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Article
Publication date: 21 August 2019

Mahesh Odiyoor, Samuel Joseph Tromans, Regi T. Alexander, Srinaveen Akbari, Gill Bell, Sandy Bering, Sujeet Jaydeokar and Amrith Shetty

The purpose of this paper is to provide a professional consensus position with regard to the provision of specialist inpatient rehabilitation services for people with…

Abstract

Purpose

The purpose of this paper is to provide a professional consensus position with regard to the provision of specialist inpatient rehabilitation services for people with intellectual disability (ID), autism and mental health, behavioural or forensic needs in the UK.

Design/methodology/approach

The concept of rehabilitation is discussed, as well as the functions and goals of specialist inpatient rehabilitation services with regard to the aforementioned contexts. Current use of rehabilitation beds is considered, both on a regional and national scale, as well as various outcome measures, including effectiveness, patient safety and patient experience.

Findings

There is a clear need for specialist inpatient rehabilitation services, though historically there have been instances of inappropriate admissions, as well as lengthy inpatient stays that could have been significantly reduced with the right type of community support package. Such services should be subjected to rigorous measurement of outcome measures, to determine that patients within such services are receiving a consistently high standard of care. Additionally, amendments to current legal frameworks should be considered, with a view to accommodating for individuals with capacity who require continuous community-based supervision.

Originality/value

To the best of the author’s knowledge, this is the first article detailing a professional consensus position for specialist inpatient rehabilitation services for people with ID, autism and mental health, behavioural or forensic needs.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 5
Type: Research Article
ISSN: 2044-1282

Keywords

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Article
Publication date: 21 August 2019

Verity Chester, Harriet Wells, Mark Lovell, Clare Melvin and Samuel Joseph Tromans

Elucidating where antisocial or violent behaviour arises within the life course of individuals with intellectual disability (ID) could improve outcomes within this…

Abstract

Purpose

Elucidating where antisocial or violent behaviour arises within the life course of individuals with intellectual disability (ID) could improve outcomes within this population, through informing services and interventions which prevent behaviours reaching a forensic threshold. The paper aims to discuss this issue.

Design/methodology/approach

The Historical Clinical Risk Management-20, Version 3 assessments of a cohort of 84 inpatients within a forensic ID service were analysed for this study, with a particular emphasis on items concerned with the age at which antisocial or violence first emerged.

Findings

For most participants, violent or antisocial behaviour was first observed in childhood or adolescence. The study also highlighted a smaller subgroup, whose problems with violence or antisocial behaviour were first observed in adulthood.

Originality/value

The study findings suggest that targeted services in childhood and adolescence may have a role in reducing the offending behaviour and forensic involvement of people with ID. This has implications for the service models provided for children and adolescents with ID with challenging or offending behaviour.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 5
Type: Research Article
ISSN: 2044-1282

Keywords

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Article
Publication date: 3 January 2017

Alice Shelton, Samuel Joseph Tromans, Sabyasachi Bhaumik and Reza Kiani

The purpose of this paper is to discuss the challenges of assessment and management of psychotic symptoms in a background of intellectual disability (ID) and…

Abstract

Purpose

The purpose of this paper is to discuss the challenges of assessment and management of psychotic symptoms in a background of intellectual disability (ID) and treatment-resistant epilepsy caused by a genetic syndrome.

Design/methodology/approach

Ring chromosome 20 [r(20)] syndrome is characterised by the triad of severe refractory epilepsy, mild to severe ID and behavioural problems. This paper describes the presentation of r(20) syndrome in a young woman with moderate ID and treatment-resistant epilepsy, who experiences psychotic symptoms at times of improved seizure control.

Findings

There are several diagnostic possibilities for such a presentation, including psychotic symptoms due to adverse effects of anti-epileptic medications and forced normalisation (alternating psychosis).

Originality/value

This paper advocates judicious use of antipsychotic medication to manage psychotic symptoms, as well as involvement of both patient and close family members throughout all stages of care. It is essential to strike a balance between control of epileptic seizures and psychiatric symptoms, providing an optimal benefit to the patients’ quality of life by meeting their complex needs through a multidisciplinary and multi-agency team input.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 11 no. 1
Type: Research Article
ISSN: 2044-1282

Keywords

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Article
Publication date: 2 November 2015

Reza Kiani, Asit Biswas, John Devapriam, Regi Tharian Alexander, Satheesh Kumar, Hayley Andrews and Samuel Joseph Tromans

Clozapine is a well-known antipsychotic medication licensed for treatment-resistant schizophrenia, but there is limited research available to suggest its efficacy in the…

Abstract

Purpose

Clozapine is a well-known antipsychotic medication licensed for treatment-resistant schizophrenia, but there is limited research available to suggest its efficacy in the context of personality disorder and intellectual disabilities presenting with high-risk behaviour with or without psychotic symptoms. The purpose of this paper is to raise awareness of the benefits of using clozapine in patients with intellectual disabilities and personality disorder that present with a complex picture of serious risk of harm to both their life and the lives of others.

Design/methodology/approach

The authors present five patients with intellectual disabilities and serious life-threatening challenging behaviour whom were started on clozapine as part of their multidisciplinary treatment plan to manage their presentation. The authors completed baseline assessment of five main symptom domains and then repeated this assessment following treatment with clozapine.

Findings

In all five cases use of clozapine was objectively associated with an improvement in symptomatology, quality of life and a safe transfer to the community.

Originality/value

The findings suggest that judicious use of clozapine could be considered as one of the effective pharmacological strategies in the management of patients with intellectual disabilities and personality disorder who present with serious life-threatening challenging behaviours.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 9 no. 6
Type: Research Article
ISSN: 2044-1282

Keywords

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Article
Publication date: 3 July 2019

Samuel Tromans, Verity Chester, Chaya Kapugama, Amy Elliott, Sarah Robertson and Mary Barrett

The purpose of this paper is to explore the perspectives of healthcare professionals on autism in adult females with intellectual disability (ID), including regarding the…

Abstract

Purpose

The purpose of this paper is to explore the perspectives of healthcare professionals on autism in adult females with intellectual disability (ID), including regarding the gender ratio of autism, the clinical manifestation of autism in females, and the recognition, screening and diagnosis of autism.

Design/methodology/approach

The questionnaire was developed following a review of the relevant literature and distributed to professionals within three healthcare trusts as well as members of two clinical research groups. The questionnaire was completed by 80 ID healthcare professionals. Data were aggregated and analysed using Microsoft Excel.

Findings

ID healthcare professionals had a lack of recognition of the smaller gender ratio of autism in patients with ID as compared to those without ID. Most respondents reported believing that autism manifests differently in females; with women demonstrating a greater ability to mask their symptoms. A considerable proportion of participants reported feeling less confident in recognising, screening and diagnosing autism in female patients, with many endorsing a wish for additional training in this area.

Practical implications

These findings suggest that ID healthcare professionals are keen to improve their skills in providing services for women with autism. Training programmes at all levels should incorporate the specific needs of women with ASD, and individual professionals and services should actively seek to address these training needs in order to promote best practice and better outcomes for women with autism.

Originality/value

This is the first published questionnaire exploring the perspectives of healthcare professionals regarding autism in adult females with ID.

Details

Advances in Autism, vol. 5 no. 3
Type: Research Article
ISSN: 2056-3868

Keywords

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