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Background: The assessment of schizophrenia in autistic people with intellectual disabilities is challenging. This study aimed to explore the identification of schizophrenia in this population. Methods: Using data from a clinical multi-centre study, reported symptoms in 26 autistic individuals with intellectual disabilities diagnosed with co-occurring schizophrenia were explored. Scores on two checklists (Psychopathology in Autism Checklist [PAC], Aberrant Behaviour Checklist [ABC]) were compared with two comparison groups: autistic individuals with intellectual disabilities and other mental disorders (94), or no mental disorder (63). Results: Reported symptoms of schizophrenia in this population met the formal diagnostic criteria. For PAC/ABC scales, only PAC psychosis differed for the schizophrenia group. Among participants with schizophrenia, two were diagnosed with additional mental disorders. Elevated scores for anxiety and depression were common. Conclusions: Emphasising core symptoms seems necessary when assessing co-occurring schizophrenia in autistic people with intellectual disabilities. The PAC may serve as a helpful screening tool.

Psychosocial treatments like psychotherapy and group therapy are common for the treatment of depression in the general population. Depression in people with intellectual disability presents challenges, because people with intellectual disability often cannot consent to various treatments, clinicians and family members must be involved and use their best judgment. A selected review was conducted to highlight the progress in psychosocial treatment of depression within the last four decades. The main search terms were intellectual disability (ID), depression, and treatment. Nine articles were chosen; and included cognitive behaviour therapy (CBT), computer-assisted CBT, mindfulness-based cognitive therapy (MBCT), exercise therapy, behaviour activation, self-help intervention, dialectal behaviour therapy (DBT), and psychodynamic/psychoanalytical therapy. There were no articles on mental health nursing. Adaptions included smaller groups (in group intervention), visual material, simplifying of concepts, longer duration/more sessions, more practical help, more repetitions when learning new skills, more guiding, professional caregiver/family involvement, and individual support within group interventions.

Assessment of schizophrenia (SCZ) in people with autism spectrum disorder (ASD) is complicated due to confounding symptoms between ASD and SCZ. These confounding factors are aggravated when the patient has sparse verbal skills. A selective review was conducted to identify behavioural equivalents when assessing SCZ in individuals with ASD with sparse verbal skills, from 16 years of age. Only clinical papers were reviewed. Eight relevant articles were analysed for the use of behavioural equivalents in clinical settings. The results showed that especially disorganized speech and behaviour and negative symptoms can be observed in patients with SCZ and ASD who speak sparsely. It is not possible to observe delusions, but they may be reported by the patients when treated adequately for some time, usually months. Hallucinations cannot be observed directly, but 'hallucinatory behaviour' may be interpreted as hallucinations when observed concurrently with other SCZ symptoms. Additionally, age of onset and marked impaired global functioning compared to habitual functioning may constitute a diagnosis of SCZ in ASD. ASD is considered a lifelong condition and may be identified within the first 3-4 years, while SCZ onset is usually in adolescence or early adulthood.

Introduction: Anxiety disorders are highly prevalent in individuals with autism spectrum disorder (ASD), but knowledge is limited regarding identification and treatment of these disorders in individuals with ASD and more severe levels of intellectual disability (ID). The current case study aims to explore and describe the inpatient, psychiatric assessment in an adolescent male with ASD, severe ID and self-injurious behaviour (SIB) who was diagnosed with a co-occurring anxiety disorder. The study further aims to explore the implications of this diagnosis for subsequent intervention and care, including management of SIB. Materials and methods: Case study including multimodal, psychiatric assessment and subsequent intervention. Results: Following changes in care strategies attempting to incorporate the understanding of anxiety/trauma as contributing to SIB, a reduction of SIB was observed, and this reduced frequency was maintained when the patient was discharged from the inpatient setting. Conclusions: Though no causal inferences are possible, these experiences indicate that further research is needed regarding possible associations between SIB and anxiety in individuals with ASD, including implications for treatment. Experiences from the current case further indicate that it is possible to recognize and diagnose anxiety disorder in complex cases involving ASD, severe ID, limited verbal language skills, and severe SIB.

Background: Patients with intellectual disability in psychiatric services are rarely asked about their experiences when admitted to inpatient units. Aim: To enhance the understanding of ward atmosphere for inpatients with co-occurring intellectual disabilities (ID) and mental illness by exploring patients' experiences from a specialised mental health inpatient unit. Methods: A selected sample of 10 adults with comorbid mental illness and ID were recruited for a qualitative interview study based on Gunderson's conceptualisation of therapeutic components in mental health wards. The patients were interviewed by two experienced clinicians and interviews were analysed using directed content analysis. Results: Patients' experience of their relationships with ward staff seemed central to their experiences of several aspects of mental health nursing. Feeling safe, contained, and validated, were further important aspects. However, the patients seemed to have little influence on treatment choices and did not report participating in shared decision-making. Conclusions: The patients' answers in this study are in line with previous research on ward atmosphere for patients in the general population. However, more research is necessary to inform future mental health nursing for patients with ID, both in inpatient and ambulatory services.

