Dual Diagnosis Mental Retardation and Psychiatric Disorders

1
Dual DiagnosisMental Retardation and Psychiatric
Disorders

• By
• Suzanne Collier

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Table of Contents

• I. History
• II. Causes
• Disorders
• A. Affective
• B. Anxiety
• C. Psychosis
• D. Social Communication and
  Pervasive Developmental Disorders

• E. Attention-Deficit/
  Hyperactivity
• F. Adjustment
• G. Posttraumatic Stress
  Disorder
• H. Conduct Disorders
• I. Substance Abuse
• J. Maladaptive Behavior Disorders
• IV. Medical Problems
• Genetic Syndromes and Behavioral Phenotypes
• Treatments

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History

• -Since the1960s diagnosis
• and treatment of psychiatric disorders has
  improved.
• -1980s Dual Diagnosis
• to move away from wards of Mental Hospitals or
  Residential Facilities.
• -Many mislabeled
• with schizophrenia.

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Causes

• -7-10 of children have psychiatric disorders.
• -30-42 of children with Mental Retardation have
  them.
• -Caused by an interaction among
• biological, environmental, and psychosocial
  factors.
• Ex. TBI (traumatic brain injury) neurotransmitter
• Alterations with post-injury peer acceptance can
  develop into depression.

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Affective or Mood Disorders

• -2-5 of children and
• 5-15 of children with
• Mental Retardation
• -3 Syndromes
• 1. Dysthymia 2 years chronic low-grade
  depression with
• functional impairments
• 2. Major Depression
• Emotional withdrawl, lack of interest in daily
  activities, sleep and appetite problems, poor
  concentration, worthlessness, guilt, and thoughts
  of death and suicide. This has a hereditary
  precipitated by life stresses.

• 3. Bipolar Disorder all of the above with
  depression and with the mania comes inflated
  self-esteem, decreased sleep, pressured talking,
  distractibility, racing thoughts, excessive
  pleasurable activities. This has a strong
  hereditary component and a gene locus.

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Anxiety Disorders

• -Strong hereditary component
• -Phobias, Panic, Separation anxiety
• -(OCD) Obsessive- compulsive biological basis,
  repetitive purposeful behavior and persistent
  senseless thoughts

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Psychosis

• Delirium- sudden confusion associated with TBI,
  drugs, and medical disorders like encephalitis
• Schizophrenia Catatonic, delusions,
  inappropriate emotional expressions,
  hallucinations, and loosening speech for 6 months
  onset typically in adolescence.

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-Social Communication (Pervasive Developmental
Disorders or PDD) poor social interactions,
communication problems, and impaired
imagination ¼ of people with Mental
Retardation - Attention-Deficit/ Hyperactivity
impulsivity, inattentiveness, functional
impairments, 11 of people with MR have
ADHD Behavior rating scales, clinical
history, and direct observation for
diagnosis. -Post Traumatic Stress Disorder
(PTSD) threat of harm or death causing
intense fear or helplessness with recurrent
and intrusive recollections of a trauma
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-Conduct Disorders aggressive, destructive,
rule-violating, persistent patterns of bullying,
intimidating, initiating fights, setting
fires, stealing, and truancy 12 to 45 of
people with MR Causes inability to verbalize
feelings, poor impulse
control, depression, pain, and fear -Substance
Abuse genetic and familial factors
typically adolescents MR associated with
Fetal Alcohol Syndrome predisposition to
substance abuse Causes immature judgment,
impulsiveness, and a desire for social
acceptance
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-Maladaptive Behavior Disorders- repetitive
self-stimulating behavior or self injury (SIB),
-Stereotypic Movement Disorder -5 of
people with MR -environmental and biological
factors (Neurotransmitters) -
attention, autism, depression, mania, and
schizophrenia or medical conditions -Pica-
eating nonfood items
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Medical Problems

• - Hypothyroidism (common with Down
• Syndrome) can cause
• anxiety or depression
• - Excessive Drugs

