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Current developments in genetic strategies result in tracing an underlying genetic defect in the majority of neurodevelopmental disorders (NDD) patients, including those with normal functioning as well as intellectual disabilities. These genetic NDD are increasingly detected and still often underexposed in psychiatric practice.To improve (early) detection of these genetic NDD to contribute to psychiatric diagnostics and treatment, with the emphasis on reducing the mental vulnerabilities per developmental stage.Overview of developments based on literature and guidelines.Early detection includes both biological and environmental factors and provides tools for specific diagnostic procedures and treatment strategies. Within scientific research there is a tendency to translational research, which includes all levels from cell to the entire organism. This offers new insights and possibilities for personalized treatment.The current fragmented knowledge on these rare disorders needs to be bundled in the upcoming years. There is a lot of ground to be gained for psychiatric practice in this area.

Viveon-derzoekt! in makkelijke taal. “Modellen”, “sociale informatieverwerking”, “artikelen”. Mooie termen, maar waar gaat dat eigenlijk over? Vroegen de #ervaringsdeskundigen zich af! Wetenschappelijke artikelen bevatten de mooiste uitkomsten en aanbevelingen. Maar ze zijn vooral goed te begrijpen voor onderzoekers zelf. Daar moest wat aan gebeuren, vonden de Ervaringsdeskundigen 's Heeren Loo en Maaike van Rest. Dus houden we bij #viveon een reeks interviews met onderzoekers! Dóór mensen met een #verstandelijkebeperking en vóór mensen met een verstandelijke beperking. De start van deze afleveringen zie je hier in onze reeks: Viveon-derzoekt! Ervaringsdeskundige Benjamin interviewt in deze aflevering onderzoeker Maaike over sociale informatieverwerking. Wat is sociale informatieverwerking en wat zijn de resultaten van het onderzoek? In het filmpje wordt het uitgelegd. Meer weten over sociale informatieverwerking? Kijk op onze website: https://www.viveon.nl/projecten/colou... Wil je het hele wetenschappelijke onderzoek lezen? Kijk dan hier: https://www.tandfonline.com/doi/full/... #SocialeInformatieverwerking #Ervaringsdeskundig #Onderzoek #Wetenschap #Interview #Gedrag #VerstandelijkeBeperking #Viveon

BACKGROUND: Sexual abuse in individuals with (above) average iq is associated with a wide range of behavioural and psychological clinical characteristics, including characteristics regarding body experience. However, research on the clinical characteristics of sexually abused individuals with borderline intellectual functioning or mild intellectual disability (bif-mid) is scarce. OBJECTIVE To provide an overview of the literature on the clinical characteristics of sexually abused individuals with bif-mid. METHOD: PubMed, Embase, PsycInfo, cinahl, Cochrane Library and Web of Science were searched for relevant publications using terms related to 'intellectual disability' and 'sexual abuse'. RESULTS: Seven studies were included. The studies in question mostly reported behavioural and psychological characteristics such as challenging behaviour, sexualised behaviour or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with bif-mid. None of the studies reported problems regarding body experience. CONCLUSIONS Sexual abuse in individuals with bif-mid is associated with a broad range of behavioural and psychological characteristics similar to that of individuals with (above) average iq. Whether sexually abused individuals with bif-mid have similar problems in body experience as sexually abused individuals with (higher than) average iq needs to be investigated.

BACKGROUND: Sexual abuse in individuals with (above) average iq is associated with a wide range of behavioural and psychological clinical characteristics, including characteristics regarding body experience. However, research on the clinical characteristics of sexually abused individuals with borderline intellectual functioning or mild intellectual disability (bif-mid) is scarce. OBJECTIVE To provide an overview of the literature on the clinical characteristics of sexually abused individuals with bif-mid. METHOD: PubMed, Embase, PsycInfo, cinahl, Cochrane Library and Web of Science were searched for relevant publications using terms related to 'intellectual disability' and 'sexual abuse'. RESULTS: Seven studies were included. The studies in question mostly reported behavioural and psychological characteristics such as challenging behaviour, sexualised behaviour or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with bif-mid. None of the studies reported problems regarding body experience. CONCLUSIONS Sexual abuse in individuals with bif-mid is associated with a broad range of behavioural and psychological characteristics similar to that of individuals with (above) average iq. Whether sexually abused individuals with bif-mid have similar problems in body experience as sexually abused individuals with (higher than) average iq needs to be investigated.

