Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA.
J Intellect Disabil Res. 2022 Oct;66(10):805-816. doi: 10.1111/jir.12972. Epub 2022 Aug 16.
Research regarding the accuracy of co-morbid psychiatric diagnoses in individuals with intellectual and developmental disabilities (IDD) is sparse. Yet correct diagnostic assignment is vital so that effective and appropriate treatment can be implemented, especially for the large numbers of individuals requiring expensive and restrictive behavioural health crisis services.
A retrospective review of de-identified data from multidisciplinary specialty team assessments completed for 50 individuals with ID (IntellectualDisability) with and without ASD and unresolved behavioural health challenges was conducted. The accuracy and reliability of the psychiatric diagnoses upon referral were compared with the diagnoses after the comprehensive team evaluation, and within-individual diagnostic agreement was calculated. The agreement between the Mood and Anxiety Semi-Structured interview tool (MASS) and the full team evaluation was also calculated. The influence of demographic and clinical characteristics on diagnostic agreement was explored.
The most common chief complaints upon referral were aggression to others and self-injurious behaviour. Individuals were taking a median of six medications (interquartile range: 5 to 7); 80% were taking an antipsychotic medication. The most common medical conditions were constipation (70%) and gastroesophageal reflux disease (52%). Measures of interrater reliability of the referral diagnoses with the team assessment were below 0.5 (kappa range: -0.04 to 0.39), with the exception of ruling out dementia (kappa = 0.85). The interrater reliability estimates for the MASS evaluations for depression and anxiety were higher (kappa = 0.69 and 0.64) and reflected higher sensitivity and PPV. The odds of any referral diagnosis being confirmed by team evaluation were low: 0.25 (range: 0 to 0.67). The level of diagnostic agreement for each patient was not significantly attributable to demographic or clinical characteristics, although effect sizes indicate a possible positive relationship to age and the number of prescribed psychotropic medications at referral.
Individuals in the current study had serious psychiatric and behavioural problems despite psychiatric care in their communities. The majority of psychiatric diagnoses provided upon referral were not supported by the multidisciplinary specialty team's assessment. In addition to possible diagnostic inaccuracy, the group in the study suffered from multiple medical co-morbidities and were exposed to polypharmacy. Results emphasise the importance of multidisciplinary evaluation by clinicians with expertise in neurodevelopmental disabilities when people with ID with and without ASD have complex behavioural health needs that are unresponsive to usual care. In addition, based on agreement with the full team evaluation, the MASS shows promise as an assessment tool, especially with regards to identifying anxiety and depression.
针对智障和发育障碍（ID）个体合并精神疾病诊断的准确性的研究较为匮乏。然而，正确的诊断对于实施有效的、适当的治疗至关重要，尤其是对于那些需要昂贵且限制较多的行为健康危机服务的大量个体而言。
对完成的 50 名 ID（智力障碍）个体的多学科专业团队评估的去识别数据进行回顾性分析，这些个体患有或不患有 ASD 且存在未解决的行为健康挑战。在进行全面的团队评估后，比较了转诊时的精神科诊断的准确性和可靠性，并计算了个体内的诊断一致性。还计算了心境和焦虑半结构化访谈工具（MASS）与完整团队评估之间的一致性。探索了人口统计学和临床特征对诊断一致性的影响。
转诊时最常见的主要诉求是对他人的攻击和自残行为。个体平均服用六种药物（四分位间距：5-7）；80%的个体服用抗精神病药物。最常见的医疗状况是便秘（70%）和胃食管反流病（52%）。转诊诊断与团队评估的观察者间可靠性的衡量指标低于 0.5（kappa 范围：-0.04 至 0.39），除了排除痴呆症（kappa=0.85）。MASS 评估用于抑郁和焦虑的观察者间可靠性估计值较高（kappa=0.69 和 0.64），并反映了更高的敏感性和阳性预测值。任何转诊诊断被团队评估证实的可能性都较低：0.25（范围：0-0.67）。每个患者的诊断一致性水平与人口统计学或临床特征无显著相关性，但效应大小表明与年龄和转诊时开的精神药物数量之间可能存在正相关关系。
尽管社区中有精神科护理，但当前研究中的个体仍存在严重的精神和行为问题。大多数在转诊时提供的精神科诊断都没有得到多学科专业团队评估的支持。除了可能的诊断不准确之外，研究组中的个体还患有多种医学合并症，并接受了多种药物治疗。研究结果强调了在有和没有 ASD 的 ID 个体出现复杂行为健康需求且对常规护理无反应时，由具有神经发育障碍专业知识的临床医生进行多学科评估的重要性。此外，根据与完整团队评估的一致性，MASS 作为一种评估工具具有潜力，尤其是在识别焦虑和抑郁方面。
