Famacos en adultos con discapacidad intelectual

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  • Publicado : 13 de mayo de 2010
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International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities
SHOUMITRO DEB,1,2 HENRY KWOK,1,3 MARCO BERTELLI,1,4 LUIS SALVADOR-CARULLA,1,5 ELSPETH BRADLEY,1,6 JENNIFER TORR,1,7 and JARRET BARNHILL1,8
FOR THE GUIDELINE DEVELOPMENT GROUP OF THE WPA SECTION ON PSYCHIATRY OF INTELLECTUAL DISABILITY
1WPA Section onPsychiatry of Intellectual Disability
2Department of Psychiatry, University of Birmingham, 25 Vincent Drive, Birmingham B15 2FG, UK
3Kwai Chung Hospital, Hong Kong, China
4Italian Society for the Study of Mental Retardation, Florence, Italy
5University of Cadiz, Spain
6Department of Psychiatry, University of Toronto, Canada
7Monash University, Melbourne, Australia
8University of North CarolinaSchool of Medicine, Chapel Hill, NC, USA
•  Other Sections▼
o Abstract
o THE INTERNATIONAL GUIDE
o FUTURE DIRECTIONS
o References
Abstract
Psychotropic medications are used regularly to manage problem behaviours among people with intellectual disabilities. This causes concern because often these medications are used out of their licensed indicationsin this context. The WPA Section on Psychiatry of Intellectual Disability has recently developed an evidence and consensus-based international guide for practitioners for the use of psychotropic medications for problem behaviours among adults with intellectual disabilities. This guide advises on assessment of behaviours, producing a formulation, initiation of treatment, assessment of out-come andadverse effects, follow-up arrangements, and possibility of discontinuation of treatment.
Keywords: Intellectual disabilities, problem behaviours, psychotropic medications, international guide
•  Other Sections▼
o Abstract
o THE INTERNATIONAL GUIDE
o FUTURE DIRECTIONS
o References
 
Intellectual disability (ID) or mental retardation or learningdisability is a lifelong condition included in the group of mental disorders in all the international classification systems. It is a syndrome grouping (meta-syndrome) including a heterogeneous range of clinical conditions characterized by a deficit in cognitive functioning prior to the acquisition of skills through learning 1. Over 30% of people with ID have a comorbid psychiatric disorder, which oftenhas its onset in childhood and persists through adolescence and adulthood 2,3.
In spite of this evidence, ID and related conditions are still considered a marginal area of psychiatry. In many countries there is little or no training provision on ID during undergraduate medical training or psychiatric specialization. The World Health Organization (WHO) has recently highlighted the unmet careneeds of persons with ID 4. Psychiatrists are the first health professionals in contact with this population group and there is a global gap in training and guidelines on mental health issues related to ID.
Within the ID field, the assessment, differential diagnosis and treatment of problem behaviours (PBs) deserve special attention. The rate of PBs in people with ID is high 5and their presentationis determined by many complex factors. The pathogenic contribution of organic conditions, psychiatric disorders, environmental influences, or a combination of these has to be carefully established for every single case.
The prevalence of PBs in people with ID seems to be sufficiently high 5,6to constitute a major concern in this population. Depending on the definition and methodology, rates havebeen reported to vary from 5.7 to 17% 7-10. Using the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities (DC-LD) 11, Cooper et al 12,13recently found the point prevalence of aggression and self-injurious behaviour to be 9.8% and 4.9%, respectively, among adults (16 years and over) with ID in a community setting.
It has been reported that 20-45% of people...
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