ACHTERGROND De prevalentie van psychische problematiek bij mensen met een (visuele en) verstandelijke beperking is hoog en daarom is de noodzaak groot voor adequate psychologische behandeling.DOEL De effectiviteit van psychotherapie bij mensen met een (visuele en) verstandelijke beperking in kaartbrengen en onderzoeken welke aanpassingen nodig zijn in behandelprotocollen. METHODE Onderzoeken van een willekeurige selectie dossiers (n = 50), invullen vragenlijst door behandelaars (n = 5) en analyseren van videobeelden van mentaliseren-bevorderende therapiesessies (n = 12). RESULTATEN Uit een kwalitatieve beoordeling van therapie-effect bleek dat voor 88% van de cliënten therapie effectief was waarin de helft of alle behandeldoelen behaald werden. De psychotherapeutische methoden kwamen overeen, zoals in de literatuur is aanbevolen, met behandelmethoden voor personen zonder een beperking, hoewel praktische en specifieke aanpassingen nodig waren. CONCLUSIE Een groot aantal psychotherapeutische methoden kan, met de nodige aanpassingen, gebruikt worden bij de behandeling van cliënten met (visuele en) verstandelijke beperking met psychische problematiek.BACKGROUND: The prevalence of psychological problems in people with (visual and) intellectual disabilities is high and therefore there is a substantial need for adequate psychological treatment. AIM: To examine the effectiveness of psychotherapy in people with a (visual and) intellectual disability and to study which adjustments are needed in treatment protocols. METHOD: A random selection of client files (n = 50) was studied, therapists completed questionnaires (n = 5) and videos of mentalisation based therapy sessions (n = 12) were analysed. RESULTS: A qualitative assessment of therapy effect showed that for 88% of clients therapy was effective, half or all treatment goals were achieved. The psychotherapeutic methodologies corresponded, as recommended in the literature, to methodologies used for persons without a disability, although practical and specific adjustments were needed. CONCLUSION: A large number of psychotherapeutic methods, with the necessary adjustments, can be used in the treatment of persons with (visual and intellectual) disabilities with psychological problems.

Since the end of January 2020, covid-19 is a group A infectious disease according to the Public Health Act (in Dutch: Wet publiekegezondheid or Wpg). To avert the risk of infection with covid-19, coercive measures can be imposed under this law. Almost at the same time, since January 1 2020, two new Dutch laws regulate the mandatory care for people with intellectual disability and dementia (the Care and Compulsion Act (in Dutch: Wet zorgendwang or Wzd) and for people with a mental disorder (the Mandatory Mental Health Care Act (in Dutch: Wet verplichte GGZ or Wvggz). Just like the Wpg, the Wzd and Wvggz allow coercion for the benefit of third parties. In this clinical lesson we describe the use of the Wpg, Wzd and Wvggz in order to avert covid-19 infection risk.

The Dynamic Risk Outcome Scales (DROS) was developed to assess treatment progress of patients with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and severe behavioral and/or psychiatric problems. Because of the focus on dynamic risk factors, practitioners also see this instrument as a tool for risk assessment.br/AIM: To investigate the predictive value of the DROS on different classifications and severities of recidivism.br/METHOD: DROS data from the routine outcome monitoring (ROM) of 250 forensic patients with MID-BIF who were discharged between 2007 and end of 2014 were linked to recidivism data from the Judicial Information Service.br/RESULTS: The DROS total score predicted general, violence and sexual recidivism better than chance (AUCs0.58), although the effect was small. A DROS-recidivism subscale predicted general, violence and other recidivism with a medium to large effect (AUCs0.67). The predictive values of the DROS total score and DROS-recidivism subscale were comparable to those of the Historic, Clinical, Future (in Dutch: HKT)-30.br/CONCLUSION: The DROS total score and DROS-recidivism subscale predict different classifications of recidivism better than chance. However, for risk assessment the DROS appears to have no added value to the HKT-30.

Little is known about suicide among individuals with mild intellectual disabilities (mid).br/AIM: To explore risk factors for suicide among a small group of clients with mid who committed suicide.br/METHOD: Case files of 11 clients with mid were analysed using the Integrated Motivational Volitional model.br/RESULTS: Most suicides seem to have taken place impulsively and not on the basis of a predetermined plan. Most clients had comorbid mental health problems, predominantly trauma-related, impulse control and externalizing behavioural problems. The (imminent) loss of contact, such as in the case of transfer from one ward to another ward or to a facility, seems an important risk factor for suicide.br/CONCLUSION: Clients with mid residing in a treatment facility may have an increased risk of suicide because of an interaction between client characteristics and treatment context.

Little is known about the influence of mild intellectual disability/borderline intellectual functioning (mid/biF) or posttraumatic stress disorder (ptsd) on treatment results in severely mentally ill (smi).br/AIM: To investigate whether screeners determining mid/biF or ptsd are associated with less favorable treatment outcome in smi.br/METHOD: The screener for intelligence and learning disabilities (scil) was used to screen for mid/biF. The trauma screening questionnaire (tsq) was used to detect ptsd. Outcomes of these screeners were associated with repeated measures on the health of the nation outcome scales (HoNOS) in 628 smi at the Mental Care Centre of Oost Brabant.br/RESULTS: In 628 patients one or more HoNOS was acquired. In 352 (56%) patients a scil was acquired, in 334 (53%) patients a tsq. The largest improvement was observed in patients not meeting the criteria for mid/biF and/or ptsd. Less improvement was observed in patients with ptsd and a suspected iq between 70-85, estimated with the scil. No significant change on the HoNOS was observed in patients with an estimated iq below 70.br/CONCLUSION: Routine screening for mid/biF and ptsd symptoms is important for early recognition of the disorder, resulting in providing better treatment interventions for patients with mid/biF and ptsd.

