Prescribing psychotropic medications in patients with intellectual disability (ID) requires certain nuances in approach that may be unfamiliar to some psychiatrists. In this article, we’ll discuss some aspects of assessment and treatment that you may find useful when you encounter and work with such patients.

Psychotherapy is all about communicating, yet people with intellectual disability often have significant limitations in their communication skills, depending on their level of cognitive functioning. Is it possible for us to help these patients? If so, how? Julie Gentile, MD (www.juliegentile.com) has been looking at these questions for 20 years.

Patients with intellectual disability often have difficulty controlling their emotions, which is what leads to so-called “challenging behaviors.” These behaviors include a range of aggressive and impulsive interactions, such as assault to self or others, stealing, fire-setting, sexual offenses, and other problematic situations.

Ketamine has become increasingly popular as an off-label medication for rapid onset treatment of refractory depression. Recently, the American Psychiatric Association convened a task force to review the data and come up with some recommendations.

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The post-test for this issue is available for one year after the publication date to subscribers. By successfully completing the test you will be awarded a certificate for 2 CME credits.

How do you start a new patient on antidepressant treatment? We do this countless times in our practices, and reviewing the topic may feel a bit like returning to residency. However, it’s important to revisit our standard operating procedures from time to time to ensure we’re thinking carefully about our decisions during our busy days.

You’ve tried different SSRIs and then some, but your patient either can’t tolerate what you’ve prescribed or simply hasn’t experienced a lift in mood. Now what? Dr. Gitlin has some ideas.

Your patient has now failed four antidepressant medications, both alone and as cocktails. What else can you pull out of your bag of tricks? Dr. Becker suggests considering transcranial magnetic stimulation (TMS), which he maintains is underutilized. “Many of my colleagues right down the hall from me still don’t think of TMS for treatment or don’t know who to refer for it,” he says. “I think it should be more readily considered for a lot of patients out there.”

For a look at how TMS works, how effective it is, how it compares with electroconvulsive therapy (ECT), whether some brands of TMS machines are better than others, and what you have to do to make sure your patient’s health insurance plan picks up the tab, we spoke with Dr. Becker, who prescribes this treatment for some of his patients.

Dr. Gardiner recommends ConsumerLab.com to patients to “try to stop them from hurting themselves with mislabeled products or wasting their money” and to help determine whether a supplement might interfere with a medication he is prescribing.