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Psychiatric Morbidity in Older People with Moderate and Severe Learning Disability

II: The Prevalence Study

Published online by Cambridge University Press:  02 January 2018

Pradip Patel ,
David Goldberg  and
Steve Moss
Pradip Patel
Affiliation:
Hester Adrian Research Centre, University of Manchester
David Goldberg
Affiliation:
Institute of Psychiatry, London
Steve Moss*
Affiliation:
Hester Adrian Research Centre, University of Manchester, Oxford Road, Manchester M13 9PL
*
∗Correspondence
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Abstract

We present a prevalence study of psychiatric morbidity in people over 50 years of age with learning disability (LD), using a new semistructured clinical interview specifically for use with people who have LD (the ‘PAS-ADD’). Assessment involved parallel interviewing of subject and informant, these two sets of information being combined to reach a final diagnosis using ICD-9 and DSM-III-R criteria. Detection of dementia involved interviews with informants, plus investigation of loss of cognitive function over a three-year period. The experimental sample was a mixed community and institutional group (n = 105), including, as far as possible, all people in a single administrative district (Oldham) matching the age and ability criteria. Prevalence of psychiatric disorder excluding dementia was 11.4% (n = 12), most of which were depression and anxiety. Seventy-five per cent of these cases were unknown to mental health services. However, immediate care staff were usually aware of the symptoms, although often unaware of their clinical significance. Prevalence of dementia was also 11.4% (n = 12), with a combined case prevalence of 21.0% (n = 22). The PAS-ADD proved a flexible interview, effective in use with people of varying linguistic level and intellectual ability: 61.9% (n = 65) of the sample were able to be interviewed, fully adequate clinical interviews being obtained with a group of 38 people whose mean IQ was only 39. In the remaining 38.1% (n = 40), diagnosis relied exclusively on informant data. Overall, the combination of subject and informant data was essential for sensitive case detection.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 163 , Issue 4 , October 1993 , pp. 481 - 491
Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Baker, B., Seltzer, G. B. & Seltzer, M. M. (1977) As Close as Possible: Community Residences for Retarded Adults. Boston: Little, Brown, and Co.Google Scholar
Burger, P. C. & Vogel, F. S. (1973) The development of pathologic changes of Alzheimer's disease and senile dementia in patients with Down's syndrome. American Journal of Pathology, 73, 457–468.Google ScholarPubMed
Campbell, M. & Malone, R. P. (1991) Mental retardation and psychiatric disorders. Hospital and Community Psychiatry, 42, 374–379.Google ScholarPubMed
Corbett, J. A. (1979) Psychiatric morbidity and mental retardation. In Psychiatric Illness and Mental Handicap (eds James, F. E. & Snaith, R. P.). London: Gaskell.Google Scholar
Day, K. (1985) Psychiatric disorder in the middle-aged and elderly mentally handicapped. British Journal of Psychiatry, 147, 660–667.CrossRefGoogle ScholarPubMed
Dean, C., Surtees, P. & Sashidharan, S. P. (1983) Comparison of research diagnostic systems in an Edinburgh community sample. British Journal of Psychiatry, 142, 247–256.Google Scholar
Ellis, W. G., McCulloch, J. R. & Corley, C. L. (1974) Presenile dementia in Down's syndrome. Neurology, 24, 101–106.CrossRefGoogle ScholarPubMed
Feighner, J. P., Robins, E., Guze, S. B., et al (1972) Diagnostic criteria for use in psychiatric research. Archives of GeneraI Psychiatry, 26, 57–63.Google Scholar
Gask, L. (1988) The Psychiatric Assessment Schedule (PAS) (revised). Manchester: Department of Psychiatry, Manchester University.Google Scholar
Gianturko, D. T. & Busse, E. W. (1978) Psychiatric problems encountered during a long-term study of normal ageing volunteers. In Studies in Geriatric Psychiatry (ed. Isaacs, A. D.). Chichester: Wiley.Google Scholar
Goldberg, D. & Huxley, P. (1980) Mental Illness in the Community. London: Tavistock Publications.Google Scholar
Goldberg, D. & Huxley, P. (1992) Common Mental Disorders: A Bio-social Model. London: Routledge.Google Scholar
Greenwich Directorate of Social Services (1991) Options for Change: Proposals for the Future Development of the Day Care Service for People with a Learning Disability in the London Borough of Greenwich. London: Greenwich Social Services.Google Scholar
Heaton-Ward, A. (1977) Psychosis in mental handicap. British Journal of Psychiatry, 130, 525–533.CrossRefGoogle ScholarPubMed
Hogg, J., Moss, S. & Cooke, D. (1988) Ageing and Mental Handicap. London: Chapman.Google Scholar
Hogg, J., Moss, S. & Cooke, D. (1993) The applicability of the Kaufman Assessment Battery for children (K-ABQ with older adults (50+ years) with mental retardation. Journal of Intellectual Disability Research, (in press).Google Scholar
