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Chapter 15 - Management of Violence in People With Intellectual Disability
- from Section 4 - Management in Other Groups
- Edited by Masum Khwaja, Imperial College of Science, Technology and Medicine, London, Peter Tyrer, Imperial College of Science, Technology and Medicine, London
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- Book:
- The Prevention and Management of Violence
- Published online:
- 09 May 2023
- Print publication:
- 11 May 2023, pp 248-259
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Summary
Violent behaviour displayed by individuals with intellectual disability (ID) is one of the biggest challenges to services. It can cause serious consequences to the health and well-being of the individual and those involved in their care, including exclusion from services or social groups. There is a greater risk of violence in the ID population and aetiological causes include biological and psychosocial factors and developmental disorders such as ASD and ADHD. Key management strategies involve a review of these factors, robust risk assessments and collaborative working utilising a multidisciplinary approach. Psychological and behavioural support interventions offered should be person-centred and tailored according to their needs. The goal is to assess and modify psychological, environmental or social factors and improve challenging behaviour. Pharmacological treatment can be helpful where underlying physical or mental health illnesses contribute to aggression. In those without obvious causes of violent behaviour, psychotropic medication can be also used to attenuate risks; however, current evidence base is limited and medication options should be considered on a case-by-case basis.
COVID-19 deaths in people with intellectual disability in the UK and Ireland: descriptive study
- Bhathika Perera, Richard Laugharne, William Henley, Abigail Zabel, Kirsten Lamb, David Branford, Ken Courtanay, Regi Alexander, Kiran Purandare, Anusha Wijeratne, Vishwa Radhakrishnan, Eileen McNamara, Youshan Daureeawoo, Indermeet Sawhney, Mark Scheepers, Gordon Taylor, Rohit Shankar
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- Journal:
- BJPsych Open / Volume 6 / Issue 6 / November 2020
- Published online by Cambridge University Press:
- 16 October 2020, e123
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Background
Rapid spread of coronavirus disease 2019 (COVID-19) has affected people with intellectual disability disproportionately. Existing data does not provide enough information to understand factors associated with increased deaths in those with intellectual disability. Establishing who is at high risk is important in developing prevention strategies, given risk factors or comorbidities in people with intellectual disability may be different to those in the general population.
AimsTo identify comorbidities, demographic and clinical factors of those individuals with intellectual disability who have died from COVID-19.
MethodAn observational descriptive case series looking at deaths because of COVID-19 in people with intellectual disability was conducted. Along with established risk factors observed in the general population, possible specific risk factors and comorbidities in people with intellectual disability for deaths related to COVID-19 were examined. Comparisons between mild and moderate-to-profound intellectual disability subcohorts were undertaken.
ResultsData on 66 deaths in individuals with intellectual disability were analysed. This group was younger (mean age 64 years) compared with the age of death in the general population because of COVID-19. High rates of moderate-to-profound intellectual disability (n = 43), epilepsy (n = 29), mental illness (n = 29), dysphagia (n = 23), Down syndrome (n = 20) and dementia (n = 15) were observed.
ConclusionsThis is the first study exploring associations between possible risk factors and comorbidities found in COVID-19 deaths in people with intellectual disability. Our data provides insight into possible factors for deaths in people with intellectual disability. Some of the factors varied between the mild and moderate-to-profound intellectual disability groups. This highlights an urgent need for further systemic inquiry and study of the possible cumulative impact of these factors and comorbidities given the possibility of COVID-19 resurgence.
9 - Management of violence in people with intellectual disability
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- By Ingrid Bohnen, Central & North West London NHS Foundation Trust, Alina Bakala, Central & North West London NHS Foundation Trust, Yogesh Thakker, Central & North West London NHS Foundation Trust, Anusha Wijeratne
- Edited by Masum Khwaja, Dominic Beer
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- Book:
- Prevention and Management of Violence
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 89-95
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Summary
Violent behaviour displayed by individuals with intellectual disability is one of the biggest challenges to services. It is one of many manifestations of challenging behaviour. It may include punching, slapping, pushing, pulling, kicking, pinching, scratching, pulling hair, biting, head butting, using weapons, choking and throttling, and sexual violence. Violence can occur in a variety of settings: in in-patient and community-based settings such as family homes, settings run by statutory organisations as well as those in the private and voluntary sector. Children with intellectual disability and severe challenging aggressive behaviour may be placed in residential schools.
Violent behaviour has many serious consequences for both individuals with intellectual disability and formal and informal carers, and is a major obstacle to the individual's social integration. Violent behaviour is also one of the main reasons for referral to mental health professionals and services. Often violent behaviour leads to multiple admissions to institutions and psychiatric facilities. Staff working with individuals with intellectual disability who experience challenging behaviour, including violent behaviour, may experience high levels of stress and burnout (Jenkins et al, 1997; Male & May, 1997).
