Disabilità intellettiva, relazionale e gravi problematiche di salute mentale nell’arco di vita di una persona:
- Disabilità o disturbo?
- Classificazione standard
- Classificazione attuale
- Diagnosi psichiatrica nella disabilità intellettiva
- I gravi disturbi psichiatrici (Dr. Bertelli)
Alteraciones neuropsiquiátricas de pacientes con deterioro cognitivo leve y d...Capítulo de Demencia
Articulo desarrollado por Nilton Custodio, Sheila Castro-Suarez, Eder Herrera-Pérez, David Lira, Rosa Montesinos, Erik Guevara-Silva, Liza Núñez del Prado y Nora Rojas para la revista Interciencia.
In the documentary Planning for Hope: Living with Frontotemporal Disease and on the pages of the Planning for Hope website, you can learn more about this disease, its impact, and sources of hope for victims and their families. Although there are hundreds of thousands FTD victims in the United States alone, they tend to live in different areas and have limited opportunities to share with other FTD victims.
To learn more about FTD and order the Planning for Hope DVD, go to http://ftdplanningforhope.com/.
Alteraciones neuropsiquiátricas de pacientes con deterioro cognitivo leve y d...Capítulo de Demencia
Articulo desarrollado por Nilton Custodio, Sheila Castro-Suarez, Eder Herrera-Pérez, David Lira, Rosa Montesinos, Erik Guevara-Silva, Liza Núñez del Prado y Nora Rojas para la revista Interciencia.
In the documentary Planning for Hope: Living with Frontotemporal Disease and on the pages of the Planning for Hope website, you can learn more about this disease, its impact, and sources of hope for victims and their families. Although there are hundreds of thousands FTD victims in the United States alone, they tend to live in different areas and have limited opportunities to share with other FTD victims.
To learn more about FTD and order the Planning for Hope DVD, go to http://ftdplanningforhope.com/.
This presentation by Gavin Giovannoni looks at the new treatment paradigm for MS. It includes: arguments for early treatment in multiple sclerosis, the effect of MS on quality of life and whether highly-effective treatments stabilise MS.
It was presented at the MS Trust Annual Conference in November 2013.
Breve introduzione ai Recommender Systems e al problema della diversità dei suggerimenti, con utili riferimenti bibliografici.
Slide usate durante il talk http://www.eventbrite.it/e/biglietti-club-degli-sviluppatori-puglia-recommender-systems-9384077027?aff=eorg
This presentation by Gavin Giovannoni looks at the new treatment paradigm for MS. It includes: arguments for early treatment in multiple sclerosis, the effect of MS on quality of life and whether highly-effective treatments stabilise MS.
It was presented at the MS Trust Annual Conference in November 2013.
Breve introduzione ai Recommender Systems e al problema della diversità dei suggerimenti, con utili riferimenti bibliografici.
Slide usate durante il talk http://www.eventbrite.it/e/biglietti-club-degli-sviluppatori-puglia-recommender-systems-9384077027?aff=eorg
Executive Master in Direzione delle Risorse Umane
Un’opportunità per chi vuole lavorare nell’ambito delle Risorse Umane
Business M@ster in collaborazione con Plan
Le opportunità di formazione professionale, di inserimenti lavorativi socio-terapeutici, d’iscrizione alle categorie protette, di accesso alle cooperative di tipo B presenti sul territorio (Dr.ssa Pertici)
La presentazione mette a confronto i contenuti dei commi 8 e 9 della L.183/2015 e lo schema di d.lgs.157/2015 relativo a misure di conciliazione vita lavoro e maternità (atto IV del Jobs act)
Intervento di Renato Dorrucci al convegno "Uguaglianza e merito per la crescita economica e sociale" del 5 giugno 2008, organizzato dal gruppo Donne di Manageritalia.
Similar to Progetto Sportello Unico Disabilità - 2a - Classificazione e diagnosi dei disturbi dello Sviluppo Intellettivo e Salute Mentale (Bertelli) (ENG)
There is Time to Adjust. Aging as a Protective Factor for Autism-Crimson Publ...CrimsonPublishersGGS
There is Time to Adjust. Aging as a Protective Factor for Autism by Diego Iacono in Gerontology & Geriatrics studies
Autism spectrum disorder (ASD) is formally diagnosed before the age of 3 that is, when the central nervous system (CNS) is not yet completely formed, but it is mature enough to generate behavioural abnormalities in some individuals when compared to an age- matched group of typically developed children [1,2]. However, ASD is not a life-threating disease and children diagnosed with ASD age at the same rate as their peers. The possible detrimental or beneficial factors associated with aging in children affected by ASD are not fully known. Surprisingly, the amount of peer-reviewed medical and scientific international literature published on the topic of aging with autism is quite modest and sporadic [3]. The scarcity of aging-ASD investigations derives from the lower level of attention, and related funding opportunities, from the major public and private funding agencies for research across the globe
Most people with dementia undergo behavioral changes during the course of the disease. They may become anxious or repeat the same question or activity over and over. The unpredictability of these changes can be stressful for caregivers. As the disease progresses, your loved one's behavior may seem inappropriate, childlike or impulsive. Anticipating behavioral changes and understanding the causes can help you deal with them more effectively.