Horne, M. (1989) Identifying ‘hidden’ populations of older adults with mental handicap: outreach in the U.K. Australian and New Zealand Journal of Development Disabilities, 15, 207–218.CrossRefGoogle Scholar
Iverson, J. C. & Fox, R. A. (1989) Prevalence of psychopathology among mentally retarded adults. Research in Developmental Disabilities, 10, 77–83.Google Scholar
Jorm, A. F. & Korten, A. E. (1988) Assessment of cognitive decline in the elderly by informant interview. British Journal of Psychiatry, 152, 209–213.CrossRefGoogle ScholarPubMed
Kiernan, C. & Moss, S. C. (1990) Behavioural and other characteristics of the population of a mental handicap hospital. Mental Handicap Research, 3, 3–20.CrossRefGoogle Scholar
Lund, J. (1985) The prevalence of psychiatric morbidity in mentally retarded adults. Acta Psychiatrica Scandinavica, 72, 563–570.CrossRefGoogle ScholarPubMed
Menolascino, F. J. (1989) Clinical care update: model services for treatment/management of the mentally retarded - mentally ill. Community Mental Health Journal, 25, 145–155.Google Scholar
Moss, S. C. (1991) Age and functional abilities of people with a mental handicap: evidence from the Wessex mental handicap register. Journal of Mental Deficiency Research, 35, 430–445.Google Scholar
Moss, S. C. & Hogg, J. (1989) A cluster analysis of support networks of older people with severe intellectual impairment. Australian and New Zealand Journal of Developmental Disabilities, 15, 169–188.Google Scholar
Moss, S. C. & Hogg, J. & Goldberg, D. P. (1991) The Psychiatric Assessment Schedule for Adults with a Developmental Disability (the PAS- ADD): Interview Development and Compilation of the Clinical Glossary (Project proposal to the DOH). Manchester: HARC, University of Manchester.Google Scholar
Moss, S. C. & Hogg, J. & Goldberg, D. P., & Patel, P. (1991) Psychiatric and Physical Morbidity in Older People with Severe Mental Handicap. Manchester: HARC, University of Manchester.Google Scholar
Moss, S. C. & Hogg, J. & Goldberg, D. P., & Patel, P., et al (1992a) Physical morbidity in older people with moderate, severe and profound mental handicap, and its relation to psychiatric morbidity. Social Psychiatry and Psychiatric Epidemiology, 28, 32–39.CrossRefGoogle Scholar
Moss, S. C. & Hogg, J. & Goldberg, D. P., & Patel, P., Hogg, J. & Horne, M. (1992b) Demographic characteristics of a population of people with moderate severe and profound intellectual disability (mental handicap) over 50 years of age: age structure, IQ and adaptive skills. Journal of Intellectual Disability Research, 36, 387–401.CrossRefGoogle ScholarPubMed
Moss, S. C. & Hogg, J. & Goldberg, D. P., & Patel, P., Hogg, J. & Horne, M. (1993) Individual characteristics and service support of older people with moderate, severe and profound learning disability with and without Community Mental Handicap Team support. Mental Handicap Research, 6, 3–17.CrossRefGoogle Scholar
Nihira, K., Foster, R., Shellhaas, M., et al (1974) AAMD Adaptive Behavior Scale, 1974 revision. Washington, DC: American Association on Mental Deficiency.Google Scholar
Olson, M. I. & Shaw, C. M. (1969) Presenile dementia and Alzheimer's disease in mongolism. Brain, 92, 147–156.CrossRefGoogle ScholarPubMed
Reiss, S. (1990) Prevalence of dual diagnosis in community-based day programs in the Chicago metropolitan area. American Journal on Mental Retardation, 94, 578–585.Google Scholar
Reiss, S., Levitan, G. W. & Szyszko, J. (1982) Emotional disturbance and mental retardation: diagnostic overshadowing. American Journal of Mental Deficiency, 86, 567–574.Google ScholarPubMed
Solitaire, G. B. & Lamarche, J. B. (1966) Alzheimer's disease and senile dementia as seen in mongoloids: neuropathological observations. American Journal of Mental Deficiency, 70, 840–848.Google Scholar
South Edinburgh Group (1992) The Needs of Older People with Learning Difficulties. Edinburgh: Lothian Regional Council Department of Social Work.Google Scholar
Soyner, R. & Hurley, D. A. (1983) Do the mentally retarded suffer from affective illness? Archives of General Psychiatry, 40, 61–67.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) Measurement and Classification of Psychiatric Symptoms. An Instruction Manual for the PSE and catego Program. Cambridge: Cambridge University Press.Google Scholar
World Health Organization (1967) Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, 1965 revision (8th edn) (ICD-8). Geneva: WHO.Google Scholar
World Health Organization (1978) Mental Disorders. Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). Geneva: WHO.Google Scholar
World Health Organization (1992) Schedules for Clinical Assessment in Neuropsychiatry. Geneva: WHO.Google Scholar
Zigman, W. B., Seltzer, G. B., Adlin, M., et al (1990) Physical, behavioral, and mental health changes associated with aging. In Aging and Developmental Disabilities: Challenges for the 1990s (eds Janicki, M. P. & Seltzer, M. M.). Washington: Special Interest Group on Aging, AAMR.Google Scholar
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