It is unclear whether borderline intellectual functioning (bif) and/or a mild intellectual disability (mid) in patients receiving treatment in mental health care are being recognized by care providers.br/AIM: Exploratory study to register under-diagnosis of bif/mid in an outpatient clinic.br/METHOD: The number of patients diagnosed with bif/mid according to the electronic patient file (epd) was determined. From 11 August to 11 December 2015, all newly registered patients for outpatient treatment with an mbo-2 or lower educational level were screened for the possible presence of bif/mid applying the screener for intelligence and mild intellectual disability (scil). For all patients, their mental health care practitioner was asked if they suspected bif/mid. These percentages were compared. The sensitivity and specificity and the positive and negative predictive value (ppv and npv) of the opinion of the mental health care practitioners were determined.br/RESULTS: In the epd 2,8% of patients were diagnosed with bif, and 0,8% with mid. The percentage of suspected bif/mid of newly registered patients was 17,5%. The sensitivity of the assessors' opinion was 41%, the npv was 57%.br/CONCLUSION: In newly registered patients at an outpatient clinic bif and mid are important but frequently missed co-morbidities.

Sexual abuse in individuals with (above) average iq is associated with a wide range of behavioural and psychological clinical characteristics, including characteristics regarding body experience. However, research on the clinical characteristics of sexually abused individuals with borderline intellectual functioning or mild intellectual disability (bif-mid) is scarce. OBJECTIVE To provide an overview of the literature on the clinical characteristics of sexually abused individuals with bif-mid.br/METHOD: PubMed, Embase, PsycInfo, cinahl, Cochrane Library and Web of Science were searched for relevant publications using terms related to 'intellectual disability' and 'sexual abuse'.br/RESULTS: Seven studies were included. The studies in question mostly reported behavioural and psychological characteristics such as challenging behaviour, sexualised behaviour or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with bif-mid. None of the studies reported problems regarding body experience. CONCLUSIONS Sexual abuse in individuals with bif-mid is associated with a broad range of behavioural and psychological characteristics similar to that of individuals with (above) average iq. Whether sexually abused individuals with bif-mid have similar problems in body experience as sexually abused individuals with (higher than) average iq needs to be investigated.

Almost all physicians see patients with intellectual disabilities in their practices. There are still health disparities between people with intellectual disability and the general population. Consultations with this group of patients can be challenging, but there are ways to improve on them. Take your time when it comes to communicating with patients with intellectual disabilities, adapt language use and make use of visual aids. People with intellectual disabilities and complex care needs can be referred to intellectual disability physicians (AVG in Dutch) or syndrome-specific outpatient clinics.

For many yearsthere has been confusion in the Netherlands about the question of whether doctors are entitled to end the life of incompetent patients with advanced dementia. The euthanasia control commission, the disciplinary courts and the penal court all answered this question differently after a doctor had performed euthanasia on a 74-year-old woman with advanced dementia and an advance directive made at an earlier stage. On 21 April 2020 the Supreme Court provided clarity, at least to a certain extent. This contribution presents an analysis of the decisions made by the Supreme Court and their implications for self-chosen death in patients with advanced dementia.

Een nieuw instrument is ontwikkeld in samenwerking tussen verschillende wetenschappelijk onderzoekers en zorgprofessionals op woningen met mensen met een verstandelijke beperking.Deze eerste versie is een visueel aantrekkelijke zelfrapportagelijst voor mensen met een licht tot matige verstandelijke beperking.Het instrument kan individueel door de persoon worden ingevuld of samen met een begeleider worden afgenomen. Het advies aan begeleiders is om na de afname het gesprek aan te gaan over eventuele zorgen, gevoelens en beperkingen in de zelfstandigheid van de persoon.Dit nieuwe instrument KvL-VB-C met bijpassende Scoringsinstructies en het Scoreformulier op papier vindt u hier: https://www.academischewerkplaatsen-vb.nl/wp-content/uploads/2020/03/Q5-Kwaliteit-van-leven-Nederlands.pdfDe overige Rapid Response Corona-vragen en -antwoorden van de Associatie Academische Werkplaatsen Verstandelijke Beperkingen vindt u hier: https://www.academischewerkplaatsen-vb.nl/kennisvragen-covid-19/

Een nieuw instrument is ontwikkeld in samenwerking tussen verschillende wetenschappelijk onderzoekers en zorgprofessionals op woningen met mensen met een verstandelijke beperking. Deze eerste versie is een visueel aantrekkelijke zelfrapportagelijst voor mensen met een licht tot matige verstandelijke beperking. Het instrument kan individueel door de persoon worden ingevuld of samen met een begeleider worden afgenomen. Het advies aan begeleiders is om na de afname het gesprek aan te gaan over eventuele zorgen, gevoelens en beperkingen in de zelfstandigheid van de persoon. Dit nieuwe instrument KvL-VB-C met bijpassende Scoringsinstructies en het Scoreformulier op papier vindt u hier: https://www.academischewerkplaatsen-vb.nl/wp-content/uploads/2020/03/Q5-Kwaliteit-van-leven-Nederlands.pdf De overige Rapid Response Corona-vragen en -antwoorden van de Associatie Academische Werkplaatsen Verstandelijke Beperkingen vindt u hier: https://www.academischewerkplaatsen-vb.nl/kennisvragen-covid-19/