Background: Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post-traumatic stress disorder (PTSD). However, knowledge regarding identification of PTSD in this population is limited. The aim of this study was to investigate clinical experience regarding PTSD and trauma assessment in individuals with co-occurring ASD and ID. Method: Interpretative phenomenological analysis was used to explore experiences of identifying PTSD in this population among 18 mental health clinicians working with ASD and ID. Results: Informants viewed PTSD in individuals with ASD and ID as equivalent to PTSD in the general population, but with causes and expressions potentially differing. Several factors were described to contribute to challenges in identification. Conclusions: Trauma may have severe impact in individuals with ASD and ID. Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma-related symptoms in this population.

Introduction: Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) seem to be at increased risk for post-traumatic stress disorder (PTSD), but knowledge is sparse regarding its identification in this population. Previous research indicates that certain symptoms of PTSD may be more easily recognized, and that identifying reexperiencing and avoidance is particularly challenging. Methods: Interpretative phenomenological analysis was used to explore 18 experienced clinicians' perceptions of PTSD symptom expression in ASD and ID through individual, qualitative interviews. Results: Informants provided examples from all symptom groups, but these differed in how frequently they were described. Recognition of reexperiencing may rely on knowledge about individuals' trauma experience. Avoidance may present in a wider range of ways. Conclusion: Development of reexperiencing and avoidance may follow different trajectories in this population, contributing to challenges in recognition. Reexperiencing may be more severe in ASD/ID. Implications are discussed in light of current diagnostic criteria.

Introduction: autism spectrum disorder (ASD) and intellectual disability (ID) seem to influence the risk of and vulnerability to exposure to trauma and adverse events. While assessment of a psychiatric disorder in ASD and ID generally is challenging, identification of post-traumatic stress disorder (PTSD) seems particularly so, and knowledge does not seem easily accessible. Methods: This article provides a systematic review of studies describing trauma reactions in individuals with both ASD and ID, including studies involving any single case with the combination of ASD, ID, and PTSD. To systematically explore PTSD symptom presentation in the group, all reported symptoms from studies were assigned by DSM-5 criteria. Results: Eighteen studies met the inclusion criteria, eight group studies and 10 case studies. Assessment methodology in studies varied, as did the format of symptom report. DSM-5 criteria provided a useful framework for integrating findings across studies, indicating that PTSD may be identified in individuals with ASD and ID. However, symptoms involving alterations in arousal and negative alterations in thought and behavior seem more easily identified than symptoms of reexperiencing and avoidance. Conclusions: There is an urgent need to identify behavioral equivalents to PTSD symptoms in this group, making it possible to identify warning signs of trauma and abuse even if such incidents are not known to family or professional carers.

Background: People with 22q11.2 deletion syndrome (DS) are assumed to be especially vulnerable to developing mental illness such as psychosis. Aim: The study was established to contribute to knowledge about metyrosine medication in patients with 22q11.2 DS and psychosis. Methods: A case study was established including a woman with intellectual disability, 22q11.2 DS, and psychosis. Metyrosine medication was implemented, as conventional anti-psychotic medication was unsuccessful. Results: Effect of metyrosine medication included both psychotic symptom relief with decreased aggressive behaviour. Adjunctive milieu therapy contributed to compliance. Conclusion: For patients with 22q11.2 DS and psychosis, metyrosine medication may prove effective. However, there are significant ethical dilemmas related to metyrosine medication for psychotic symptoms.

Background: Mental health services for patients intellectual disabilities (ID) and additional mental illnesses are only sparsely studied. Objective: The objective was to describe a representative sample of patients with ID in a specialized psychiatric department. Methods: Data were collected from case files in a 7-year period. Of 143 invited patients, 133 participated. Results: More than 60% were admitted involuntarily. Schizophrenia was found in 30.1%, mood disorder in 25.6%, and anxiety disorders in 15.8%, Obsessive Compulsive Disorder (OCD) in 8.4% and Post Traumatic Stress Disorder (PSTD) in 12.9%, PD in 14.3%, and ADHD in 12%. Average waiting time was 6.1 months. Length of stay was 9.1 months for the inpatients. Conclusion: Services for patients with ID appear to still be reliant on inpatient units for at least a proportion of their patients. More research is needed to find out why this is. The results raise questions about referring, compliance between psychiatric diagnosis, and interventions.