Due to the indicative synaptic elimination as a core phenomenon co-occurring or predicating schizophreniform pathogenesis and the temporal comorbidity of anomalous self-experience, we posit that the neurobiological etiology of formal thought disorder in schizophrenia arises from robust loss of synaptic density at young adulthood mediated by dysregulation of Rho GTPase proteins marked by overzealous targeting from the innate immune system complement cascade.
Running head PTSD2PTSD5Post-Traumatic Stress Di.docxtodd581
Running head: PTSD
2
PTSD
5
Post-Traumatic Stress Disorder
Amber Hope
Argosy University
Post-Traumatic Stress Disorder
Anderson, Cesur, & Tekin (2015)open up the discussion with focusing on the onset of PTSD among individuals. They present PTSD as a severe disorder with a focus on the destruction of thinking, emotions, and actions. Adamsons & Johnson (2013) argue that PTSD influences an individual to become unstable in terms of thinking and acting. Most schizophrenic patients end up either being responsive or withdrawn (Bargai, Ben-Shakhar, & Shalev, 2007). PTSD is different from multiple personalities due to the symptoms differences between the two disorders (Herring et al., 2008). Patients who suffer from the disease either hear things or see them. They have an altered personality and always feel angry and irrational (O'Mahen & Flynn, 2008). Patients show bizarre behavior. They have preoccupation when it comes to issues focusing on religion (Söderquist, Wijma, Thorbert, & Wijma, 2009). PTSD patients feel indifferent to essential situations.
Individuals who possess the disorders lack a strong personality and may not pose a danger to those around them (Baumeister, Vohs, Aaker, & Garbinsky, 2013). Chassin (2010) states that there are several causes of PTSD. Brummelte & Galea (2016) confirm that factors such as poor parenting, childhood experiences, and low motivation in life are not the causes of PTSD. (Fusar-Poli, et al., 2014) Presents an argument that the roots of PTSD are caused by various issues in the human environment that influence the minds to become unstable. Individuals may have infections in their brains, a significant factor that may lead to them having the disorder (Dein, 2017).
PTSD exists in the genetic coding of individuals which influences individuals to pass it from one generation to another with much ease (Dziwota, Stepulak, Włoszczak-Szubzda, & Olajossy, 2018). Despite the disorder lacking a cure, it does not mean that it is not manageable (Dziwota, Stepulak, Włoszczak-Szubzda, & Olajossy, 2018). Some combination of prescriptions and therapeutic techniques are vital in dealing with the disorder.
References
Adamsons, K., & Johnson, S. (2013). An updated and expanded meta-analysis of nonresident fathering and child well-being. Journal of Family Psychology, 27(4),, 589.
Anderson, D., Cesur, R., & Tekin, E. (2015). Youth depression and future criminal behavior. Economic Inquiry, 53(1),, 294-317.
Bargai, N., Ben-Shakhar, G., & Shalev, A. (2007). Posttraumatic stress disorder and depression in battered women: The mediating role of learned helplessness. Journal of Family Violence, 22, 267-275.
Baumeister, R., Vohs, K., Aaker, J., & Garbinsky, E. (2013). Some key differences between a happy life and a meaningful life. The Journal of Positive Psychology, 8(6),, 505-516.
Biaggi, A., Conroy, S., Pawlby, S., & Pariante, C. (2016). Identifying the women at risk of antenatal anxiety and depression: a systematic revi.
Emotional intelligence-as-an-evolutive-factor-on-adult-with-adhdRosa Vera Garcia
ADHD adults exhibit deficits in emotion recognition, regulation, and expression. Emotional intelligence (EI) correlates with better life performance and is considered a skill that can be learned and developed. The aim of this study was to assess EI development as ability in ADHD adults, considering the effect of comorbid psychiatric disorders and previous diagnosis of ADHD. Method: Participants (n = 116) were distributed in four groups attending to current comorbidities and previous ADHD diagnosis, and administered the Mayer–Salovey–Caruso Emotional Intelligence Test version 2.0 to assess their EI level. Results: ADHD adults with comorbidity with no previous diagnosis had lower EI development than healthy controls and the rest of ADHD groups. In addition, ADHD severity in childhood or in adulthood did not influence the current EI level. Conclusion: EI development as a therapeutic approach could be of use in ADHD patients with comorbidities.
