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Mike Stawski: Who are These People? A Profile of Patients and their Families Treated by the Schneider Outpatient Unit for Developmental Psychiatry - Slide presentation
1. Knowledge Database
• Topic of lecture: Who are These People? A Profile of Patients
and their Families Treated by the Schneider Outpatient Unit
for Developmental Psychiatry
• Lecturer name: Mike Stawski
Schneider Children's Medical Center, Israel
• The lecture was given at the Beit Issie Shapiro’s
6th International Conference on Disabilities - Israel
• Year: 2015 Length of lecture: 12:27 minutes
2. Presentation to BIS Conference,
Tel Aviv, July 2015
Dr. Mike Stawski, M.B., B.S., MRCPsych
The Outpatient Unit for Neurodevelopmental
Psychiatry, Dept. of Psychological Medicine, Schneider
Children’s Medical Center in Israel
3. The problem
Available solutions
◦ Non-specialist
◦ Specialist
A profile of OUDP patients
Discussion, feedback
3
4. ◦ In European countries 2% mild learning disability,
0.35% severe learning disability (Roy et al., 2000)
◦ In Israel about 0.4 % of the general population are
formally (legally) diagnosed
◦ Point prevalence of psychiatric disturbance is from
10% to upwards of 60% (King et al., 1997)
4
5. Generic psychiatry departments
Schneider Developmental Psychiatry Outpatient Unit
Beit Issie Shapiro Dual Diagnosis Unit
5
6. Werner S., Stawski, M., Y. Polakiewicz, Y. & Levav, I.
(2013). Psychiatrists’ knowledge, training and
attitudes regarding the care of individuals with
intellectual disability, Journal of Intellectual Disability
Research, 57(8), 774–782
6
7. Our findings suggest inadequacy of existing
services.
The problem is probably with the basic model,
rather just its local implementation.
There are various options for improving services.
7
8. For children/adolescents with intellectual disability
and additional psychopathology
Established in 2001
Psychiatrists and paramedical staff
8
9. To obtain a clinical and demographic profile of the
patients and their families
To examine the effectiveness of treatment
To test a number of hypotheses regarding factors
related to the severity of behavioural/psychiatric
disturbance
9
10. 1. The OUDP Demographic Questionnaire
2. The Aberrant Behaviour Checklist (ABC)
3. The Family Assessment Device (FAD) General
Functioning subscale
4. The 12- item General Health Questionnaire (GHQ-12)
5. Vineland Adaptive Behavior Scales, Second Edition
(Vineland-II)
10
11. Assessments were performed zero (T1), four (T2),
eight (T3), and twelve months (T4) after intake
Vineland Questionnaire only at intake
Satisfaction Questionnaire only at twelve months
Other measures at every time point
11
13. High rate of physical disability, often more than one
CP / other motor impairment - 44%
Epilepsy - 33%
Visual impairment - 22%
Other physical disability - 18%
13
16. For those patients for whom level of ID could be
ascertained:
Mild - 51%
Moderate - 28%
Severe - 16%
Profound - 5%
16
17. PDD - 33%
Externalizing disorders (hyperkinetic disorder or
conduct disorder) – 30%
Internalizing disorders (OCD, other anxiety disorders,
selective mutism, depressive disorder, PTSD) - 18%
Various other - 18%
No disturbance - 3%
17
18. ABC Irritability scale score - 17.6, (SD 11.5 ), i.e. 1 SD
over the mean of a “normative” sample, i.e.
“significant behavioural problems”
ABC stereotypy scale score - 6.0, (SD 7.2 ) i.e. 1 SD
over the mean of a “normative” sample, i.e.
“significant behavioural problems”
18
19. Antipsychotics - 20% of cases
Stimulants - 25%
Other medication - 18%;
No medication - 38%
19
20. Individual psychotherapy – 10%
Family therapy / work with parents - 56%
Behavioural therapy - 34%
Other non-medical recommendations - 5%
None - 21%
20
21. Level of adaptive behavior relative to age (assessed
by Vineland Adaptive Behavior Scales) would be
negatively correlated with behavioral problems
(assessed by ABC scale scores)
21
22. Vineland score correlated negatively with
◦ ABC irritability scale score (Spearman's rho= -.35,
p=.025)
◦ ABC lethargy scale score (Spearman's rho= -.40, p=.009)
◦ ABC stereotypy scale score (Spearman's rho= -.41,
p=.007)
i.e., the lower the relative adaptive behaviour level of
child, the higher the irritability, lethargy and stereotypy
scale scores
22
23. Level of adaptive behavior relative to age (assessed
by the Vineland Adaptive Behavior Scales) would
correlate negatively with level of parental
disturbance (assessed by GHQ-12)
23
24. Relative level of adaptive behaviour was
significantly correlated with mothers’ mental health
problems (Spearman's rho = -.35, p = .048), but not at
all with fathers’ (Spearman's rho= -.07).
24
25. Over time, we would see clinical
improvement, i.e., a reduction in behavioral
disturbance (assessed by ABC scale scores)
25
26. Significant improvement on ABC Irritability scale
score on repeated measures ANOVA (F = 46.4, p =
0.025)
Trend towards significance in improvement on:
◦ ABC Stereotypy scale score (F = 2.62, p = 0.06)
◦ Hyperactivity scale score (F = 1.70, p = 0.18)
26
27. Family disturbance (assessed by FAD General
Functioning subscale) would at different time points
correlate positively with parental disturbance
(assessed by GHQ-12)
27
28. FAD General Functioning subscale correlated
positively with maternal GHQ-12 at a significant or
highly significant level at all time points except the
first (at which a positive correlation trending
towards significance was found)
No such correlation was found for fathers
28
29. 79% of respondents were satisfied / very satisfied
with their treatment.
Parents’ feelings of having been understood by their
therapists were highly significantly correlated with
maternal mental health problems (GHQ-12)!!
29
30. More single - parent families
High rate of physical disability, often multiple
“Behavioural problems” / “violence” are the
commonest complaints
Prior treatment with psychotropics is frequent
Any other prior treatment is infrequent
2/3 of diagnoses are accounted for by PDD and
externalizing disorders
30
31. Main problems are in the realms of irritability and
stereotypy
Families functioning in the “stressed“ range
We used less antipsychotic, more stimulants, more
non-medical interventions
31
32. The lower the relative adaptive behaviour level of
child, the more irritability, lethargy and stereotypy-
type problems
Relative level of adaptive behaviour as well as
problems in the realms of irritability, stereotypy
and hyperactivity were correlated with mothers’
mental health problems
32
33. Perceived family functioning is positively correlated
with maternal but not paternal mental health
Significant improvement in area of irritability over
one year
Reasonable satisfaction rating
33
35. This is generally a sicker-than-usual population
This specialist psychiatric clinic uses less
psychotropic medications, less antipsychotics, more
non-medical modes of intervention
Keep an eye out for parental mental health, gaps
between parents, and family functioning
We need to find ways of achieving improvement in
areas other than just irritability
35
36. Dual diagnosis is a common and poorly treated
problem
The nonspecialist psychiatrist needs to keep in
mind non-psychotropic modes of treatment
Specialist care can be effective and is appreciated
We need to keep in mind patients' physical and
parents’ mental health, and family functioning
Be nice to dogs and little children