when it is compounded by a diagnosis such as depression, anxiety, or psychosis. Indeed, psychiatric co-occurring diagnoses such as these affect patients with developmental disabilities more frequently than the general population. These patients will frequently struggle to reach educational and functional goals or have adverse interactions with the law. Expert consultation with a psychiatric provider is highly recommended in cases such as these. This generation of physicians is dealing with aging issues in the developmentally disabled population. With good medical care and modern medical interventions, individuals are frequently living long beyond what they were in the past. They are living long enough to develop conditions relative to age frequently seen in the general population not previously seen in this group. Significant Challenges in Treating Individuals with a Developmental Disability As previously mentioned, patients with developmental disabilities tend to reveal their medical problems in unusual or underappreciated ways. Often, they will do things that seem inexplicable such as banging their head when they have a headache. Caution is warranted for those who have an unexplained fever with abdominal pain. Often a CT will reveal serious pathology such as a perforated or blocked bowel. Additionally, there are concerns relative to specific drugs prescribed because of behavioral problems. The following is a partial list of classes of drugs and their effects: • Antipsychotic drugs: Anticholinergic effects such as difficulty swallowing, and constipation as well as extrapyramidal reactions. • Lithium: Hypothyroidism; total or partial diabetes insipidus which can result in dehydration with hypernatremia. • Mood stabilizers: Depakote or VPA can lead to increased ammonia causing lethargy. Carbamazepine can cause neutropenia and or thrombocytopenia. • Seizure medications: These drugs can lead to neutropenia or thrombocytopenia and can be symptomatic at toxic levels. They can result in RBC macrocyte morphology which can mask iron deficiency. Physical Abnormalities, Diagnoses, and Findings There are frequent physical abnormalities in individuals with developmental disabilities, below is a partial list of such findings: • General: Seizures, short stature, unusual facies, behavior related to psychiatric co-occurring diagnoses, aggression, resistance to treatment, anxiety, SIB (self-injurious behavior), sleep disturbance, obesity, hypothermia, dehydration with hypernatremia, syndrome of inappropriate ADH, high levels of seizure medications or lithium, high levels of ammonia, anticholinergic symptoms, and movement disorders • Skin: Lacerations that are self-inflicted or related to falls, pressure ulcers, MRSA • Head: Headache or sinusitis sometimes manifest by head banging • Eyes: Corneal lacerations and abrasions, retinal detachment, cataracts (manifested by new difficulty with ambulation), glaucoma, conjunctivitis, subconjunctival hemorrhage • ENT: Impacted cerumen, foreign bodies in the ears and nose, drooling • Respiratory: Aspiration or other pneumonia, pulmonary fibrosis with chronic lung disease related to aspiration • CV: Lipid disorders related to medications; QT prolongation related to medications • GI: GERD, bleeding, ingestion of foreign objects, regurgitation, rumination, dysphagia related to medications, constipation secondary to anticholinergic medications, megacolon, bowel blockage, feeding tubes (G and J), gallbladder disease difficult to diagnose clinically, pancreatitis, mildly elevated liver enzymes related to medications, acute abdomen causing sepsis, Hepatitis B, foreign bodies in the rectum. • GU: Urine retention, urinary tract infections, diabetes insipidus with hypernatremia, hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone, chronic kidney disease, suprapubic catheters, foreign bodies in the vagina • Endocrine: Diabetes, hypothyroid, increase prolactin related to antipsychotic drugs • Hematologic: Iron deficiency, neutropenia and or thrombocytopenia, macrocytic RBC related to seizure medication The life that a person with developmental disabilities has is the only life they know. 31 |
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