A psychiatrist’s approach to dual diagnosis

Abstract

The experiences of a general psychiatrist working with adults with intellectual disability presenting with challenging behaviours and/or psychiatric illness are described. Three general principles of harm minimisation, building and maintaining relationships with staff, and the systematic collection of behavioural data are discussed. The differing approaches required for institutional versus private office practice are described. Significant reductions in the use of antipsychotic medications have been achieved within large institutions. Three case histories are provided to illustrate the approach taken.