Greetings to all our subscribers! Thank you for supporting our publications. As Editor-in-Chief of TCPR, I’ll always be here to ensure you get independent and practical content with each issue.

In this month’s issue, we cover a surprisingly neglected topic in psychiatry: How do we interview and treat patients who are intellectually disabled? Personally, when such patients come into my office, I feel at a loss: They are often accompanied by group home staff bearing a stack of forms for me to fill out, and it’s not clear how to approach communicating with patients whose verbal skills are limited. I decided to get some advice, and what better way to do so than to find the country’s best experts to help create a dedicated issue on the topic? The guidance they offer has already helped me in my practice, and I hope you’ll find it useful too—let me know either way. I always love to hear directly from subscribers, so feel free to email me with your thoughts at dcarlat@thecarlatreport.com.

Take Home Points From This Issue

 

Tips for communicating with ID patients

• Talk directly to patients; they may not be able to talk much, but they can usually understand what’s being said


• Ask patients’ permission before discussing issues with their collateral contacts


• Use patients’ mean length of utterance—eg, if a patient communicates in sentences of 6–8 words, you should do the same


• To get more accurate information, use cross-questioning (ask about something in more than one way). Eg: Ask, “Do you sleep at night?” followed by, “Do you ever have problems sleeping?”


• Ask one question at a time, avoiding multiple-choice questions and double-barreled questions


• Link questions to salient events to help jog memory

 

Tips for psychopharmacology treatment Items to assess for

• Psychosocial issues, such as staff turnover, changes in family contact, or other alterations in routine


• Medical issues, such as GERD, constipation, infections, dental conditions, or reactions to new medications


• Psychiatric disorders underlying challenging behaviors, such as anxiety, depression, and psychosis

 

Points to consult with staff/family about

• Establishing a timeline of medication trials


• Tracking specific symptoms and behaviors for several weeks after making medication changes

 

Specific medications to recommend for ID patients

• Antipsychotics: aripiprazole, lurasidone, ziprasidone


• Antidepressants: escitalopram, sertraline


• Mood stabilizers for agitation: valproate, lithium


• Adjunctive agents: alpha agonists, beta blockers, ­naltrexone

 

Psychotherapy tips for working with challenging ­behaviors in ID

Challenging behaviors are common in ID patients and may be related to underlying mood disorders, psychotic disorders, and general difficulty modulating emotions. They may include self-harm or assault, stealing, fire-setting, and sexual offenses. Suggestions include:

• Use DBT and skill systems training


• Have clients rate feelings


• Teach emotion regulation skills, such as mindfulness, on-track thinking and actions, a safety plan, and “new-me ­activities”