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Dual diagnosis
(DD and psychiatric illness) is also a relatively common clinical
finding. Estimates of the prevalence
of psychiatric illness in this population as, stated in the literature, vary
widely but in most cases are noted as being higher than that of the general
population. Individuals with or
without a formal diagnosis may exhibit behaviors of concern such as self
injury, pica, and aggression. The
services of a behavior analyst can be very helpful is elucidating the
function of these behaviors and formulating a plan to assist the individual
with avoiding injury or restraint and increasing functional communication. Depending on the degree of intellectual
impairment, the services of other types of therapists, e.g. counseling
psychologists, may be helpful.
Occasionally there will be a need for more specialized types of
therapy. In all cases it is most
helpful to engage the assistance of mental health professionals with specific
experience working with adults with DD.
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When
psychotropics are being considered, focused attention should be given to
their potential effect on function in a number of ways. If, for example, the person has
difficulties with ambulation, drugs which affect the sensorium may increase
the risk for falls and injury. Some
psychotropics (e.g. phenothiazines) may have effects on swallowing ability
and motility of other parts of the gut thus worsening dysphagia and/or constipation,
both common problems in this population.
All persons who are at risk should be screened and, if found, treated
for tardive dyskinesia. Finally,
whether or not the patient has been diagnosed with a seizure disorder, the
withdrawal of anticonvulsants being used as psychotropics should be done with
care as seizures could occur (see preceding discussion). Link to
psychotropic guideline here
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