Een nieuw instrument is ontwikkeld in samenwerking tussen verschillende wetenschappelijk onderzoekers en zorgprofessionals op woningen met mensen met een verstandelijke beperking.Deze eerste versie is een visueel aantrekkelijke zelfrapportagelijst voor mensen met een licht tot matige verstandelijke beperking.Het instrument kan individueel door de persoon worden ingevuld of samen met een begeleider worden afgenomen. Het advies aan begeleiders is om na de afname het gesprek aan te gaan over eventuele zorgen, gevoelens en beperkingen in de zelfstandigheid van de persoon.Dit nieuwe instrument KvL-VB-C met bijpassende Scoringsinstructies en het Scoreformulier op papier vindt u hier: https://www.academischewerkplaatsen-vb.nl/wp-content/uploads/2020/03/Q5-Kwaliteit-van-leven-Nederlands.pdfDe overige Rapid Response Corona-vragen en -antwoorden van de Associatie Academische Werkplaatsen Verstandelijke Beperkingen vindt u hier: https://www.academischewerkplaatsen-vb.nl/kennisvragen-covid-19/

The prevalence of antipsychotic drug use in people with intellectual disability (id) is high and largely off-label for challenging behaviour (cb), while evidence for their efficacy lacks. Side-effects frequently occur. Guidelines recommend appropriate psychotropic drug use by monitoring of effects and side-effects and discontinuing off-label use for cb. However, they are insufficiently adhered to. Discontinuation often fails due to behavioural worsening by largely unknown causes.br/AIM: To offer an overview of results of off-label antipsychotic drug discontinuation and determinants for success or failure.br/METHOD: Literature search in Medline, embase and Psycinfo.br/RESULTS: Prospective open-label studies show that discontinuation in selected populations is possible in 33-40% and in placebo-controlled studies in 55-82%. Challenging behaviours, as measured with a standardized scale, mostly remained similar in those who succeeded as well as in those who failed to discontinue. Health problems, extrapyramidal symptoms, higher antipsychotic drug dosage, more severe cb, autism and male gender in participants, negative emotions towards cb, less knowledge on psychotropic drugs and male gender of support professional were related to less chance of successful discontinuation.br/CONCLUSION: To improve results of antipsychotic drug discontinuation, proper diagnostics of underlying causes for cb, involvement of all stakeholders and enhancement of treatment opportunities for psychopathology in people with id are needed. Integrative care and knowledge development of id- and mental health care may be helpful.

The prevalence of psychological problems in people with (visual and) intellectual disabilities is high and therefore there is a substantial need for adequate psychological treatment.br/AIM: To examine the effectiveness of psychotherapy in people with a (visual and) intellectual disability and to study which adjustments are needed in treatment protocols.br/METHOD: A random selection of client files (n = 50) was studied, therapists completed questionnaires (n = 5) and videos of mentalisation based therapy sessions (n = 12) were analysed.br/RESULTS: A qualitative assessment of therapy effect showed that for 88% of clients therapy was effective, half or all treatment goals were achieved. The psychotherapeutic methodologies corresponded, as recommended in the literature, to methodologies used for persons without a disability, although practical and specific adjustments were needed.br/CONCLUSION: A large number of psychotherapeutic methods, with the necessary adjustments, can be used in the treatment of persons with (visual and intellectual) disabilities with psychological problems.

Psychiatric disorders are also prevalent in people with intellectual disability and borderline intellectual disability.br/AIM: To provide an introduction of the organisation of care and its development for people with intellectual disability and borderline intellectual disability.br/METHOD: A description of specific concerns in prevalence, presentation, diagnosis, and a short summary of (the evolution) of care in the Netherlands and Belgium.br/RESULTS: Compared to the end of last century there is more attention for the needs of this group. The provided care is also more professional.br/CONCLUSION: Although not always easy in practice, good care for people with intellectual disability and borderline intellectual disability, and comorbid psychiatric problems, requires more cooperation and the use of shared knowledge and expertise.

In people with intellectual disability (id) prescription of psychotropic drugs is often chronic and outside licensed indications.br/AIM: To provide practical strategies for prescribing psychotropic drugs in people with id.br/METHOD: We reviewed the literature and existing guidelines to summarize recommendations for prescribing psychotropic drugs in people with id.br/RESULTS: The Diagnostic Manual - Intellectual Disability is a useful tool to facilitate diagnosis of mental disorders in people with id. Challenging behaviour in the absence of a psychiatric disorder is not a licensed indication for prescribing psychotropic drugs. Because of increased vulnerability for side effects in people with id, it is crucial to carry out a risk-benefit analysis before prescribing psychotropic drugs. In line with existing guidelines, we recommend monitoring of treatment and adverse effects with standardized scales adapted for id.br/CONCLUSION: A careful decision-making process regarding initiation and continuation is essential to prevent insufficient as well as excessive pharmacotherapy in people with id.

People with intellectual disability (id) frequently suffer from somatic and psychiatric comorbidity. Somatic morbidity can be the cause and the result of mental health problems. Timely diagnosis and interdisciplinary management are essential for optimal health, development and quality of life.br/AIM: To improve interdisciplinary cooperation of professionals involved in care for patients with id, with emphasis on prevalence, diagnosis, and treatment of somatic comorbidity.br/METHOD: Literature review and expert opinion.br/RESULTS: Epidemiology, diagnostics, and treatment of somatic comorbidity in patients with id are discussed. Additionally, roles and responsibilities of involved professionals are addressed.br/CONCLUSION: Somatic comorbidity is highly prevalent in patients with id. People with id should be regularly screened for somatic comorbidity, and re-evaluated in case of behavioral changes. Where available, an id physician can be included in the interdisciplinary care team.

