Psychosis and Disorganized Behavior in Adults with Autism and Intellectual Disability: Case Identification and Staff-Patient Interaction

Abstract

Psychotic disorder in patients with moderate, severe, and profound intellectual disability has not been attended to adequately. These patients have traditionally “fallen between” the specialized psychiatry for patients in the normal population and the specialized services for patients with intellectual disability.

Patients with moderate, severe, and profound intellectual disability report their symptoms poorly when they experience a psychotic condition. Because of this, there is a need to establish behavioral indicators, which relate to both case identification and treatment.

Behavioral disorganization was found to be an especially reliable and valid indicator of schizophrenia in the patients in a project at Oslo University Hospital.

Behavioral disorganization and speech disorganization also were found to occur concurrently, which generates a hypothesis of a general co-occurrence and that the two are equivalent indicators of thought disorder. Behavioral disorganization was found to be a relevant, effective measure for evaluation of staff communication skills.

Four selected categories of staff communication skills – responsiveness, attention sustenance, task sustenance, and emotional support – when taken together, were effective in improving behavioral disorganization and the amount of patient initiatives. Task sustenance and joint attention were most effective to decrease a patient’s disorganized behavior, whereas emotional support was most effective in increasing initiatives from the patient. Meaningful response from staff and emotional support, which were assumed to be effective towards disorganized behavior, did not appear to be successful when examined empirically.