Application of DC‐LD to an intellectual disability population

Published date07 September 2012
Pages259-264
Date07 September 2012
DOIhttps://doi.org/10.1108/20441281211261140
AuthorJohn Tully,Diana Schirliu,Maria Moran
Subject MatterEducation,Health & social care
Application of DC-LD to an intellectual
disability population
John Tully, Diana Schirliu and Maria Moran
Abstract
Purpose – The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning
Disabilities/Mental Retardation (DC-LD) was introduced in 2003 in an attempt to improve accuracy of
diagnosis in the intellectual disability population. The paper aims to apply this system to a sample of a
population with intellectual disability to further investigate its usefulness in the clinical setting.
Design/methodology/approach – A sample of 50 patients within an intellectual disability service was
identified. Each individual was interviewed by a registrar in psychiatry of intellectual disability in the
presence of their key worker or a carer that knew the individual well. Chart notes were extensively
reviewed for clearly documented history of psychiatric symptoms and behavioural difficulties. The
information gathered was applied as per the DC-LD criteria to identify appropriate diagnoses. Previously
documented diagnoses were also recorded for comparison purposes.
Findings – There was considerable discrepancy between the rates of psychiatric diagnoses after
application of DC-LD and rates of previously documented diagnoses within the sample. Use of DC-LD
led to the reclassification of many previously documented diagnoses, mainly as behavioural disorders.
There were also discrepancies between rates of diagnosis of pervasive developmental disorders and
Alzheimer’s disease before and after use of DC-LD.
Originality/value – This study adds to the evidence regarding the usefulness of DC-LD in the intellectual
disability population andalso highlights the shortcomings of non-systematic methods of diagnosis. It was
agreed that DC-LD criteria be applied to all service users in this population in the future.
Keywords Intellectual disability,Diagnosis, Pervasive developmental disorders, Behavioural disorders,
Alzheimer’s disease, Learning disabilities, Disabilities, Elderly people
Paper type Research paper
Background
Psychiatric disorders are common in the intellectual disability population with widely varying
rates documented (Cooper et al., 2007; Corbett, 1979; Lund, 1985; Reid, 1972). Accuracy of
diagnosis of psychiatric illness in individuals with intellectual disability is important for
predicting outcomes, response to treatment andavoiding inappropriate prescribing, but can
be particularly difficult within this population due to a number of factors (Cooper,2003). These
difficulties have been discussed in detail elsewhere, and include difficulties with
communication, obtaining accurate collateral information and level of co-morbidities
(Cooper, 2003). The Diagnostic Criteria for Psychiatric Disorders for Use with Adults with
Learning Disabilities/Mental Retardation (DC-LD) (RCPysch, 2001) was introduced in an
attempt to improve accuracy of diagnosis in the intellectual disability population and has been
shown to have high levels of concordance with expert clinical opinion (Cooper, 2003).
The structure and design of the DC-LD has also been discussed in detail elsewhere
(Cooper et al., 2003; Felstrom et al., 2005). In summary, the key differences between it and
other classificatory systems are: a hierarchical system of diagnosis, a separate section
(Level III D) for documentation of problem behaviours and the lack of separate axes for
documentation of biological or psychosocial information.
DOI 10.1108/20441281211261140 VOL. 6 NO. 5 2012, pp. 259-264, QEmerald Group Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
PAGE 259
John Tully and
Diana Schirliu are both
Registrars in Psychiatry and
Maria Moran is Consultant
Psychiatrist, all at Brothers
of Charity Intellectual
Disability Service,
Renmore, Ireland.

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