Recognition of intellectual abilities of a patient is essential for good treatment. However, this may be hard to achieve, even by experienced professionals.br/AIM: To educate professionals how to detect and diagnose intellectual impairment accompanied by an approximate knowledge on methods and pitfalls in establishing psychiatric diagnoses.br/METHOD: Several valid instruments for the screening of intellectual impairment in the Netherlands are described in conjunction with adjoining steps in the diagnostic process.br/RESULTS: To determine mild intellectual disability or borderline intellectual functioning by screening and testing intelligence and adaptive functioning, and by establishing an integrative diagnosis by including emotional as well as social level of functioning. Some pitfalls in the diagnostic process are discussed.br/CONCLUSION: Clinicians must be aware which tools to use to determine broad functioning of the patient and which further steps are necessary for a good diagnosis.

Mental competence is a complex concept within the contexts of ethics, law, psychology and medicine. Competency is a prerequisite for giving informed consent for a medical intervention. It has long been wrongly thought that people with intellectual disabilities as a group are incapacitated, but competence is not a categorical trait of a certain group of persons. Capacities can fluctuate over time and can vary per decision or action domain. The more severe the intellectual disability, the less likely that someone is competent in health care decision-making.br/AIM: To describe specifically the meaning of the concept of competence in people with intellectual disabilities and the legal frameworks in the Netherlands and Belgium. Furthermore, to provide practices for assessing competence and to focus on supporting competence in this target group.br/METHOD: Overview of the most recent theory and practical methods.br/RESULTS: The assessment of decision-making competence can be difficult and has far-reaching consequences, and must therefore be applied carefully and well-founded.br/CONCLUSION: It is advisable to support people with an intellectual disability in order to be able to make decisions themselves as much as possible.

Mild intellectual disabilities (mid) are underdiagnosed in psychiatric institutions. Aggression is a problem in patients with mid admitted in psychiatric institutions.br/AIM: To clarify the background of aggression problems and to give advice on how to prevent them.br/METHOD: Discussion of the literature and practical experience.br/RESULTS: Agression problems are not only a correlate of the mid but are interrelated with the interpersonal style and personal characteristics of the staff involved in the treatment process, the living group climate, the working climate and the characteristics of the organization.br/CONCLUSION: By taking in account all these features the treatment of aggression and diminishing of aggressive incidents of patients with mid admitted in psychiatric institutions can be dealt with in a more effective way.

In mental health care in the Netherlands, there is rarely a focus on people with a borderline intellectual functioning as a separate group. However, borderline intellectual functioning appears to be an important vulnerability for the development of mental disorders.br/AIM: To focus on borderline intellectual functioning as an important vulnerability and co-morbidity in mental health care.br/METHOD: A survey of scientific literature, recent reports and available practical knowledge on borderline intellectual functioning, mental disorders and mental health care.br/RESULTS: People with borderline intellectual functioning have a high risk of developing mental disorders and a specific clinical profile with, in addition to cognitive impairments, psychosocial problems and co-morbidity as important characteristics.br/CONCLUSION: Borderline intellectual functioning is an important co-morbidity in mental health care. Through an explicit focus on borderline intellectual functioning in research, education and in clinical practice, we can better learn to recognize borderline intellectual functioning among our patients and take into account their specific clinical profile.

BACKGROUND There is a growing interest in de presence of people with mild and borderline intellectual disabilities (MBID) in de criminal justice system in The Netherlands.br/AIM: To present an overview of the current knowledge regarding the prevalence of MBID in the criminal justice system and the importance of recognition of MBID in this contact.br/METHOD: Several recent publications are listed and a number of recent developments in the Dutch criminal justice system have been described.br/RESULTS: The perception that there is an overrepresentation of people with an MBID in the criminal justice chain is confirmed. In addition, it is noted that there are various ways in which not recognizing the problem of MBID can lead to damage.br/CONCLUSION: It is concluded that recognition of the MBID problem is of great importance, but that within the criminal justice system knowledge about this problem should also increase in order to prevent problems.

Despite the increasing attention for people with a (borderline) intellectual disability within the field of mental health care in The Netherlands and Flanders, access to mental health care for this vulnerable group is still limited.br/AIM: To explore the access to mental health care in the Netherlands and Flanders for people with borderline intellectual functioning or an intellectual disability.br/METHOD: A survey of scientific literature, recent reports and available practical knowledge about mental disorders in people with borderline intellectual functioning or an intellectual disability and their access to mental health care.br/RESULTS: Insufficient knowledge about mental disorders in long term intellectual disability care and insufficient knowledge of, and experience with borderline intellectual functioning and intellectual disability among mental health care providers play a role in the limited access to good mental health care. More exchange of knowledge and sharing of experiences is necessary to ultimately properly address the needs of this group.br/CONCLUSION: Structural collaboration between mental health care and care for people with an intellectual disability is needed.

Uit onderzoek bij Bartiméus blijkt dat bij 60 procent van de onderzochte adolescenten en volwassenen met een visuele-en-verstandelijke beperking met ernstige gedragsproblemen, deze problemen waarschijnlijk kunnen worden verklaard vanuit gehechtheidsproblematiek. Het goede nieuws is dat veilige vertrouwensrelaties kunnen worden opgebouwd. Dit boek heeft als doel om betrokkenen bij de opvoeding van en zorg voor kinderen en volwassenen met een visuele-en-verstandelijke of verstandelijke beperking te ondersteunen in het opbouwen van een veilige relatie. Naast een theoretisch deel, wordt op een praktische manier uitgelegd hoe je een veilige vertrouwensrelatie kunt opbouwen.

