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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: 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: 1 December 2008

Hugh Middleton

Consideration is given to the extent to which the DSM and ICD approach to psychiatric case definition and treatment supports clinical activity. Their validity as a way of…

Abstract

Consideration is given to the extent to which the DSM and ICD approach to psychiatric case definition and treatment supports clinical activity. Their validity as a way of defining ‘mental illness’ is found wanting and they do not, in themselves, usefully guide treatment. These conclusions are set in a critical realist approach to ‘mental illness’, which draws attention to the legitimacy of several differing perspectives, each reflecting their own sets of interests and allegiances. DSM‐V and ICD‐11 are due to be published in 2012 and 2014 respectively, and their architects are called upon to be clear about which of these constituencies they are representing.

Details

Mental Health Review Journal, vol. 13 no. 4
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 7 June 2019

Paula Robinson, Emma Griffith and Chris Gillmore

Studies show that experiences of repeated or complex trauma are very common in patients with severe mental health problems. Unfortunately, many professionals do not…

Abstract

Purpose

Studies show that experiences of repeated or complex trauma are very common in patients with severe mental health problems. Unfortunately, many professionals do not routinely ask about abuse, due to concerns about how to ask and respond. There is also a need for frontline staff to be trained in trauma-informed care. The purpose of this paper is to identify the needs of inpatient staff and developed a tailor-made training package.

Design/methodology/approach

A training programme was developed from focus-group discussion and delivered to the team. Questionnaires were administered pre-, post-training and at three-month follow-up, to assess changes in knowledge, confidence and worries in the assessment and treatment of complex trauma.

Findings

There was an increase in self-reported staff confidence (p=0.001) and knowledge (p=0.028) about working with complex trauma and their worries decreased (p=0.026) between pre- and post-training.

Practical implications

In order to sustain the benefits of training for longer, recommendations were made to the service for on-going training, supervision and evaluation.

Originality/value

Given the recent interest in complex trauma within the literature (Diagnostic and Statistical Manual of Mental Disorders – Fifth Version (DSM-V); International Statistical Classification of Diseases – 11th Version (ICD-11)), the piloting and development of complex trauma training packages is timely. To the author’s knowledge, this is the first published account of complex trauma training for inpatient staff. This paper offers clinical and research implications to services who may want to develop as trauma-informed services within the NHS.

Details

Mental Health Review Journal, vol. 24 no. 2
Type: Research Article
ISSN: 1361-9322

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Book part
Publication date: 30 July 2014

Michael L. Wehmeyer, Karrie Shogren, Miguel Angel Verdugo, Laura Nota, Salvatore Soresi, Suk-Hyang Lee and Yves Lachapelle

Historically, the condition we now refer to as intellectual disability has been conceptualized using models that were extension of the medical model. Recent advances…

Abstract

Historically, the condition we now refer to as intellectual disability has been conceptualized using models that were extension of the medical model. Recent advances, however, have emphasized person-environment fit models of disability that view disability, intellectual, and other cognitive disabilities, as the lack of fit between a person’s capacities and the demands of the context. This chapter examines these shifts in conceptualization and the ways in which this changes how interventions are designed to provide support to enable people with intellectual disability to live, learn, work, and play in their communities. Such interventions and supports include issues pertaining to Universal Design for Learning, multi-tiered systems of supports, and the primacy of promoting the self-determination of people with disabilities. The importance of efforts to promote social inclusion is also discussed, as well as strategies to promote transition to adulthood. Authors from several countries provide examples of how these new intervention paradigms are being implemented across the world.

Details

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

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Book part
Publication date: 24 July 2020

María Beatriz Quintanilla-Madero

Burnout syndrome is characterized by exhaustion, cynicism, and inefficacy. Considered a work–stress-related condition, burnout first described professional activities that…

Abstract

Burnout syndrome is characterized by exhaustion, cynicism, and inefficacy. Considered a work–stress-related condition, burnout first described professional activities that provide a direct service to people, such as the health and teaching professions. Recent scholarship, however, points to the existence of burnout in any kind of work and at any level of the organization. Some have noted a high prevalence of burnout in the general population, and especially increased prevalence among healthcare professionals. This chapter thus aims to analyze burnout syndrome, including its detection and prevention in organizations. It will proceed by reviewing classic and recent scientific literature on burnout, and its impact on the individual and the organization. It also evaluates organizational interventions meant to prevent burnout and help employees, as well as assess some coping strategies employees can take up to develop a healthier relationship with their jobs.

