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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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

In the last decade, much has been debated about the topic of BDSM in various scientific fields. With the slow and steady blending of BDSM with mainstream culture, which escalated rapidly with the appearance and extreme popularity of Fifty Shades of Grey, BDSM has become a current topic of discussion in a broad variety of contexts. Moreover, with the recent change in medical classification of BDSM practices in ICD-11 (World Health Organization, 2018), which strictly clinically separated the sexological diagnosis of nonconsensual sadism from consensual SM practices, BDSM has also become a hot issue in the community of diagnostic experts. This chapter explores three aspects of the evolution of BDSM subculture in the postcommunist Czech Republic in the context of the continuous worldwide development of BDSM subculture – (1) role-play, (2) unification, and (3) commodification in the BDSM subculture – situating them within the broader context of the development of society in the postcommunist environment and the development of the BDSM scene worldwide.

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.

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.

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).

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.

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.

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.

The purpose of this study is to investigate how mock jurors’ experiences of deliberations are impacted by the defendant having a personality disorder.

This study used a qualitative approach to explore mock jurors’ experiences during the deliberations of a fictional defendant, Sarah Priest. Ten participants formed two mock juries, and each mock jury were given two case studies to deliberate. Case study one described Priest as having “Severe Personality Disorder, Borderline Pattern” whereas case study two described Priest as having “Complex Mental Health Problems”. There were no changes to the content of the case studies aside from the change in language used to describe the defendant.

An inductive thematic analysis identified two main themes relating to juror experience: “Interaction with Other Mock Jurors” and “Language as a Barrier to a Verdict”. Participants constructed that prosocial interactions with other mock jurors in the deliberations helped them make a verdict decision, but some of these interactions led to disagreements between participants due to a wide variation of opinion. Second, the different description of the defendant in each case study were constructed to have made the deliberations and decision-making difficult, but for different reasons. In case study one, a lack of knowledge surrounding BPD was the reason for this difficulty, and in case study two, participants thought that the applicability of diminished responsibility criteria were unclear, making it hard to reach a verdict.

The findings have key implications for the judicial system; common experiences can be identified and recorded to implement procedures to protect jurors from adverse experiences.

There is a lack of studies that have investigated juror experience in the UK, and the few studies available have used a quantitative methodology. The approach taken in the current study is, therefore, unique in a UK context. The findings have key implications for the judicial system; common experiences can be identified and recorded to implement procedures to protect jurors from adverse experiences.