Transcript Psychiatric manifestations of medical problems in adults with

Psychiatric manifestations
of Medical Problems in Adults with
Intellectual Disability
Shirley Portuguese MD MHA
BINA Clinic, Beer Yaakov Psychiatric center
Content
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BINA Clinic
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Psychiatric Comorbidities in ID
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Physical Comorbidities in ID
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Psychiatric Manifestations of medical problems – case studies
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How to Prepare for the Psychiatrist ?
BINA Clinic
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Beer Yaakov outpatient clinic
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Multidisciplinary model by a joining psychiatrist
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References including: Welfare municipal Units, service
suppliers, child and adolescent psychiatric clinics, special
Education facilities, etc.
ID Psychiatric Comorbidities
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Up to 2/3 of ID adults have comorbid psychiatric disorder
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Prevalent - Mood disorders, Autism, ADHD, Schizophrenia
and Conduct disorder
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The more severe the disability the higher the rate of
psychiatric disorders.
Common Medical Manifestations in ID
Physical maintenance
Hygiene, vision, hearing, dental problems
Genetically related
Down syndrome - heart, ear, eye, thyroid, blood, GI etc
Tuberous sclerosis - brain, kidney, etc
Fragile X - ear, sinus, eye, seizures, ADHD etc
Common Medical Manifestations in ID
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Stress related - Peptic ulcer, Myocardial infarction etc
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Sedentary Lifestyle - metabolic syndrome, sleep apnea etc
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Iatrogenic – including medication side effects :
- Antipsychotic (eg Risperidone) akathisia, dystonia etc
- Benzodiazepine (eg Clonex) drowsiness, coordination etc
Abstract
Up to two thirds of adults with intellectual disability have a comorbid
psychiatric disorder, including mood disorders, autism, ADHD,
schizophrenia and conduct disorder. The more severe the disability the
higher the rate of psychiatric disorders. The presentation of medical
problems can mimic psychiatric signs and symptoms thus hinder proper
diagnosis and treatment. Medical causes can include medication side
effects (such as antipsychotic medications causing dystonia or akathisia),
metabolic deficits (such as diabetes and vitamin deficiencies), sleep
disorders (such as sleep apnea syndrome) and many more. Medical
problems might be masked by language and communication thus not
addressed by the general practitioner. A psychiatrist specializing in adults
inflicted by intellectual disability should be aware of possible physical
diseases that might mimic psychiatric disorders allow for a better
medical care.
Patient A
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50 y female with ID (moderate) from hostel
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Primary Complaint- Anxiety 3 months not improved by SSRI
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History- Picky eater, vegetarian, severe menstruation
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Interview – Anxious, irritable, fatigue, refuses to work
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Physical examination – warm clothes, pale, pulse 90/min
Patient A Diagnosis - Anemia
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Treatment- Food supplements (iron, B12), stop bleeding
Patient B
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42 y female ID (severe) from hostel
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Primary Complaint- Eating problems 1 mo, food cut for her
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Interview - Slowness, back aches, Odd gait
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Physical- muscles spasms of lower back and jaw
Patient B Diagnosis –Dystonia
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Risperidone started 1 mo due to behavioral disturbances
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Antipsychotic side effects include Dystonia
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Treatment- stop Risperidone if possible
Try Anticholinergic medications
Patient C
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35y Male with Down’s syndrome
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Complains- Cognitive decline inc. memory and concentration
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Family crisis 3 years ago -> depressive symptoms and
behavioral disorders.
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Received SSRI -> Zyprexa. Gained 20 kg in 2 years.
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Interview- sleepiness, low concentration
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Mother says he snores
Patient C diagnosis - Sleep Apnea syndrome
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Obstruction of larynx causing decline in oxygen delivery to the brain
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Results- sleepiness, decline of concentration & attention, depression,
anxiety etc
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Childhood – Large Adenoids, Adulthood – Obesity
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Treatment – CPAP (mask during sleep)
Patient D
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27y Female with ID
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Complains- Irritability, Anger outbursts, preoccupation
with toilet, wet herself for 2 weeks
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Received Benzo -> worsening of wetting.
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Interview- has an new boyfriend in hostel, abdominal pain
especially during urination
Patient D diagnosis
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Urine sample- Urinary Tract infection
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Symptoms – persistent urge to urinate, burning sensation
while urinating, frequent urination, pelvic/ rectal pain
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Treatment- Oral antibiotics
Medical issues to address Before
attending a Psychiatrist
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Vision & Hearing
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Pain and discomfort (inc. teeth, ears, abdomen)
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Blood pressure, pulse
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Blood Tests – blood count, liver and kidney function, TSH,
B12, Folic acid, Glucose
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Complete medical history including medications and
family history, preferably GP visit
QUESTIONS?