Presentation slides of a research proposal for using simple eye-tracking system for diagnosis of ADHD.
In collaboration with Hossein Razbarry in the university of Trento. Affective Computing project.
Journey to posttraumatic stress disorder Sajia Iqbal
Journey to PTSD covers what PTSD is, its symptoms, its severe conditions in globe, some theoritical causes leading PTSD, models' strength and weakness.
Similar to Progetto Sportello Unico Disabilità - 2a - Classificazione e diagnosi dei disturbi dello Sviluppo Intellettivo e Salute Mentale (Bertelli) (ENG) (20)
Legge e Diritti
- Legislazione scolastica attuale sulla disabilità: normativa, classificazione
- Cenni di organizzazione scolastica: gli organi collegiali
- Gli strumenti dell’inclusione scolastica: POF, PEI, PDF, Diagnosi Funzionale, GLH-GLHI. (Dr.ssa Santori)
- Diritto all’inclusione: cosa, quando e come richiedere servizi
- L’ampliamento dell’offerta formativa sul territorio fiorentino: Cred Ausilioteca, Centro Ausilii, Chiavi della Città
- Le organizzazioni e le associazioni per la disabilità :panoramica dei servizi offerti (Dr.ssa Santori)
Servizi in Toscana
- Tutela della salute e servizi: Normativa, Diagnosi, Cura, Riabilitazione, Altro
- I servizi dell'Area disabilità nel territorio toscano: Sanitario e sociale
- Percorsi di cura e riabilitazione in Toscana: cassificazione dei servizi di riabilitazione, tipologia dei servizi e modalità di accesso (Dr.ssa Ensabella)
Età evolutiva
- Disturbi dello sviluppo intellettivo e relazionale in età evolutiva
- Diagnosi differenziale, intervento precoce e problematiche della transizione
(Dr. Boschetto)
Disabilità intellettiva, relazionale e gravi problematiche di salute mentale nell’arco di vita di una persona:
- La disabilità intellettiva come raggruppamento di disturbi del neurosviluppo
- Ridefinire una categoria nel nuovo sistema diagnostico internazionale
Progetto Sportello Unico Disabilità della Fondazione San Sebastiano della Misericordia di Firenze
- Fondamenti filosofici ed etici dei diritti delle persone disabili.
- Storia e sociologia delle associazioni dei familiari dei disabili in Toscana.
- Storia dell’organizzazione dei servizi per la disabilità in Toscana (Dr. Lombardi)
The next conference of MHID (Mental Health in Intellectual Disabilities congress) will take place in 2015 in Florence, under the patronage of Misericordia di Firenze and Opera Diocesiana Assistenza. Let see why!
La prossima conferenza di MHID (Mental Health in Intellectual Disabilities) si svolgerà nel 2015 a Firenze, con il patrocinio della Misericordia di Firenze e Opera Diocesiana Assistenza. Vediamo perchè!
More from Ven. Arc. della Misericordia di Firenze (8)
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Progetto Sportello Unico Disabilità - 2a - Classificazione e diagnosi dei disturbi dello Sviluppo Intellettivo e Salute Mentale (Bertelli) (ENG)
1. Sportello Unico Disabilità (SUD)
- 2 Classificazione e diagnosi dei disturbi dello
Sviluppo Intellettivo e Salute Mentale
(Dott. Marco Bertelli)
2. INTELLECTUAL DEVELOPMENTAL DISORDERS
AND MENTAL HEALTH:
CLASSIFICATION AND DIAGNOSTIC ISSUES
Marco Bertelli, MD, Psychiatrist, MISP
Presidente EAMH-ID - European Association on Mental Health in Intellectual Disability
Presidente WPA-SPID - World Psychiatric Association - Section Intellectual Disability
Segretario SIDiN – Società Italiana per i Disturbi del Neurosviluppo
Presidente Eletto AISQuV - Società Italiana per lo studio della Qualità di Vita
Direttore Scientifico CREA - Research and Clinical Centre of Fondazione San Sebastiano, Florence (Italy)
www.crea-sansebastiano.org
office: mbertelli@crea-sansebastiano.org
private: bertelli.fi@tiscali.it
3.
4.
5. WPA-SPID POSITION STATEMENT
ID is a health condition
ID is a meta-syndrome characterised by an
impairment in cognitive functioning prior to the
acquisition of skills through learning
the intensity of the deficit is such to interfere in a
significant way with individual normal functioning as
expressed in limitations in activities and restriction in
participation (disabilities)
Salvador-Carulla L.. and Bertelli M. Intellectual Disability: A Hidden Mental Health Priority Area. Psychopathology, 2007
6. IDD DEFINITION
A group of developmental conditions characterized by a significant
impairment of cognitive functions, which are associated with
limitations of learning, adaptive behavior and skills.