Details

Strategy, Power and CSR: Practices and Challenges in Organizational Management
Type: Book
ISBN: 978-1-83867-973-6

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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

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Article
Publication date: 6 July 2015

Hilde Katrine Andersen

The range of prevalence of personality disorder (PD) found in people with intellectual disability (ID) has been reported as vast, and has included data from dissimilar…

Abstract

Purpose

The range of prevalence of personality disorder (PD) found in people with intellectual disability (ID) has been reported as vast, and has included data from dissimilar settings. The purpose of this paper is to review the reported prevalence of PD in the general population of people with ID, and to consider how different and changing ideas about PD have affected these rates.

Design/methodology/approach

Cross-sectional studies of the prevalence of PD in people with ID were identified. The quality of the studies was considered, along with how cases of PD were identified.

Findings

Six studies were included. The reported prevalence of PD in people known to have ID ranged from 0.7 to 35 per cent. Possible reasons for this wide range included different views of PD and methods of assessment.

Research limitations/implications

The wide range of findings suggests that methodological differences are significant. Consideration to how clinicians should respond to the overlap of impairment between ID and PD may improve the conceptual clarity of PD, informing future epidemiological research.

Originality/value

This review was limited to studies of samples likely to be representative of the general ID population. The range of prevalence estimates was narrower than previously reported, and more likely to reflect the true prevalence rate of PD amongst people who have ID. Consideration was also given to how different ideas of PD led to different methods and may have contributed to variance in the results.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 9 no. 4
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 5 September 2016

Biza Stenfert Kroese, Sara Willott, Frances Taylor, Philippa Smith, Ruth Graham, Tara Rutter, Andrew Stott and Paul Willner

Trauma-focussed cognitive-behaviour therapy (TF-CBT) is the most effective treatment for post-traumatic stress disorder (PTSD). Individuals who present with complex PTSD…

Abstract

Purpose

Trauma-focussed cognitive-behaviour therapy (TF-CBT) is the most effective treatment for post-traumatic stress disorder (PTSD). Individuals who present with complex PTSD are among the most complex and challenging patients seen by intellectual disability psychology and psychiatry services. The purpose of this paper is to study TF-CBT intervention for people with intellectual disabilities and complex PTSD.

Design/methodology/approach

Three groups of adults with intellectual disabilities (ID) presenting with complex PTSD (n=3, n=5 and n=4) were treated using a 12-week manualised intervention adapted from a procedure routinely used in adult mental health services. Participants completed the Impact of Event Scale as adapted for people with intellectual disabilities (IES-ID) before and after the intervention, and interviews conducted to ascertain their experiences of the group were analysed using interpretative phenomenological analysis (IPA).

Findings

The ten participants who completed the intervention showed a 27 per cent decrease in median Impact of Event Scale Intellectual Disabilities scores, equivalent to a medium effect size (d=0.50). Five themes were identified from the interviews: being listened to; it is nice to know you are not the only one; being in a group can be stressful; the importance of feeling safe; achieving and maintaining change. Participants also provided constructive feedback to promote improvements to the manual.

Research limitations/implications

A feasibility study followed by methodologically robust clinical trials is now needed to establish the effectiveness of the intervention and its utility in clinical practice.

Practical implications

This small study has confirmed the potential of TF-CBT as an intervention for extremely vulnerable individuals with ID who present with complex PTSD.

Social implications

The findings indicate that a group intervention is both feasible for and acceptable to adults with ID.

Originality/value

To date, no study has investigated the effectiveness and feasibility of a TF-CBT group intervention for adults with mild ID.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 10 no. 5
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 11 December 2017

H. Frank Cervone

Informatics work introduces information professionals to taxonomies and other classification systems outside the boundaries of traditional bibliographic systems. This…

Abstract

Purpose

Informatics work introduces information professionals to taxonomies and other classification systems outside the boundaries of traditional bibliographic systems. This paper aims to provide an overview of the International Statistical Classification of Diseases and Related Health Problems (ICD) for informaticians and information professionals who may not have worked with the system previously.

Design/methodology/approach

In this paper, the author reviews the purpose, history, current use and future trends of the ICD classification system.

Findings

ICD is used globally as a standard vocabulary for medical diagnoses and, in the USA, for medical procedures in hospitals. Understanding the classification system is vital to working with clinical medical data.

Originality/value

The ICD classification system is not commonly used by information professionals. This paper provides a brief overview that will familiarize the information professional with the standard and its uses related to medical practice.

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