Uit onderzoek bij Bartiméus blijkt dat bij 60 procent van de onderzochte adolescenten en volwassenen met een visuele-en-verstandelijke beperking met ernstige gedragsproblemen, deze problemen waarschijnlijk kunnen worden verklaard vanuit gehechtheidsproblematiek. Het goede nieuws is dat veilige vertrouwensrelaties kunnen worden opgebouwd. Dit boek heeft als doel om betrokkenen bij de opvoeding van en zorg voor kinderen en volwassenen met een visuele-en-verstandelijke of verstandelijke beperking te ondersteunen in het opbouwen van een veilige relatie. Naast een theoretisch deel, wordt op een praktische manier uitgelegd hoe je een veilige vertrouwensrelatie kunt opbouwen.

Uit onderzoek bij Bartiméus blijkt dat bij 60 procent van de onderzochte adolescenten en volwassenen met een visuele-en-verstandelijke beperking met ernstige gedragsproblemen, deze problemen waarschijnlijk kunnen worden verklaard vanuit gehechtheidsproblematiek. Het goede nieuws is dat veilige vertrouwensrelaties kunnen worden opgebouwd. Dit boek heeft als doel om betrokkenen bij de opvoeding van en zorg voor kinderen en volwassenen met een visuele-en-verstandelijke of verstandelijke beperking te ondersteunen in het opbouwen van een veilige relatie. Naast een theoretisch deel, wordt op een praktische manier uitgelegd hoe je een veilige vertrouwensrelatie kunt opbouwen.

Uit onderzoek bij Bartiméus blijkt dat bij 60 procent van de onderzochte adolescenten en volwassenen met een visuele-en-verstandelijke beperking met ernstige gedragsproblemen, deze problemen waarschijnlijk kunnen worden verklaard vanuit gehechtheidsproblematiek. Het goede nieuws is dat veilige vertrouwensrelaties kunnen worden opgebouwd. Dit boek heeft als doel om betrokkenen bij de opvoeding van en zorg voor kinderen en volwassenen met een visuele-en-verstandelijke of verstandelijke beperking te ondersteunen in het opbouwen van een veilige relatie. Naast een theoretisch deel, wordt op een praktische manier uitgelegd hoe je een veilige vertrouwensrelatie kunt opbouwen.

BACKGROUND: Fragile X syndrome (fxs) is the most common hereditary cause of intellectual disability and autism spectrum disorders. Targeted treatment is currently lacking. In the past decades an enormous amount of knowledge has been obtained concerning the involved molecular pathways, introducing potential targets for disease modifying therapy. AIM: To present an overview of the development of targeted treatment for fxs. METHOD: Several important publications were collected and indexed. RESULTS: While preclinical animal model studies with targeted interventions are promising, the translation to the clinic has been disappointing. CONCLUSION: Targeted treatment for fxs is necessary and could be applied in other causes of autism spectrum disorders and intellectual disability. Factors relating to translation, study design and outcome measures are possibly contributing to the disappointing results. The clustering of patient care in a center of expertise is required to clinically implement future therapeutic strategies and to facilitate research. In addition, this improves patient care, one example being the recent medical guideline for children with fxs.

In ambulant psychiatric care, intellectual disability (id) is often not recognised. Therefore, a Screener for Intelligence and Learning disabilities (scil) was recently introduced to assist recognition. However, because, current therapy is not adjusted for id-related problems, its effectiveness remains unknown.br/AIM: To gain insight into adequate adaptation of interventions by professionals for patients with severe mental illness (smi) and id, to improve the quality of care without the need to develop a completely new program of therapy.br/METHOD: A qualitative design (n=15) including 8 interviews and one focus group, among psychiatric practitioners and id experts.br/RESULTS: Five main themes were identified to adjust therapy: treatment, communication, inclusion of the network, estimation of support needs and self-management. CONCLUSIONS To align therapy with the requirements of patients with smi and id, a patient-oriented approach to care is necessary. Simple but effective modifications, summarised in a toolkit, appear to contribute to this. To offer appropriate care to patients with smi and id, attention is needed for both a support-oriented and a recovery-oriented approach.

BACKGROUND: In people with intellectual disability (ID) prescription of psychotropic drugs is often chronic and outside licensed indications. AIM: To provide practical strategies for prescribing psychotropic drugs in people with ID. METHOD: We reviewed the literature and existing guidelines to summarize recommendations for prescribing psychotropic drugs in people with ID. RESULTS: The Diagnostic Manual - Intellectual Disability is a useful tool to facilitate diagnosis of mental disorders in people with ID. Challenging behaviour in the absence of a psychiatric disorder is not a licensed indication for prescribing psychotropic drugs. Because of increased vulnerability for side effects in people with ID, it is crucial to carry out a risk-benefit analysis before prescribing psychotropic drugs. In line with existing guidelines, we recommend monitoring of treatment and adverse effects with standardized scales adapted for ID. CONCLUSION: A careful decision-making process regarding initiation and continuation is essential to prevent insufficient as well as excessive pharmacotherapy in people with ID.