IDD is a life span condition requiring consideration of
developmental stages and life transitions.
Most individuals with IDD continue to acquire skills and
competencies, especially with optimal care, training, education and
opportunities for learning.
However IDD is a vulnerable group associated with a higher rate
of mental and physical disorders and related unmet care needs as
well as an increased risk of abuse and neglect.
Salvador-Carulla L.. Reed G., Bertelli M. et al, World Psychiatry, in press
9. Is IQ reduction an useful criterion for ID?
1.Ardila A., (1999). A Neuropsychological Approach to Intelligence. Neuropsychology Review, Vol. 9, No. 3,1999; 45. 2.Salvador-Carulla L., Bertelli M.
(2007). Intellectual Disability: A Hidden Mental Health Priority Area. Psychopathology. 41:10-16. 3. Tiekstra M, Hessels MG, Minnaert AE. Learning
capacity in adolescents with mild intellectual disabilities. Psychol Rep. 2009 Dec;105(3 Pt 1):804-14; 35. 4.Torresan, P. (2006). Le intelligenze multiple.
Revista Conceptos, UMSA.
10. IQ AND COGNITIVE PROFILE IN GS
Syndrome
ID level
Down
Mild, moderate or severe
X Fragile
15% mild
49% moderate
26% severe
10% profound
Williams
7q delection
Mild or moderate
Smith-Magenis
(17p delection)
Specific Cognitive Dysfunction
Mild or moderate
Bertelli et al. (2011). PSICOGEN (PSIchyatric disorders and Cognition in GENetic syndromes).In submission.
11. IQ AND COGNITIVE PROFILE IN GS - 2
Syndrome
ID level
Warkany 2
(trisomy 8)
moderate or severe
Phenylketonuria
moderate or severe
Klinefelter
(47 XXY)
absent or borderline
Galctosemia
Specific Cognitive Dysfunction
absent or borderline
Bertelli et al. (2011). PSICOGEN (PSIchyatric disorders and Cognition in GENetic syndromes).In submission.
13. SCFs AND NOT IQ
FOR BIOLOGICAL SUBSTRATES
Findings of recent studies of genetics, neuroimaging and
neurophysiology identified more correlations with
cognitive functions (such as perceptual organization
deficit, poor working memory, lexical, visual-spatial and
phonological processing) than with IQ scores1,2,3,4,5,6
1. Steinlin M. (2008). Cerebellar disorders in childhood: cognitive problems. Cerebellum. 7:607-10; 2.Tavano A., Borgatti R. (2010). Evidence for a link among cognition,
language and emotion in cerebellar malformations. Cortex. 46:907-18; 3.Ardila A., Pineda D., Rosselli M. (2000). Correlation between intelligence test scores and executive
function measures. Archives of Clinical Neuropsychology. 15:31-6; 4.Friedman N.P., Miyake A., Corley R.P., Young S.E., Defries J.C., Hewitt J.K. (2006). Not all executive
functions are related to intelligence. Psychological Science. 17:172-9; 5.Johnson W., Jung R.E., Colom R., Haier R.J. (2008). Cognitive abilities independent of IQ correlate
with regional brain structure. Intelligence. 36:18-28; 6.Mackintosh NJ. (1999). IQ and Human Intelligence. Reviewed by Robert Plomin. The American Journal of Human
Genetics. 65:1476-1477.
14. 17,5 %
12,5 %
6%
2,5%
RM
FIL
NORMALE
ALTO
GENIO
Hassiotis A, Strydom A, Hall I, Ali A, Lawrence-Smith G, Meltzer H, Head J, Bebbington P. Psychiatric morbidity and social functioning
among adults with borderline intelligence living in private households. J Intellect Disabil Res. 2008 Feb;52(Pt 2):95-106.
15. BORDERLINE INTELLIGENCE
N = 8450 adults
around 1/8 of the population has borderline intelligence
(12,3% of the sample)
this people present higher rate of:
- neurotic disorders
- substance abuse
- personality disorders
- social disability
- psycho-pharmacological therapies, but not speech
therapies
- health service use, including emergency services
Hassiotis A. et al. J Intellect Disabil Res. 2008 Feb;52(Pt 2):95-106
16. Is the age limit of 18 an useful criterion for ID?
Although the specific age limit of 18 is clearly arbitrary,
WPA-SPID members expressed general agreement on the
importance to keep a distinction between a persistent
process that begins at birth and a change occurring after a
normal development.
