The Medical Care of People With Intellectual Disability

Abstract

Background: An estimated 1.5 million persons in Germany are intellectually disabled. Persons with intellectual disability (ID) are especially vulnerable to somatic and mental illnesses.

Methods: This review is based on pertinent literature retrieved by selective searches in PubMed and the Cochrane Library.

Results: Genetic abnormalities are a frequent cause of diseases that affect multiple organs and need interdisciplinary treatment. A number of somatic diseases are more common in persons with ID than in the general population, including epilepsy (30-50% in persons with severe or very severe ID, vs. 0.5% in the general popu- lation) and dementia (five times more common than in the general population). Patients with Down syndrome are 20 times more likely than the general population to develop acute lymphoblastic leukemia. Some mental illnesses, too, are more common in persons with ID, e.g., autism spectrum disorders (7.5-15% vs. 1% in the general population). The history and the findings of the physical and psychiatric examination are assessed in accordance with the biopsychosocial model of disease, and in the light of the patient's mental developmental age. Structured instruments for behavioral evaluation and diagnosis are an important additional component of the diagnostic assessment. A holistic approach is required that takes multiple life areas into account and involves the patient's familial and social environment, while obeying the rules of simple language. Psychotherapeutic and psychosocial measures must be adapted to the patient's cognitive abilities and mental developmental age.

Conclusion: Intellectually disabled persons can be treated in a multimodal, multiprofessional approach. As of early 2019, there were 38 medical centers for adults with intellectual disability or severe multiple disabilities in Germany (Medizinische Behandlungszentren für Erwachsene mit geistiger Behinderung oder schweren Mehrfachbehinderungen, MZEB), where they can be cared for with due attention to their special needs.

Figure

The biopsychosocial model of disease * Autism-spectrum disorders, attention-deficit/hyperactivity disorder, emotional developmental disorders, developmental trauma disorders, attachment disorders (modified from [e60]: Sappok T (ed.): Psychische Gesundheit bei intellektueller Entwicklungsstörung. Stuttgart: Kohlhammer 2018; reprinted with the kind permission of Kohlhammer Verlag)

eFigure

The link between psychiatric disturbances and mental developmental age The frequency of certain mental illnesses depends, among other things, on mental developmental age. The arrow symbolizes increasing mental developmental age. Certain disorders are more common in persons with a low mental developmental age (e.g., autism) or may occur only in such persons (e.g., pica, rumination, feeding disorders); while, for other disorders, a minimal developmental age appears to be a prerequisite. For example, the development of a socal phobia or of a body-image disorder requires the prior development of mentalizing capacity (theory of mind). Other types of mental illness, e.g., affective disorders, post-traumatic stress disorder, and dementia, can arise independently of mental developmental age and can be found at all stages of development. ADHD, attention-deficit/hyperactivity disorder