debates about psychiatric diagnosis.

Details

Mental Health Review Journal, vol. 16 no. 3
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 15 March 2013

Ronn Johnson, Heidi Beckenbach and Samantha Kilbourne

This paper aims to present an overview of a variety of risk assessment issues that are of particular relevance for work with juvenile fire setters in clinical and forensic…

Abstract

Purpose

This paper aims to present an overview of a variety of risk assessment issues that are of particular relevance for work with juvenile fire setters in clinical and forensic settings. The paper seeks to consider Juvenile Fire Setting (JFS)‐Youthful Misuse of Fire (YMF) across a broad array of clinical domains, including developmental, prognostic, and the diagnostic utility anticipated by using the DSM‐5. National standards and risk assessment levels are to be examined.

Design/methodology/approach

The paper includes a comprehensive review of the research and practices related to juvenile fire setters. This review included assessment and intervention resources that are used in diverse practice environments. The authors reviewed the literature to establish a nexus between risk assessment and community‐based interventions which were illustrated by a nationally recognized YMF mental health program (FATJAM).

Findings

The paper provides empirically‐based insights into key issues for working with these forensic cases. It offers discussion regarding diagnostic issues that are relevant to the DSM‐5.

Research limitations/implications

Because of the conceptual or theoretical approach used, the research basis for generalizations is restricted to the practice‐based analyses provided by the authors. Therefore, practitioners and researchers are urged to further test the observations and conclusions presented.

Originality/value

This paper is unique in that it increases the knowledge base related to the diagnostic applications with the DSM‐5, as well as evidence‐based interventions for JFS as it pertains to public safety.

Details

Journal of Criminal Psychology, vol. 3 no. 1
Type: Research Article
ISSN: 2009-3829

Keywords

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