17. INCREASE OF AUTISM AND ASDs
PREVALENCE RATE
■
Autism1
1. Newschaffer et al., 2007.
2. Lazoff et al., 2010; Baron-Cohen et al., 2009
■
ASD2
18. PREVALENCE RATE (%)
ASD AND ID
PDD in ID = 30-40%1
ID in autism = 25-80%2
in ID around 50% of ASDs has been previously
diagnosed with schizophrenia3
risk of underestimating ASD in ID in favour of
schizophrenia4
1. Kraijer 1997 (N=718); Morgan et al. 2002 (N=571); La Malfa et al., 2004 (N=166 adults); Cooper et al., 2007
2. Hoekstra et al., 2009 BJP; Centers for Disease Control and prevention USA, 2006; Edelson, 2006; Matson e Shoemaker, 2009;
Baird et al., 2006; Noterdaeme e Wriedt, 2010; Bryson and Smith, 1998
3. Bryson et al. Prevalence of autism among adolescents with intellectual disabilities. Canadian J of Psychiatry, 2008; 53(7): 449-59
4. Palucka et al., 2009; Savage et al., 2007
19. PREVALENCE RATE (%)
ASD AND SCHIZOPHRENIA
21% of people with schizophrenia receive a
lifetime diagnosis of PDD-NOS1
around 50 % of people with autismo also meets
criteria for schizophrenia disorganised-type2
at least 1.5% of psychiatric outpatients don’t
receive the right diagnosis of ASD; 26% of these is
diagnosed with schizophrenia3
1. Sporn et al., 2004; Towbin et al., 2005
2. Konstantareas and Hewitt, 2001
3. Nylander and Gilberg, 2001
20. PREVALENCE RATE (%)
OF PSYCHIATRIC DISORDERS IN ID WITH AND WITHOUT AUTISM
Prevalence
Tool
with A
without A
Bradley & Bolton, 2006
SAPPA
Bradley et al., 2004
DASH
50
>50
16,7
25
50
67
58
8
8
8
25
8
Depression
Mania
Eating Disorders
Schizophrenia
Bradley E.A. and Bolton P. Episodic psychiatric disorders in teenagers with learning disabilities with and without autism. British Journal of
Psychiatry, 2006, 189: 361-366
Bradley E.A., Summers J.A., Wood H.L., Bryson S.E. Comparing rates of psychiatric and behavior disorders in adolescents and young adults
with severe intellectual disability with and without autism. J of Autism and Developmental Disorders, 2004; 34(2): 151-161
21. GENETIC OVERLAPPING BETWEEN AUTISM AND IDD
Gene:
Protein:
• FMR1 Xq27.32
• neuroligina3
• GRIK2 6q16.32
• neurexina3
• HOXA1 7p15.32
• SHANK-33
• PTCHD11
• CNTNAP24
• NLGN4 and IL1RAPL12
• PUM25 implications in mRNA
• RPL102
• CGG trinucleotide6
deletion
• 1q21.12
LTD on mGluR7
• 15q13.32
• 16p11.22
1Noor A, Scherer SW. Disruption at the PTCHD1 locus on Xp22.11 in autism spectrum disorder and intellectual disability. Sci Transl Med. 2010 September 15; 2(49)
2Pinto D, Scherer SW. Functional Impact of Global Rare Copy Number Variation in Autism Spectrum Disorder Nature. 2010 July 15; 466(7304): 368–372. doi:10.1038/nature09146
3Bakkaloglu B, et al. Molecular cytogenetic analysis and resequencing of contactin associated protein-like 2 in autism spectrum disorders. Am J Hum Genet. 2008 Jan;82(1):165-73.
