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Severe intellectual disability: systematic review of the prevalence and nature of presentation of unipolar depression
- Authors:
- WALTON Catherine, KERR Mike
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(5), 2016, pp.395-408.
- Publisher:
- Wiley
Background: The diagnosis of depression in severe and profound intellectual disability is challenging. Without adequate skills in verbal self-expression, standardized diagnostic criteria cannot be used with confidence. The purpose of this systematic review was to investigate the assessment and diagnosis of unipolar depression in severe and profound intellectual disability. The review aimed to examine the methods used to assess for depression. The secondary aim was to explore the frequency and symptoms of depression. Methods: The PRISMA (2009) Checklist for systematic review was followed, and a search of electronic databases was undertaken. Nine studies were included in the qualitative synthesis from over 2000 records identified. Results: The quality of the studies was assessed and scored, with a wide range of results. Individual studies scored between 2 and 7 of a maximum possible score of 8. The diagnostic tools utilized by each of the studies were assessed and compared. Conclusions: In terms of the methods used to assess for depression, results were varied. This was due to the heterogeneous nature of the individual study designs. The Aberrant Behaviour Checklist consistently showed promise, in particular when combined with other instruments or clinical examination. Qualitative analysis of the selected studies has shown a wide variation in the quality of primary research in this field, with more required to make firm conclusions regarding the diagnosis, frequency and presentation of depression in severe and profound intellectual disability. (Publisher abstract)
Prader Willi syndrome: systematic review of the prevalence and nature of presentation of unipolar depression
- Authors:
- WALTON Catherine, KERR Mike
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(3), 2016, pp.172-184.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to assess the prevalence and nature of presentation of unipolar depression in individuals with Prader-Willi syndrome (PWS). Design/methodology/approach: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2009) checklist for systematic reviews was followed where possible. Findings: Seven studies were included in the qualitative synthesis from a total of 261 records identified. The quality of the studies was then assessed: scores for each study design ranged from between 3 and 6 of a possible score total of 6. The frequency of depression ranged between studies from 4 to 22 per cent. four studies showed over 50 per cent of patients appeared to suffer from psychotic symptoms. Low mood, anhedonia and irritability were described as features of depression, although no fixed pattern of psychopathology arose from across the studies (excluding psychosis). This review has provided evidence to suggest that depression is a frequent occurrence in the PWS population. One study found that the incidence of depression differed between the genetic subtypes, raising questions regarding the relationship between genotype and behavioural phenotypes. A high proportion of individuals with depression suffered from psychotic symptoms. Research limitations/implications: The small number of heterogeneous studies included in this study precluded meta-analysis of the results. This highlights the need for further original research in this field. Practical implications: An increased awareness of the frequency of depressive symptoms within the PWS population will aid in the timely diagnosis and management of the disorder which will reduce psychiatric morbidity. The noted high proportion of psychotic symptoms associated with depression should raise the index of suspicion with clinicians and aid appropriate management decisions. Originality/value: This review has provided preliminary evidence for the nature of presentation of unipolar depression in PWS. It has highlighted the possibility of an increased propensity towards depression with psychotic symptoms. There is some suggestion of a differing presentation and course of unipolar depression between the common genetic subtypes of PWS which warrants further investigation. (Publisher abstract)
Down syndrome: systematic review of the prevalence and nature of presentation of unipolar depression
- Authors:
- WALTON Catherine, KERR Mike
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(4), 2015, pp.151-162.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to assess the prevalence and nature of presentation of unipolar depression in individuals with Down syndrome (DS). Design/methodology/approach: The PRISMA (2009) checklist for systematic review was followed where possible. Findings: Eight studies were included in the qualitative synthesis from a total of 634 records identified. The quality of the studies was then assessed: the studies all scored either 5 or 6 out of 6. The incidence of depression ranged between studies from 5 to 13 per cent. It was found that depression is more common in DS than the general intellectual disability population; this on a background of mental ill health of all causes being less common in DS. It was suggested that, excluding organic disorders, depression is the most common psychiatric problem in DS. In terms of the nature of depression, the evidence was less clear. Various “vegetative” and biological symptoms were observed, with no fixed pattern. There was evidence for withdrawal symptoms and psychosis. Research limitations/implications: The small number of studies included in this review, and their heterogeneity, highlights the need for further original research in this field. Practical implications: - An increased awareness of the frequency of depression in individuals with DS will aid in a timely diagnosis, therefore reduce psychiatric morbidity. Clinicians should be aware of the varied presentation, with no clear clinical picture, in order to maintain a high index of suspicion in an individual presenting with “atypical” symptoms. Originality/value This review has provided preliminary evidence that depression may be the most commonly experienced psychiatric disorder in DS. (Publisher abstract)