CLINICAL HANDBOOK OF SCHIZOPHRENIA

42. Intellectual Disability and Other Neuropsychiatric Populations 445take their work on behalf of their ward seriously and have a strong moral commitment tohis or her welfare. Ethical principles for the practitioner caring for individuals with neuropsychiatricdisorders who have guardians are with fundamentally the same as those forany person. Fully informing guardians of possible risks and benefits of proposed treatmentsenables guardians to do their work well.Many persons who are judged to be incapacitated and have guardians appointed bya court still possess a degree of clinical capacity; that is, they can understand significantinformation about their condition and about proposed treatment. They should also be informedabout treatment choices or proposals on a level consonant with their ability tocomprehend, and when possible, their agreement with planned treatment or tests shouldalso be sought.KEY POINTS• Schizophrenia occurs in conjunction with ID.• Psychosis with schizophrenia-like features also occurs in association with other neuropsychiatricdisorders such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease,epilepsy, and traumatic brain injury.• Recognition of signs and symptoms, and therefore diagnosis, may be difficult in personswith neuropsychiatric disorders or ID, because signs and symptoms may appear in atypicalfashion, or be obscured or altered by impaired cognition or impaired speech and languagefunction.• Even so, careful attention to accurate diagnosis matters. Not diagnosing schizophreniawhen it exists results in dangerous undertreatment. Overdiagnosis and overtreatment arealso harmful, for example, by causing long-term exposure to antipsychotic medicines andtheir possible hazards without commensurate benefit.• The pharmacological treatment of schizophrenia in persons with ID or other neuropsychiatricdisorders is similar to treatment of persons without such conditions, except that extracare is required.• The long-term prognosis of schizophrenia in persons with concomitant neuropsychiatric disordersis unknown. Lifelong treatment may be needed, but prudence indicates a treatmentreview at least annually, using clinical judgment to confirm efficacy and a positive benefit-toriskassessment.REFERENCES AND RECOMMENDED READINGSAman, M., DeSmedt, G., Derivan, A., Lyons, B., & Findling, R. (2002). Double-blind, placebo-controlledstudy of risperidone for the treatment of disruptive behaviors in children with subaverageintelligence. American Journal of Psychiatry, 159(8), 1337–1346.American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4thed., text rev.). Washington, DC: Author.American Psychiatric Association Committee. (1990). APA Committee on Psychiatric Services forPersons with Mental Retardation and Developmental Disabilities: Task force report: Psychiatricdisorders in the developmentally disabled. Washington, DC: Author.Bodfish, J., Crawford, T., Powell, S., Parker, D., Golden, R., & Lewis, M. (1995). Compulsions inadults with mental retardation: Prevalence, phenomenology, and comorbidity with stereotypyand self-injury. American Journal of Mental Retardation, 100(2), 183–192.Bouras, N., Martin, G., Leese, M., Vanstraelen, M., Holt, G., Thomas, C., et al. (2004). Schizophrenia-spectrumpsychoses in people with and without intellectual disability. Journal of IntellectualDisability Research, 48(6), 548–555.Cassidy, S. B. (1997). Prader–Willi syndrome. Journal of Medical Genetics, 34, 917–923.Duggan, L., & Brylewski, J. (1999). Effectiveness of antipsychotic medication in people with intellec-