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Genetic Syndromes and Behavioral Phenotypes

• -Fragile X males MR,
• poor eye contact, communication impairments,
  stereotyped movements
• - females less severe
• modest cognitive impairments, shyness,
• impulsivity, distractibility,
• and personality disorder

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• Rett Syndrome in girls, X-linked dominate
• neurological disorder, autistic features,
  loss of
• purposeful hand movements, at onset
  wringing
• and hand flapping, and hyperventilation
• -Prader- Willi Syndrome microdeletion of
• chromosome 15, decreased muscle tone,
• short stature, obesity, MR,
  underdeveloped
• gonads, almond-shaped face, upslanted
  eyes,
• narrow forehead
• -impulsive, obstanant, and disinhibited

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• -Lesch-Nyhan Syndrome X-linked disorder,
• metabolism of purines (DNA building
  blocks),
• MR, progressive neurological disorder, boys
  bite
• lips and fingers, neurotransmitter
  abnormalities in
• dopamine and serotonin (causing
  self-injury in
• animals), no success yet with medication
• Williams Syndrome MR with cocktail party
  speech,
• Down Syndrome maybe with dementia in
  young
• adulthood,

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Treatments

• Referral to Mental Health Professionals for a
• detailed history of current symptoms,
  behaviors,
• individual and family medical history,
  interview
• parents and child for direct observation,
  psychological and behavior assessment,
  functional behavior analysis (natural setting), a
  treatment plan on developmental level, medical
  conditions, and familys strengths and weakness.

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• Comprehensive Plan Rehabilitation, Education,
• emotional needs, social stressors, familys
  needs,
• Psychiatric diagnosis and behavior problems,
• interdisciplinary teamwork with Special
  Education
• Program, Rehabilitation Therapy,
  Psychotherapy,
• Social Skills Training, Behavior Therapy,
  and
• Pharmacological Management

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Special Education
Programs

• -Small class size and one on one supervision
• -Record behavior, incorporate behavior management
  techniques, emotional support,
• modify curriculum, guidance counselor
  support.
• 
  Rehabilitation Therapy
• -Evidence for language impairments or inabilities
  effecting behavior problems like aggressiveness
  and SIB
• -Speech-language therapy and alternative
  communication systems
• -Physical and Occupational Therapy
• 
  Psychotherapy
• -MR underserved
• -Provides supportive relationship, self-esteem,
  social skills, emotional conflicts and problem
  solving,

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Social Skills Training -inappropriate
interactions, may be secondary to developmental
delays or disabilities, or part of a Psychiatric
disorder -to improve eye-contact, smiling, and
sharing, appropriate affection, awareness of
others emotions, Behavior Therapy -data-based
assessment in a persons natural social
environment with events, -functional behavior,
minimize reinforcement of inappropriate behavior
and reward adaptive -operant functional analysis
manipulates variables, and designs interventions
for control
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-Cognitive Behavior Therapy MR with high
functioning for anxiety disorder, phobias, or
depression - techniques to master
compulsive rituals -Pharmacological Management
-1950s tranquilizer abuse
-Antidepressants, newer agents serotonin
reuptake inhibitor like Prozac, Zoloft,
and Paxil -OCB lessened by Anafranil
-Stereotypic Behavior with Autism and MR with
serotonergic medication -Stimulant
Ritalin and Dexedrine for ADHD (side
effects irritability, sleep, stereotypies, and
maybe ineffective with MR
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-Antipsychotic Mellaril and Haldol for mania and
schizophrenia (debated with MR)
-several have serious side effects on a
long-term -Mood Stabilizers lithium and
antiepileptic drug (Tegretol, Depakene,
and Depakote) for Bipolar and cyclical
mood with MR -evidence in controlling SIB
and aggression with opiate antagonists
and beta adrenergic blockers Psychoactive
medication identified, periodically
reevaluated, adequate trial, avoid multiple
medications, and careful monitoring