4Alarcón M, et al. Linkage, association, and gene-expression analyses identify CNTNAP2 as an autism-susceptibility gene. Am J Hum Genet. 2008 Jan;82(1):150-9
5
Vessey J.P., Schoderboeck L., Gingl E., Luzi E, et al. Mammalian Pumilio 2 regulates dendrite morphogenesis and synaptic function. PNAS ( Proceedings of the National Academy of
Sciences). Published online before print January 28, 2010
6
Gabis LV, Baruch YK, Jokel A, Raz R. Psychiatric and autistic comorbidity in fragile x syndrome across ages. J Child Neurol. 2011 Aug;26(8):940
7Lüscher C, Huber KM. Group 1 mGluR-dependent synaptic long-term depression: mechanisms and implications for circuitry and disease. Neuron. 2010 Feb 25;65(4):445-59
22. GENETIC OVERLAPPING
BETWEEN AUTISM AND SCHIZOPHRENIA
Chromosome 1q21.1 deletion 1
Chromosome 15q13.3 deletion 1
Chromosome 3q29 and 22q11.21 deletion
Chromosome 16p11.2 duplication 1
exonic NRXN1 deletion 1
exonic VIPR2 and C16orf72 duplication 1
Chromosome 16p11.22
NRXN1 2p16.3 gene disrupted in ASD, MR, schizophrenia4
16p13.11 deletion
Deficits in RNA transcription without changes in DNA sequence5-6
1. Levinson DF, Gejman PV. Copy Number Variants in Schizophrenia: Confirmation of Five Previous Findings and New Evidence for 3q29 Microdeletions and VIPR2 Duplications. Am J
Psychiatry. 2011 Mar;168(3):302-16
2. McCarthy SE, Sebat J. Microduplications of 16p11.2 are associated with schizophrenia. 2009 Nov;41(11):1223-7
3. Akbarian S, Huang HS. Epigenetic regulation in human brain-focus on histone lysine methylation. Biol Psychiatry, 2009 Feb 1;65(3):198-203; Singh SM, O'Reilly R. (Epi)genomics and
neurodevelopment in schizophrenia: monozygotic twins discordant for schizophrenia augment the search for disease-related (epi)genomic alterations. Genome, 2009 Jan;52(1):8-19
4. Pinto D, Scherer SW. Functional Impact of Global Rare Copy Number Variation in Autism Spectrum Disorder Nature. 2010 July 15; 466(7304): 368–372. doi:10.1038/nature09146
5. Akbarian S, Huang HS. Epigenetic regulation in human brain-focus on histone lysine methylation. Biol Psychiatry, 2009 Feb 1;65(3):198-203
6. Singh SM, O'Reilly R. (Epi)genomics and neurodevelopment in schizophrenia: monozygotic twins discordant for schizophrenia augment the search for disease-related (epi)genomic
alterations. Genome, 2009 Jan;52(1):8-19
23. THE PROTEINS OF COGNITION
Pum 2 and elF4E and Scn1a
Neuroligina
SHANK-3
CNTNAP2
'cadherin' (Calcium
dependent adhesion
molecules) 10 and 9
Neurexine 1 (NRXN1)
N= 3540 under genomic comparative hybridization
NRXN1 mutation resulted to be associated with ASDs, IDD, and SLD
Ching MS, Shen Y, Tan WH, et al. Deletions of NRXN1 (neurexin-1) predispose to a wide spectrum of developmental disorders. Am J Med Genet B
Neuropsychiatr Genet. 2010 Apr 7.
24. THE ROLE OF FMRP IN MAJOR MENTAL DISORDERS
Fragile X Mental Retardation Protein is highly enriched in neurons and
binds to approximately 4% of mRNAs in mammalian brain
FMRP loss is a hallmark of fragile X syndrome (FXS), the most common
inherited form of mental retardation
reductions of FMRP in psychiatric disorders
•
autism
•
schizophrenia
•
bipolar disorder
•
major depressive disorder
Fatemi SH, Folsom TD. The role of fragile X mental retardation protein in major mental disorders. Neuropharmacology. 2011 Jun;60(7-8):1221-6. Epub 2010
Nov 22.
25. GENETICS OF NEURODEVELOPMENTAL DISORDERS
RELN
reelin
neuronal migration and synaptic function
Npas4G
Npas4
social and cognitive functions
1q21.1
CHD1, PBKAB2
chromatine and AMP kinase regulation
16p11.2
SEZ6L2
expressive language and socialisation
16p13.1
NDE1, NTAN1
synaptic plasticity, memory
GRIN2
NMDA rec
working memory and perceptual binding
TCF4
TCF4
memory and attention (N150)
NRXN1
neurexine
synaptic functions
CNTNAP2
contactin-L2
cell adhesion and receptors
SHANK 3
ProSAP2
synapse and dendritic spine formation
Ullman et al.,Human mutation, 2007; Folsom et al. Neuropharmacology, 2012; Coutallier et al. PLos One, 2012; Crespi et al. J Neurodev Disord, 2012; Endele et
al. Nat Genet, 2010 ; Hennekam et al. Dev Med Child Neurol, 2012
26. METACATEGORY
WPA-SPID proposed to include in a cluster of disorders
sharing salient cognitive symptoms and similarities on risk
factors, clinical factors, genetic phenotype, early onset, course,
and co-morbidity.
