Between 1996 and 2012 a number of articles about disorders of intellectual development (now the preferred term) were published in Advances in Psychiatric Treatment (now BJPsych Advances). These were well received and it was thought that it would be of value if these articles were updated and additional material added. The result is this volume.
The main aim of this book is to give advice to the clinician about clinical difficulties encountered in people with intellectual disabilities. Many of the chapters assist in this aim; those by Elspeth Bradley and Marika Korossy on behaviour disorders and Neill Simpson and Neil Arnott on linking primary and secondary care are particularly helpful to the practising physician. There are a wide number of possible causes provoking behaviour disturbance in this population and these are summarised extensively in the well-referenced Bradley chapter and in the contributions by Tom Berney and by the editor and Sheila Hollins. Anthony Holland and Jeremy Turk provide valuable background information on classification and behavioural phenotypes respectively, and I learned that the RASopathies (due to anomalies in the Ras/mitogen-activated protein kinase genetic pathway) are associated with hyperactivity.
Shoumitro Deb, writing on psychotropic medication, extensively describes the protocol for employment of these drugs, but details of how to use these drugs in practice is largely confined to clinical impressions. The evidence base for the use of these agents in this population is meagre but I was sorry to read that lithium is not recommended as a mood stabiliser despite the fact that this drug is only one of a handful that is licensed for the treatment of self-injury and aggressive behaviour.
The most entertaining and revealing chapter is by Simon Halstead, who describes frankly his personal experiences working in the forensic field. He laments the massive expansion of private facilities for the supposed management of those with behaviour difficulties, exemplified by the scandal at Winterbourne View. The greatly reduced opportunities for this population to partake in enjoyable outdoor activities, as a result of concerns about danger in our risk-averse culture, are also highlighted.
Because of the provenance of its contributors, Clinical Topics in Disorders of Intellectual Development is understandably parochial; all the authors are either British or Canadian. Notwithstanding, this book is worth reading and in most areas is a valuable reference guide.
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