Psychiatric Disorders Among Individuals with Intellectual Disabilities
Moderator: Robert Fletcher, DSW, Executive Director, NADD Presenter: Jarrett Barnhill, MD

A general discussion of drug pharmacokinetics and the ways psychotropic drugs act on the brain will be given. General categories of psychotropic medications will be discussed. Presentation of drug reactions/side effects as behavioral problems will be outlined. A general discussion of commonly used herbal remedies will be presented.

The role of each member of the interdisciplinary team in successful use of psychotropic drug programs will be presented. Handout materials will include cross-indexed, referenced lists of presently available psychotropic medications and their uses and crossword puzzles reinforcing important drug concepts.

Educational Objectives

Participants will be able to answer the following questions:

• How do general principles of brain function relate to psychotropic medications and their side effects?
• How do medications get into the body, and how does this affect how they work?
• How do different classes of psychotropic medications act on the brain?
• What general sorts of drug reactions frequently occur and how may this show up as behavior problems?
• What herbal remedies are frequently used for psychiatric purposes and what is the scientific basis for their use?

This presentation will provide a clinical update and review of primary psychiatric disorders in individuals with intellectual disabilities. The focus is on clinical symptoms and the process of differential diagnosis. Mood Disorders are a heterogeneous group of psychiatric disorders that can be classified based on genetic vulnerability, age of onset, comorbidity with other neuropyschiatric disorders, severity of symptoms, changes in endocrine function, and polarity.

Differentiating the sub-types of anxiety and other disorders according to clinical presentation will be discussed, along with bio-psychosocial approaches to treatment. The differential diagnosis of psychotic disorders is complicated by the degree of intellectual disability, associated neurological and metabolic disorders, and problems with the validity of diagnosis.

The underlying neurobiology of positive and negative symptoms, recent research in neuroimaging, and neurochemistry, as well as the emergence of new treatments will be reviewed. Self-injurious behavior, aggression, and a range of disruptive, repetitive behaviors are now being scrutinized. The differential diagnosis of repetitive, disruptive and occasionally destructive behaviors involves a step-wise process. Discussion and clinical examples will be used throughout this presentation.

Educational Objectives

Upon completion of this symposium, the clinician will be able to:

• Discuss the process of differential diagnosis of psychiatric disorders using behavioral and direct observational input.
• Differentiate anxiety and mood disorders based on clinical history and changes in target symptoms.
• Discuss the differential diagnosis of psychotic disorders, especially delirium, schizophrenia, and psychotic mood disorders.
• Integrate clinical findings into a rationale treatment habilitation plan

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