F7
Salvador-Carulla L.. Reed G., Bertelli M. et al, World Psychiatry, in press
F1
27. ICD-11-beta morbidity linearisation
and “impairment of behaviour”
• 05 Mental and behavioural disorders
NEURODEVELOPMENTAL DISORDERS
Disorders of Intellectual Development (DID)
5A00. Mild DID: IQ 50-69; in adults mental age (MA) 9 - <12 y
5A01. Moderate DID: IQ 35-49; in adults, MA 6 - <9 y
5A02. Severe DID: IQ 20 – 34; in adults, MA 3 - <6 y
5A13. Profound DID: IQ <20; in adults, MA <3 y
5A0Y. Other disorders of intellectual development
5A0Z. Disorders of intellectual development, unspecified
ICD-10 impairment of behaviour F7x. 1 “RETIRED”
28. DSM-5 ID/IDD Position
• disturbo con insorgenza nell’età evolutiva che include deficit
intellettivi e adattivi negli ambiti della concettualizzazione, della
socializzazione e delle capacità pratiche
• i livelli di gravità vengono definiti sulla base del funzionamento
adattivo e non sui punteggi di quoziente intellettivo (QI), poiché è
stato giudicato che sia il funzionamento adattivo, nelle aree della
concettualizzazione, della socializzazione e delle abilità pratiche, a
determinare il livello di supporto necessario a mantenere una
condizione di vita accettabile. In più, quando basse (inferiori a 60), le
misure di QI perdono di validità
• si continuano a distinguere 4 livelli di gravità (lieve, moderato, grave
e gravissimo), ma con criteri diversi dal DSM-IV e IV-TR.
APA. Diagnostic and Statistic Manual for Mental Disorders - %th edition, 2013
29. DSM-5 ID/IDD Position - 2
• il disturbo è stato collocato in un raggruppamento meta-sindromico, o
meta-strutturale, denominato ‘disturbi del neurosviluppo
• il gruppo include condizioni con insorgenza in età evolutiva, tipicamente
precoci, spesso precedenti l’ingresso a scuola e caratterizzate da deficit
di sviluppo che producono compromissioni del funzionamento personale,
sociale, scolastico o occupazionale
• il range di deficit spazia da limitazioni molto specifiche
dell’apprendimento e del controllo delle funzioni esecutive ad una
compromissione globale delle abilità sociali o dell’intelligenza
• i disturbi del neurosviluppo si presentano spesso insieme, per esempio
individui con autismo hanno spesso anche disabilità intellettiva (disturbo
dello sviluppo intellettivo) e molti bambini con disturbo da deficit
d’attenzione e iperattività hanno spesso anche un disturbo specifico
dell’apprendimento.
APA. Diagnostic and Statistic Manual for Mental Disorders - %th edition, 2013
30. DSM-5 ID/IDD Diagnostic Criteria
A. Deficit delle funzioni intellettive, come il ragionamento, la soluzione
di problemi, la pianificazione, il pensiero astratto, il giudizio,
l’apprendimento scolastico o l’apprendimento dall’esperienza,
confermato sia da valutazione clinica che da prove d’intelligenza
individualizzate e standardizzate.
B. Deficit del funzionamento adattivo che si manifesti col mancato
raggiungimento degli standard di sviluppo e socio-culturali per
l’indipendenza personale e la responsabilità sociale.
Senza supporto continuativo i deficit adattivi limitano il funzionamento
in una o più attività della vita quotidiana, quali la comunicazione, la
partecipazione sociale e la vita indipendente, in più ambiti diversi,
come la casa, la scuola, il lavoro e la comunità.
C. Insorgenza dei deficit intellettivi e adattivi nell’età evolutiva.
APA. Diagnostic and Statistic Manual for Mental Disorders - %th edition, 2013
31. PROPOSAL OF LINEAR STRUCTURE FOR ICD-11
F: MENTAL AND BEHAVIOURAL DISORDERS (meta-structure)
F1: NEURO-DEVELOPMENTAL DISORDERS (meta-category)
F1.Y PROBLEM BEHAVIOURS/BEHAVIOUR DISORDER (category)
F1.Y.1 Mild and infrequent
F1.Y.2 Mild and frequent
F1.Y.3 Severe and infrequent
F1.Y.4 Severe and frequent
F1.Y.5 External boundary prevents expression of behaviour
objects)
Self-injury
F1.Y.8 Unspecified
F1.Y.1-8.1 Physical aggression to others
F1.Y.1-8.2 Verbal aggression (e.g. screaming)
F1.Y.1-8.3 Destructive to property (e.g. throwing/pulling
F1.Y.1-8.4
F1.Y.1-8.5 Oppositional
F1.Y.1-8.6 Overly-demanding
F1.Y.1-8.7 Sexually inappropriate (e.g. repeated
stripping)
F1.Y.1-8.8 Other
Can multiple sub-sub categories be specified or not? – alternative descriptors if not
WHO WG on ID for ICD-11. Proceedings of the fourth meeting, Buenos Aires 2011.
