Psychiatric disorders in intellectual disability — structured clinical viva

Challenge the frame. Mental ill-health is common in adults with ID (Cooper: clinical ~40%, DC-LD ~35%, lower with standard ICD/DSM). "Just the disability" is diagnostic overshadowing (Reiss) — symptoms of treatable illness attributed to ID.^[1][3]

Presentation. In moderate ID, depression/anxiety/psychosis often appear as change from baseline: self-injury, withdrawal, sleep change, unexplained fear, skill loss. Always exclude pain, constipation, dental disease, epilepsy and medication effects first.^[2]

DC-LD. Complementary multi-axial criteria for adults with learning disabilities accommodating pathoplasticity and hierarchical diagnosis including problem behaviours versus psychiatric illness.^[2]

Medicines. Tyrer 2008: risperidone/haloperidol not superior to placebo for aggressive challenging behaviour. Sheehan 2015: psychotropics prescribed far more often than recorded mental illness. Deb 2009: assess, formulate, non-drug options, clear targets, monitor, review. If continuing or starting medicine: start low, go slow, metabolic/EPS monitoring, time-limited goals, deprescribe when possible. Adapt psychological therapies (simplified CBT/PBS) to ability.^[4][5][6]

Close. Multiagency plan, capacity is decision-specific with support, carer education, scheduled review of risperidone indication.^[4][6]