As a consultant working in Intellectual Disability Psychiatry in Ireland, I have received most of my clinical information sources from the British Isles and Europe. I was therefore very pleased to review this book, in my area of interest, originating from the United States. It was written as a collaborative project by 13 professionals, who are mainly psychiatrists, with the majority being affiliated with Wright State University in Ohio. Dr Gentile and Dr Gillig edited the book. Dr Gentile is the Professor of Dual Diagnosis for the Ohio Department of Mental Health, among many other accolades, and also has extensive clinical, research and academic experience in the field of co-occurring mental illness and intellectual disabilities. Dr Gillig is Professor of Psychiatry at the Boonshoft School of Medicine, Wright State University, Ohio and she has written on the interface between psychiatry and neurology.
This is a comprehensive 376-page textbook and the 15 chapters cover a wide range of relevant topics. The foreword to the book points out that the field of intellectual disabilities is expanding along many fronts. Over the last 20 years, community-based placement has replaced large residential facilities in many states of America. This transformation has been accompanied by changes in treatment models, legal issues and ideology. There has been a restructuring of services with the aim of providing community programmes for many complex patients. However, availability and access to adequate care can be limited by poor distribution of qualified professionals and fragmentation of health care systems. There is now also a greater understanding of the neurodevelopmental and biopsychosocial substrates for psychiatric disorders and challenging behaviour.
The book opens with an overview of the history of intellectual disability and mental illness. Improvements in classification systems, current trends in nomenclature and the interface between intellectual disability and mental illness (dual diagnosis) are explored. The next chapters outline how to achieve a comprehensive psychiatric and medical assessment in an individual with intellectual disability. Neurological disorders and traumatic brain injury are explored in the following two chapters.
I found Chapter 6 about interviewing techniques, written by the editors themselves, very practical. I plan to introduce this chapter to all of my trainees as I think it will give them a greater understanding of the context of the developmental framework and how it can affect history taking and mental state examination. The next four chapters focus on psychiatric disorders seen in this patient group. Mood disorders, anxiety disorders, psychotic disorders and personality disorders (which can be a controversial area) are all discussed in detail.
The authors point out that challenging behaviour in the form of aggression in its various forms (verbal, physical, property destruction and auto-aggression) is the most frequent cause for mental health referrals. A chapter is therefore devoted to this topic, as the impact of aggression is significant. They outline the literature on challenging behaviour and a useful part of the chapter describes how to assess patients presenting to the emergency department. They also discuss comprehensive assessment and intervention strategies. The use of psychotropic medication in this situation and also in the treatment of mental illness in people with intellectual disability is appraised in depth.
The following chapter focuses on the use of psychotherapy in people with intellectual disability. The focus of the chapter is on the common issues of concern that may arise in treatment, barriers that complicate treatment and modifications in the provision of psychotherapeutic modalities. Behavioural assessment and treatment is covered in the next chapter. The final two chapters focus on the legal issues for treatment providers and the syndromes of intellectual disability.
This is an extremely well researched and referenced textbook which tallies with my experience of current psychiatric practice in the field of intellectual disabilities. What I thought worked very well were the real world vignettes in each chapter, which brought the text to life. They were multifaceted and interesting and they highlighted the depth of experience that the authors brought with them in writing this book. The authors emphasise the biopsychosocial approach and use of structured assessments but also the importance of development of clinical skills. This book is aimed at all psychiatrists and trainees managing patients with dual diagnosis of intellectual disability and psychiatric disorder to assist in improving their practice. There are few books that cover this area in such detail. It brings a wealth of knowledge together and any psychiatrist treating this complex patient group would benefit from having the book in their collection.