Adults with autism and intellectual disability (ID) are assumed to have high vulnerability for developing psychiatric disorders, but instruments or criteria for identifying those who may be in need of psychiatric services have been lacking. This study presents a new carer-completed screening checklist designed for this purpose. Differentiation between symptoms related to autism and to psychiatric disorders is indicated in order to identify psychiatric disorders in persons with autism. The Psychopathology in Autism Checklist (PAC) contains 30 items representing symptoms previously evaluated as specific to one of four major psychiatric disorders (psychosis, depression, anxiety and OCD) and not related to autism. Twelve items evaluated as indicators of general adjustment problems are also included. All 42 items are based on ICD-10 and DSM-IV criteria. The PAC was piloted on a sample of 35 adults with autism and ID. The score of participants previously identified with co-occurring psychiatric disorders (i.e. psychosis, depression, anxiety disorder, or OCD) were compared with the score of participants without psychiatric disorders. The results indicate acceptable psychometric properties, and that the PAC discriminates between adults with autism and ID with and without psychiatric disorders, and partially between individuals diagnosed with different psychiatric disorders. (Contains 5 figures and 6 tables.)

Introduction: Anxiety disorders are highly prevalent in individuals with autism spectrum disorder (ASD), but knowledge is limited regarding identification and treatment of these disorders in individuals with ASD and more severe levels of intellectual disability (ID). The current case study aims to explore and describe the inpatient, psychiatric assessment in an adolescent male with ASD, severe ID and self-injurious behaviour (SIB) who was diagnosed with a co-occurring anxiety disorder. The study further aims to explore the implications of this diagnosis for subsequent intervention and care, including management of SIB. Materials and methods: Case study including multimodal, psychiatric assessment and subsequent intervention. Results: Following changes in care strategies attempting to incorporate the understanding of anxiety/trauma as contributing to SIB, a reduction of SIB was observed, and this reduced frequency was maintained when the patient was discharged from the inpatient setting. Conclusions: Though no causal inferences are possible, these experiences indicate that further research is needed regarding possible associations between SIB and anxiety in individuals with ASD, including implications for treatment. Experiences from the current case further indicate that it is possible to recognize and diagnose anxiety disorder in complex cases involving ASD, severe ID, limited verbal language skills, and severe SIB. [ABSTRACT FROM AUTHOR]

Background: The identification and treatment of psychiatric disorders in individuals with autism spectrum disorders (ASD) and ID presents many challenges. We describe the development of a professional network, together with a standardized protocol for clinical assessment, designed to promote clinical competence and professional development in eight clinical centers responsible for providing mental health services to autistic individuals with ID across all four health regions of Norway. Specific aims to describe: (1) patterns of psychiatric and behavior problems in patients treated by the network, (2) patterns of change over time, and (3) the relationship between psychiatric disorders and behavior problems. Method: A standardized protocol was used to assess individual progress in 132 patients (inpatients and outpatients) with autism and ID over 2 years (at referral (T1), after 1 year (T2), and after 2 years (T3)). Changes in psychiatric symptoms and behavior problems were assessed with the Psychopathology in Autism Checklist (PAC) and Aberrant Behavior Checklist (ABC). Results: Patients showed significant (p <.001) improvements from T1 to T2 on the psychosis, depression and anxiety subscales of the PAC, but no significant improvement on the obsessive compulsive disorder (OCD) subscale. Improvements were maintained from T2 to T3. Patients showed significant (p <.01) improvements on the ABC total score and on all ABC subscales except inappropriate speech from T1 to T2; these improvements were maintained from T2 to T3. Discussion The combination of a professional network and a standardized protocol for clinical assessment has promise as a strategy for improving professional competence and facilitating specialized mental health services for autistic individuals with ID and psychiatric disorders across an extensive geographical area. [ABSTRACT FROM AUTHOR]

Mental health services for patients intellectual disabilities (ID) and additional mental illnesses are only sparsely studied. The objective was to describe a representative sample of patients with ID in a specialized psychiatric department. Data were collected from case files in a 7-year period. Of 143 invited patients, 133 participated. More than 60% were admitted involuntarily. Schizophrenia was found in 30.1%, mood disorder in 25.6%, and anxiety disorders in 15.8%, Obsessive Compulsive Disorder (OCD) in 8.4% and Post Traumatic Stress Disorder (PSTD) in 12.9%, PD in 14.3%, and ADHD in 12%. Average waiting time was 6.1 months. Length of stay was 9.1 months for the inpatients. Services for patients with ID appear to still be reliant on inpatient units for at least a proportion of their patients. More research is needed to find out why this is. The results raise questions about referring, compliance between psychiatric diagnosis, and interventions. [ABSTRACT FROM AUTHOR]

Background: People with 22q11.2 deletion syndrome (DS) are assumed to be especially vulnerable to developing mental illness such as psychosis. Aim: The study was established to contribute to knowledge about metyrosine medication in patients with 22q11.2 DS and psychosis. Methods: A case study was established including a woman with intellectual disability, 22q11.2 DS, and psychosis. Metyrosine medication was implemented, as conventional anti-psychotic medication was unsuccessful. Results: Effect of metyrosine medication included both psychotic symptom relief with decreased aggressive behaviour. Adjunctive milieu therapy contributed to complience. Conclusion: For patients with 22q11.2 DS and psychosis, metyrosine medication may prove effective. However, there are significant ethical dilemmas related to metyrosine medication for psychotic symptoms. [ABSTRACT FROM AUTHOR]