Psychiatry of Intellectual Disability A Practical Manual

Individuals with ID often present with behavioral symptoms complicated by limited expressive language skills and undiagnosed medical conditions. Many training programs do not include focused study of individuals with ID, despite the fact that patients with ID will be seen by virtually every mental health practitioner. In this book, the authors present a framework for competent assessment and treatment of psychiatric disorders in individuals with ID.

Psychiatry of Intellectual Disability is a resource guide for psychiatrists, nurse practitioners, and other prescribers treating patients with ID. It is a supplemental text for psychiatry residents, medical students, psychology graduate students, psychotherapists, counselors, social workers, behavior support specialists and nurses. To assist the practicing clinician the book includes:

• Clinical vignettes
• Clinical pearls
• Charts for quick reference
• Issues concerning medications and poly-pharmacy
• Altered diagnostic criteria specific for use with individuals with ID

There are no evidence-based principles dedicated to psychotropic medication use in ID, but consensus guidelines address the high prevalence of poly-pharmacy. Altered diagnostic criteria have been published which accommodate less self-report and incorporate collateral information; this book reviews the literature on psychotropic medications, consensus guidelines, and population-specific diagnostic criteria sets.

Psychiatry of Intellectual Disability also includes:

• Interviewing techniques and assessment tips for all levels of communicative ability as well as for nonverbal individuals
• Assessment of aggression to determine etiology and formulate a treatment plan
• Overview of types of psychotherapy and suggested alterations for each to increase efficacy
• Relevant legal issues for caregivers and treatment providers

The detective work involved in mental health assessment of individuals with ID is challenging yet rewarding. The highest quality mental health treatment limits hospital days, improves quality of life and often allows individuals to live in the least restrictive environments. Psychiatry of Intellectual Disability is a must have resource for clinicians treating the ID population.

Dedications vii

Editor biographies ix

List of contributors xi

List of abbreviations xiii

Foreword xv

1 Overview 1
Allison E. Cowan, MD and Julie P. Gentile, MD

2 Psychiatric Assessment 14
Ann K. Morrison, MD and Paulette Marie Gillig, MD, PhD

3 Medical Assessment 26
Julie P. Gentile, MD and Michelle A. Monro, DO

4 Neurologic Conditions 51
Paulette Marie Gillig, MD, PhD and Richard Sanders, MD

5 Traumatic Brain Injuries and Co-occurring Mental Illness 75
Gretchen N. Foley, MD

6 Interviewing Techniques 90
Julie P. Gentile, MD and Paulette Marie Gillig, MD, PhD

7 Mood Disorders 125
Ann K. Morrison, MD and Christina Weston, MD

8 Anxiety Disorders 146
Kelly M. Blankenship, MD

9 Psychotic Disorders 161
Allison E. Cowan, MD

10 Personality Disorders 191
Julie P. Gentile, MD and Allison E. Cowan, MD

11 Aggression 210
Julie P. Gentile, MD and Paulette Marie Gillig, MD, PhD

12 Psychotropic Medications 250
Christopher T. Manetta, DO and Julie P. Gentile, MD

13 Psychotherapy 278
Carroll S. Jackson, LISW-S and Julie P. Gentile, MD

14 Behavioral Assessment and Interventions 309
Betsey A. Benson, PhD

15 Legal Issues for Treatment Providers and Evaluators 325
Jeannette Cox, JD

16 Syndromes of Intellectual Disability 338
Kelly M. Blankenship, MD and Christina Weston, MD

Index 366

Julie P. Gentile, M.D. (jen-TILL-ee) is Associate Professor of Psychiatry at the Boonshoft School of Medicine, Wright State University, Dayton, Ohio and the Project Director for Ohio’s Coordinating Center of Excellence in Mental Illness/Intellectual Disability. She has been the Professor of Dual Diagnosis for the Ohio Department of Mental Health, the Ohio Department of Developmental Disability, and the Ohio Developmental Disabilities Council since 2003 and has evaluated more than 2,000 individuals with co-occurring mental illness and intellectual disability. She is the recipient of the American Psychiatric Association’s Frank J. Menolascino Award for Excellence in Psychiatric Services for Developmental Disabilities, the Excellence in Contributions to Clinical Practice Award from the National Association for the Dually Diagnosed, and a member of Alpha Omega Alpha Medical Honor Society. She is the recipient of numerous teaching awards and has been awarded more than $3,000,000 in grants and contracts to support her work in dual diagnosis since 2003.

Paulette Marie Gillig, M.D., Ph.D. is Professor of Psychiatry at the Boonshoft School of Medicine, Wright State University, Dayton, Ohio and on the Faculty of the Graduate School.  She has been Ohio Department of Mental Health Professor of Rural and Underserved Populations since 1998, is listed in Best Doctors in America, Who's Who in America, Who's Who in the World, is Distinguished Fellow of the American Psychiatric Association and a member of Alpha Omega Alpha Medical Honor Society. She is the recipient of numerous teaching and has published three books and over 60 articles and book chapters in the several areas of Community (Public) Psychiatry, Psychotherapy, and the Interface between Psychiatry and Neurology.  She is the Section Editor for the journal Innovations in Clinical Neuroscience.  She completed residencies in both Neurology and in Psychiatry, and also holds