32. LIFE EVENTS AND PSYCHIATRIC
DISORDERS IN PwID
Association between recent life events and traumatic
experiences across the life span and psychiatric disorders
in PwID more than in general population
Transition phases and PDs
Though they have been less studied by the literature
regarding predictors of mental illness, traumatic
experiences seem to play a more important role in
psychopathology than life events1
Martorell A., et al., 2009
33. A NEW CULTURAL MODEL FOR
NEURODEVELOPMENTAL DISORDERS / CONDITIONS
PSYCHO-CHARACTERISATION
SPECIF COGNITIVE FUNCTIONS
INDIVIDUAL SKILLS
INDIVIDUAL ATTRIBUTION OF IMPORTANCE
OFFER OF A WIDE RANGE OF OPPORTUNITIES
IMPROVEMENT OF THE INDIVIDUAL IMPORTANCE/SATISFACTION
INDIVIDUAL QoL
Bertelli et al. Advances in Mental Health and Intellectual Disabilities, in press
34. MARCO BERTELLI
MD, Psychiatrist, Psychotherapist
CREA (AMG Research and Evolution Centre) Scientific Director
Via del Sansovino, 176 - 50142 Firenze (Italy)
www.wpanet.org/spid
www.crea-amg.org
bertelli.fi@tiscali.it
mbertelli@crea-amg.org
Editor's Notes
Milner reported a mean loss of only 7.2 IQ points following dorsolateral frontal lobectomies, with mean postoperative IQ scores re- maining in the average range.
Anche l'intelligenza manca di una definizione univoca e condivisa. Essa rimanda ancora ad un’ampia gamma di significati, alcuni dei quali limitati alla logica ed alla deduttività, altri estesi all’emotività o alle abilità individuali di gestire le diverse situazioni di vita e di relazionarsi con l'esterno in modo funzionale ed adattivo.
Milner reported a mean loss of only 7.2 IQ points following dorsolateral frontal lobectomies, with mean postoperative IQ scores re- maining in the average range.
Anche l'intelligenza manca di una definizione univoca e condivisa. Essa rimanda ancora ad un’ampia gamma di significati, alcuni dei quali limitati alla logica ed alla deduttività, altri estesi all’emotività o alle abilità individuali di gestire le diverse situazioni di vita e di relazionarsi con l'esterno in modo funzionale ed adattivo.
Milner reported a mean loss of only 7.2 IQ points following dorsolateral frontal lobectomies, with mean postoperative IQ scores re- maining in the average range.
Anche l'intelligenza manca di una definizione univoca e condivisa. Essa rimanda ancora ad un’ampia gamma di significati, alcuni dei quali limitati alla logica ed alla deduttività, altri estesi all’emotività o alle abilità individuali di gestire le diverse situazioni di vita e di relazionarsi con l'esterno in modo funzionale ed adattivo.
Milner reported a mean loss of only 7.2 IQ points following dorsolateral frontal lobectomies, with mean postoperative IQ scores re- maining in the average range.
Anche l'intelligenza manca di una definizione univoca e condivisa. Essa rimanda ancora ad un’ampia gamma di significati, alcuni dei quali limitati alla logica ed alla deduttività, altri estesi all’emotività o alle abilità individuali di gestire le diverse situazioni di vita e di relazionarsi con l'esterno in modo funzionale ed adattivo.
Milner reported a mean loss of only 7.2 IQ points following dorsolateral frontal lobectomies, with mean postoperative IQ scores re- maining in the average range.
Anche l'intelligenza manca di una definizione univoca e condivisa. Essa rimanda ancora ad un’ampia gamma di significati, alcuni dei quali limitati alla logica ed alla deduttività, altri estesi all’emotività o alle abilità individuali di gestire le diverse situazioni di vita e di relazionarsi con l'esterno in modo funzionale ed adattivo.
Milner reported a mean loss of only 7.2 IQ points following dorsolateral frontal lobectomies, with mean postoperative IQ scores re- maining in the average range.
Anche l'intelligenza manca di una definizione univoca e condivisa. Essa rimanda ancora ad un’ampia gamma di significati, alcuni dei quali limitati alla logica ed alla deduttività, altri estesi all’emotività o alle abilità individuali di gestire le diverse situazioni di vita e di relazionarsi con l'esterno in modo funzionale ed adattivo.
Milner reported a mean loss of only 7.2 IQ points following dorsolateral frontal lobectomies, with mean postoperative IQ scores re- maining in the average range.
Anche l'intelligenza manca di una definizione univoca e condivisa. Essa rimanda ancora ad un’ampia gamma di significati, alcuni dei quali limitati alla logica ed alla deduttività, altri estesi all’emotività o alle abilità individuali di gestire le diverse situazioni di vita e di relazionarsi con l'esterno in modo funzionale ed adattivo.