To compare use of the GP cooperative and the level of urgency among people with intellectual disabilities (ID) who live in sheltered accommodation with that of the general population.Cross-sectional study.We investigated all healthcare-contact moments in 2014 among 432,582 people living in the servicearea covered by two GP cooperatives in one region of the Netherlands (Boxmeer, Nijmegen). In this region a total of 1,448 people with ID living in sheltered accommodation were identified on the basis of address details. We compared the type and frequency of contact and level of urgency between this group of people and the general population.Among people with ID living in sheltered accommodation, 30.9% (448/1,448) requested care from the GP cooperatives, compared with 18.4% (79,206/431,134) of the general population (relative risk [RR]: 1.7; 95% confidence interval [CI]: 1.6-1.8). The type and frequency of contact and level of urgency also differed between the two groups. Healthcare-contact moments among people with ID were more often conducted by telephone (RR: 2.7; 95% CI: 2.7-3.0) and were generally less urgent than in the general population.People with ID who live in sheltered accommodation make more use of the GP cooperative and more often have low-urgent telephone contacts in comparison with the general population. More insight is needed into the nature of healthcare-contact moments in order to improve the quality and accessibility of care from GP cooperatives for this vulnerable group.

SamenvattingPrikkelverwerkingsproblemen lijken vaak voor te komen bij een autisme spectrum stoornis. Er is weinig literatuur bekend die zich richt op prikkelverwerkingsproblemen bij mensen met autisme en een verstandelijke beperking. Het project Sensatie van een Goed Leven doet onderzoek naar prikkelverwerkingsproblemen bij deze doelgroep. Huidig onderzoek sluit hierop aan door te kijken naar de invloed die betrokkenen rondom een persoon met een autisme spectrum stoornis en een verstandelijke beperking hebben op prikkelverwerkingsproblemen. De ecologische systeemtheorie van Bronfenbrenner stelt dat de dichtstbijzijnde betrokkenen, ook wel het ‘microsysteem’ genoemd, grote invloed op het individu hebben door de continue wisselwerking tussen hen en het individu. Dit ‘systeem’ wordt binnen huidig onderzoek op een kwalitatieve wijze onderzocht door ouders, verwanten, begeleiders, leerkrachten en ervaringsdeskundigen semigestructureerd te interviewen. Een totaal van 15 respondenten beantwoordden vragen over de prikkelverwerkingsproblemen, de moeilijkheden en de aanwezige hulpmiddelen binnen hun context. Daarnaast zijn het tijdsverloop en de verschillen tussen contexten en betrokkenen uitgevraagd. De interviews zijn met de hand verwerkt, gecodeerd en geanalyseerd. Uit de resultaten blijkt dat er veel verschillen bestaan tussen de prikkelverwerkingsproblemen, de betrokkenen en contexten. Het is moeilijk vast te stellen of het verschillende beeld door de betrokkenen veroorzaakt wordt. Door communicatie en samenwerking tussen betrokkenen kunnen deze verschillen eventueel verholpen worden en kan er een optimale situatie gecreëerd worden voor de persoon waar het om draait. Het wordt aanbevolen om betrokkenen mee te nemen in onderzoek naar de prikkelverwerkingsproblemen bij deze doelgroep, omdat zij van grote waarde kunnen zijn in het vergroten van het inzicht in de problematiek., Sensory processing problems seem to be common to autism spectrum disorders. There is little available literature that focuses on sensory processing problems for people with an autism spectrum disorder and an intellectual disability. The project ‘Sensatie van een Goed Leven’ explores the sensory processing problems for this group of people. This research is in line with the project by exploring the influence of persons concerned with the individual with autism and an intellectual disability on the sensory processing problems. The ecological system theory of Bronfenbrenner states that the nearest people concerned with the individual, named ‘the microsystem’, are of great influence due to the continue interplay between them and the individual. This research explores this ‘system’ on a qualitative base by making use of semi-structured interviews with parents, relatives, psychological counsellors, teachers and experiential experts. Fifteen respondents answered questions about the sensory processing problems, it’s difficulties and the tools for handling those problems within their context. The interviews also included questions about the time course and the differences between the concerned people and contexts. The interviews are processed, coded and analyzed by hand. The results show that there are substantial differences between the sensory processing problems, between people concerned with the individual and between contexts. It is hard to determine if these people cause the differences. Proper communication and cooperation between the people concerned with the individual may resolve these differences and may create an ideal situation for the individual in question. It is recommended to involve the persons around the individual in exploring the sensory processing problems because they are of great value to amplify the insight in these problems.