Epidemiology
Rates of violent and aggressive behaviour vary considerably across studies, ranging from 2% to 51% of those with intellectually disability population (Borthwick-Duffy, 1994; Emerson et al, 2001; Crocker et al, 2006). The differences in the prevalence of violence across studies were due to methodological variations that included factors such as study settings (e.g. institutional v. community), level of intellectual disability (profound intellectual disability to mild intellectual disability, as well as borderline intellectual disability), time-span surveyed (e.g. past month, past year or more) and age group (children, adolescents or adults) (McClintock et al, 2003).
Aetiology
Biological factors
Violent behaviour in people with intellectual disability can be driven by factors which also apply to those without intellectual disability (e.g. coexistent mental illness, substance misuse, certain personality disorders). Additional inherent factors arising from the intellectual disability such as poor regulation of frustration and anxiety can compound or act independently to trigger violent behaviour (Bhaumik et al, 2005).
Some specific biological factors which have been investigated with regard to their role in precipitating aggression in people with intellectual disability include epilepsy (Creaby et al, 1993), pain (Tenneij & Koot, 2008) and menstruation (Rodgers et al, 2006).
4 - Anxiety disorders
- from Part 2 - Disorders of intellectual development: comorbidity and complications
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- By Sherva Elizabeth Cooray, formerly Honorary Senior Lecturer, Faculty of Medicine, Department of Mental Health, Alina Bakala, Consultant Psychiatrist, Central and North West London NHS Foundation Trust (NHS), UK, Anusha Wijeratne, Consultant Psychiatrist, Central and North West London NHS Foundation Trust (NHS), UK
- Edited by Marc Woodbury-Smith
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- Book:
- Clinical Topics in Disorders of Intellectual Development
- Published online:
- 01 January 2018
- Print publication:
- 01 October 2015, pp 58-71
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Summary
Anxiety is a universal human experience. It may be defined as a feeling of worry, nervousness or unease about something that has an uncertain outcome. A distressing emotion, consisting of both psychological and somatic manifestations and hyperarousal, it is frequently accompanied by behavioural reactions (Gabbard, 2014). At optimal levels, it is normal, motivational and protective and it is helpful in coping with adversity (the Yerkes–Dodson law; Yerkes & Dodson, 1906). Anxiety differs from fear, in that fear is a focused and direct response to a specific event or object that the person is consciously aware of. DSM-5 defines anxiety as: ‘anticipation of future threat’ and fear as ‘the emotional response to real or perceived imminent threat’ (American Psychiatric Association, 2013). Under ‘anxiety disorders’ it includes disorders that share features of excessive fear and anxiety and related behavioural disturbances, and the overlapping nature, similarities and differences between fear and anxiety are highlighted. Anxiety disorder, or pathological anxiety, occurs when the intensity or duration of anxiety is disproportionate to the potential for harm, or in the absence of recognisable threat to the individual. It involves increased levels of arousal, which has the effect of disorganising rather than facilitating an individual's performance. DSM-5 anxiety disorders include panic disorder, agoraphobia, specific phobias, generalised anxiety disorder, social phobia, obsessive–compulsive disorder (OCD), acute traumatic stress disorder and post-traumatic stress disorder (PTSD), anxiety disorder due to a general medical condition and substance-induced anxiety disorder.
Epidemiology
With a lifetime prevalence of 28.8% (Kessler, 2005), anxiety ranks among one of the most common categories of mental disorder reported in largescale epidemiological studies in the general population (Robins & Regier, 1991; Jenkins et al, 1997; Kessler, 2005). In primary care in the UK, where about a third of the annual 280 million consultations relate to mental health problems (Royal College of General Practitioners, 2006), anxiety and depression account for 80% of these consultations (Cooper, 1972). Nevertheless, there is general agreement that recognition rates of these conditions in primary care could be improved (Tylee & Walters, 2007). Untreated, anxiety disorders are costly to the individual and society.
Violence against psychiatrists by patients: survey in a London mental health trust
- Saleh Dhumad, Anusha Wijeratne, Ian Treasaden
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- Journal:
- Psychiatric Bulletin / Volume 31 / Issue 10 / October 2007
- Published online by Cambridge University Press:
- 02 January 2018, pp. 371-374
- Print publication:
- October 2007
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Aims and Method
A survey was undertaken to investigate assaults of psychiatrists by patients in a 12-month period. Surveys were sent to 199 psychiatrists representing all sub-specialties and grades in a London mental health trust.
ResultsThere were 129 returned responses (response rate 64.8%). In the 12-month study period, 12.4% of all psychiatrists and 32.4% of senior house officers were assaulted. None received or took up offers of formal, as opposed to informal, psychological support. Most assaults occurred on a psychiatric ward. Vulnerability to assaults was not influenced by courses on prevention and management of violence or by the attitudes of psychiatrists to violence by psychiatric patients.
Clinical ImplicationsSenior house officers are most vulnerable to assaults. Greater attention may need to be given to psychiatric wards where most assaults occurred. Trusts should ensure that those assaulted are identified and offered support.