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Psychiatry and Intellectual Disabilities in Turkey

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Psychiatry and Intellectual Disabilities in Turkey

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    1. Psychiatry and Intellectual Disabilities in Turkey Yanki Yazgan, M.D. Marmara University Faculty of Medicine (Istanbul) and Yale Child Study Ctr (CT)

    2. www.yankiyazgan.com 2 Republic of Turkey, Constitution, article 61: “ ... state takes the necessary measures to protect the disabled, and to help with their social adjustment”

    3. www.yankiyazgan.com 3 HISTORY

    4. www.yankiyazgan.com 4 A short summary of what happened Reduction of institutional care for people with ID has not been coupled with development of alternative community services. The presence of psychiatric disorders affects adaptation to living in the community, limiting quality of life Mental health needs in this population are greater than nonID. However, increasing needs have not been met.

    5. www.yankiyazgan.com 5 Definition Issues Intellectual disability is viewed as almost synonymous with mental retardation in the terminology, although ID implies a spectrum of syndromes including MR. A broader definition, such as the one proposed by Leon Eisenberg, can be expanded to include severe chronic mental disorders with intellectually constraining effects, besides the core syndromes of ID and neurodevelopmental disorders.

    6. www.yankiyazgan.com 6 ID Learning is impaired in almost all neuropsychiatric disorders. Intellectual disability is a result in most. Psychiatrists may need more understanding of development and learning processes, of which child psychiatrists may ready be more aware of.

    7. www.yankiyazgan.com 7 Increased Risk for Psychopathology Increased risk for psychopathology, and sometimes with a specific clinical picture (e.g Prader-Willi syndrome, FraX) PDD: About 75% of autistic children also meet criteria for MR. ADHD: The prevalence of ADHD in MR population is similar to that in the general population, estimated at between 4% and 11%.  CD: The prevalence of conduct disorder in children and adolescents with mild MR has been reported at 33%.

    8. www.yankiyazgan.com 8 Schizophrenia Rates of schizophenia or psychosis in persons with MR range from 1% to 9% among nonreferred samples and 2.8% to 24% in referred samples. Although variable, these rates are much higher than the 0.5% to 1% of the general population with schizophrenia.

    9. www.yankiyazgan.com 9 Post-traumatic Stress Disorder   ID population is vulnerable to abuse because of difficulties in reporting it, dependency, a tendency to want to please others, and lack of understanding of their rights. For these reasons PTSD is probably significantly underdiagnosed.

    10. www.yankiyazgan.com 10 Obsessive-Compulsive Disorder and Eating Disorders: A connection between self-injurious behavior and OCD has been postulated (PW)  Anorexia and bulimia nervosa are relatively rare in the context of MR, particularly MR of moderate to severe severity, MR is a predisposing factor for other eating disorders such as pica and rumination.

    11. www.yankiyazgan.com 11 “nothing to talk about, no one to talk to” Psychiatrists “keep off” ID/MR (and dementia) Cognitive impairment “is not interesting”. Etiology research is usually left to the other medical disciplines. “know better”?

    12. www.yankiyazgan.com 12 Not Only Poverty 12.1 % families have a member with a disability 35% have an income higher than 2K YTL (1,200 USD)

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    15. www.yankiyazgan.com 15 Social Work Side Adults practically ignored. Mild-moderate cases taken over by MEB (Min Of Education) Buildings with little operational plan have taken precedence. Municipalities increasingly more active A way of political influence SW limits itself to “care”

    16. www.yankiyazgan.com 16 Vs Other Disabilities: Services M/F:3/2 (ID); similar to other disabilities Received educational services targeting his disability (ID: 12.4 %; hearing/speech: 17%, phys. 8.8%) Received rehabilitational and care services: Second after hearing/speech disability (7.8 v. 12.0)

    17. www.yankiyazgan.com 17 SW Agency’s Definition Psychosocial support and development program (for behavior and adjustment problems): definition and solution of psychosocial problems of the individual as well as work towards the psychosocial development of the individual.

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    19. www.yankiyazgan.com 19 Who delivers special services? To whom? Intellectual disability, although present as it is in the terminology, it is mainly to imply mental retardation. Other disabilities of interest (and responsibility) to psychiatrists and child psychiatrists include are autism, pervasive developmental disorder, specific learning disability, and emotional adjustment problems.

    20. www.yankiyazgan.com 20 Decision Making Power The decision making agency is the SW unit in each province, and a board consisting of at least three of the following professionals: social worker, psychologist, child developmentalist, physician and nurse.

    21. www.yankiyazgan.com 21 Psychiatry’s Approach Should incorporate changes in clinical and scientific understanding of ID as well as the social context of human rights and new ways of service delivery to individuals at risk for psychopathology.

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    23. www.yankiyazgan.com 23 “Services should be more integrated” Lack of cohesion among different sectors working for the ID population is a common complaint. True for both governmental and non-governmental organizations.

    24. www.yankiyazgan.com 24 Why ID is Important for Consideration by Psychiatrists ID as a risk factor for psychopathology ID as a consequence of psychopathology ID as a modifier of quality of life and of being a citizen

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