Samenvatting Prikkelverwerkingsproblemen lijken vaak voor te komen bij een autisme spectrum stoornis. Er is weinig literatuur bekend die zich richt op prikkelverwerkingsproblemen bij mensen met autisme en een verstandelijke beperking. Het project Sensatie van een Goed Leven doet onderzoek naar prikkelverwerkingsproblemen bij deze doelgroep. Huidig onderzoek sluit hierop aan door te kijken naar de invloed die betrokkenen rondom een persoon met een autisme spectrum stoornis en een verstandelijke beperking hebben op prikkelverwerkingsproblemen. De ecologische systeemtheorie van Bronfenbrenner stelt dat de dichtstbijzijnde betrokkenen, ook wel het ‘microsysteem’ genoemd, grote invloed op het individu hebben door de continue wisselwerking tussen hen en het individu. Dit ‘systeem’ wordt binnen huidig onderzoek op een kwalitatieve wijze onderzocht door ouders, verwanten, begeleiders, leerkrachten en ervaringsdeskundigen semigestructureerd te interviewen. Een totaal van 15 respondenten beantwoordden vragen over de prikkelverwerkingsproblemen, de moeilijkheden en de aanwezige hulpmiddelen binnen hun context. Daarnaast zijn het tijdsverloop en de verschillen tussen contexten en betrokkenen uitgevraagd. De interviews zijn met de hand verwerkt, gecodeerd en geanalyseerd. Uit de resultaten blijkt dat er veel verschillen bestaan tussen de prikkelverwerkingsproblemen, de betrokkenen en contexten. Het is moeilijk vast te stellen of het verschillende beeld door de betrokkenen veroorzaakt wordt. Door communicatie en samenwerking tussen betrokkenen kunnen deze verschillen eventueel verholpen worden en kan er een optimale situatie gecreëerd worden voor de persoon waar het om draait. Het wordt aanbevolen om betrokkenen mee te nemen in onderzoek naar de prikkelverwerkingsproblemen bij deze doelgroep, omdat zij van grote waarde kunnen zijn in het vergroten van het inzicht in de problematiek.

Fragile X syndrome (fxs) is the most common hereditary cause of intellectual disability and autism spectrum disorders. Targeted treatment is currently lacking. In the past decades an enormous amount of knowledge has been obtained concerning the involved molecular pathways, introducing potential targets for disease modifying therapy.br/AIM: To present an overview of the development of targeted treatment for fxs.br/METHOD: Several important publications were collected and indexed.br/RESULTS: While preclinical animal model studies with targeted interventions are promising, the translation to the clinic has been disappointing.br/CONCLUSION: Targeted treatment for fxs is necessary and could be applied in other causes of autism spectrum disorders and intellectual disability. Factors relating to translation, study design and outcome measures are possibly contributing to the disappointing results. The clustering of patient care in a center of expertise is required to clinically implement future therapeutic strategies and to facilitate research. In addition, this improves patient care, one example being the recent medical guideline for children with fxs.

The new draft Law on care and coercion focuses on the care of people with a psychogeriatric disorder or intellectual disability. Perhaps this law can be applied to people suffering from chronic alcoholism, associated with an increased risk of Korsakoff's syndrome.To explore whether the new draft law on care and coercion can be applied to people suffering from chronic alcoholism who still live at home.A description of possibilities of involuntary homecare to people suffering from chronic alcoholism based on literature, current legislation and two new draft laws.It seems possible to apply the law care and coercion to people suffering from chronic alcoholism.The application of the draft law care and coercion offers the possibility of providing involuntary homecare to people suffering from chronic alcoholism, enabling the administration of thiamine. This reduces the chances of developing Korsakoff's syndrome. Further research is necessary to explore the practical possibilities in offering involuntary care.

BACKGROUND: In people with intellectual disability (ID) prescription of psychotropic drugs is often chronic and outside licensed indications. AIM: To provide practical strategies for prescribing psychotropic drugs in people with ID. METHOD: We reviewed the literature and existing guidelines to summarize recommendations for prescribing psychotropic drugs in people with ID. RESULTS: The Diagnostic Manual - Intellectual Disability is a useful tool to facilitate diagnosis of mental disorders in people with ID. Challenging behaviour in the absence of a psychiatric disorder is not a licensed indication for prescribing psychotropic drugs. Because of increased vulnerability for side effects in people with ID, it is crucial to carry out a risk-benefit analysis before prescribing psychotropic drugs. In line with existing guidelines, we recommend monitoring of treatment and adverse effects with standardized scales adapted for ID. CONCLUSION: A careful decision-making process regarding initiation and continuation is essential to prevent insufficient as well as excessive pharmacotherapy in people with ID.

Although Antillean suspects in the Netherlands are often diagnosed as being intellectually impaired, there are no validated tests available Papiamento (the native language) for assessing intelligence or functional impairment.To validate the use of the GIT 2 (Groninger Intelligentie Test 2) and the Barkley Functioning Impairment Scale (BFIS) for Antillean defendants detained by the Judicial Service of the Caribbean Netherlands in Bonaire.With the approval of the publishers, the GIT 2 and the BFIS were translated in Papiamento by two independent experts. The two translations were then re-translated into Dutch by two other independent experts. Defendants with both parents born in Bonaire who had been detained for at least 18 days by the Judicial Detention Centre of the Caribbean Netherlands (JICN) in Bonaire during the period 1 January 2013 until 1 July 2014 were examined with both tests.The Papiamento GIT 2 and BFIS tests were taken by 23 Bonairian defendants who had been detained in the JICN in Bonaire. The internal consistency and inter-item correlation of the tests were found to be satisfactory. The IQ of 95% of the participants was reproduced as a score between 79.2 and 96.8 points. In the BFIS the question about self-care was a particularly sensitive item. The use of drugs was associated with increased functional impairment.This study seems to be a promising first step towards the validation of the GIT 2 and the BFIS. Apparently, it has now become acceptable to use written Papiamento in assessment tools.