4S7Joumal of Intellectual Disability Research

VOLUME 40 PART 5 pp 457-465 OCTOBER I996

Respondent and informant accounts of psychiatric

symptoms in a sample of patients with learning disability

S. Moss,' H. Prosser,' B. Ibbotson' and D. Goldberg^

1 Hester Adrian Research Centre, University of Manchester, Manchester, and

2 Institute of Psychiatry, London, England

Abstract

This paper investigates differences in the nature and

frequency of psychiatric symptoms reported by patients

vi/ith learning disability and by key informants. The study

involved psychiatric assessment of 100 patients with

learning disabilities and key informants using the

Psychiatric Assessment Schedule for Adults with a

Developmental Disability (PAS-ADD), a semi-structured

psychiatric interview developed specifically for people

who have a learning disability. There was considerable

disagreement between respondent and informant

interviews; only 40.7% of cases were detected by both

interviews. Respondents were more likely to report on

autonomic symptoms and certain psychotic phenomena.

Other anxiety and depression symptoms were more

frequently reported by infcrnnants. The results indicate

that it is crucial for sensitive case detection to complete

both interviews where possible. If the respondent

cannot be interviewed, panic disorder or phobias may

be particularly difficult to detect.

Keyword informant, interview, mental retardation,psychiatric assessment, respondent

Introduction

The Psychiatric Assessment Schedule for Adults

Correspondence: Steve Moss, Hester Adrian Research Centre,University of Manchester, Oxford Road, Manchester M13 9PL,England.

with a developmental disability (PAS-ADD) is asemi-structured clinical interview designedspecifically for patients who have learning disability(Moss et al. 1993, 1994). The PAS-ADD, originallyderived from the Present State Examination (PSE),uses parallel versions to interview both therespondent (patient) and a key informant. Thepatient interview has been designed with amulti-level structure to allow interviewing with awide range of intellectual ability. This, plus thereliance on two sources of interview data, maximizesflexibility and symptom sensitivity. The currentversion, the PAS-ADD 10, is based on theSchedules for Clinical Assessment inNeuropsychiatry (SCAN) (WHO 1994). It has beenexpanded to include a psychosis module, and nowmakes ICD 10 diagnoses using the SCAN computeralgorithm.

In the past, the difficulties of interviewing peoplewith learning disability have resulted in a muchheavier reliance on third-party reports than in thegeneral population, a strategy which, whileconvenient to use, misses a potentially vital sourceof clinical information. Using the PAS-ADD with apopulation of people with at least a moderate levelof learning disability, we have shown that 62% couldbe clinically interviewed. Most importantly, 33% ofthe diagnosable cases would not have been detectedwithout respondent interviewing (Patel er al. 1993).

Since PAS-ADD interviewing requires, wherepossible, separate interviews with the respondentand with a key informant, two separate accounts ofmental function result, each of which is processed

1996 Blackwell Science Ltd

465Joumal of Intellectual Disability Research VOLUME 40 PART 5 OCTOBER I996

S. Moss era/. • Psychiatric symptoms

scorers because non-scoritig on the filter items leadsto termination of the section, while positive scoreslead on to the subsequent items. Whetherinterviewer behaviour contributed to thisamplification cannot be determined, but certainlydeserves attention in a future study.

One point which has arisen during the field trialsis the inherent limitation of a present-stateassessment with respect to certain classes ofdisorder. Although respondents with learningdisability often have a poor time concept or poormemory for past events, informants often have thepotential to give high-quality information on pasthistory. The PAS-ADD does not currently utilizethis potential, and as a result, is unable to makecertain diagnoses. An important example of thislimitation is the diagnosis of bipolar disorder, whichrequires evidence of both mania and depression,only one of which may be present at the time ofinterview. As mentioned earlier, a number of casesof hypomania were identified by clinicians but notby the PAS-ADD because the interview does notyet have a section for expansive mood. However,even with a section on expansive mood, thediagnosis of hypomania requires the observation of amood changes over a period of time, and hence,implies reliance on clinical history: a significantdeparture firom the present-state approach of thePAS-ADD. In the future, it may be consideredappropriate to include longer-term ratings withinthe PAS-ADD, so that hypomania and otherconditions requiring a long-term perspective onassessment can be successfully identified.

References

Hogg J. & Moss S. (igSga) Intellectual and AdaptiveFunctioning: A Demographic Study of Older People zvithMental Handicap in Oldham Metropolitan Borough, Part I.Hester Adrian Research Centre, University ofManchester, Manchester.

Hogg J. & Moss S. (1989b) Intellectual and AdaptiveFunctioning: A Demographic Study of Older People zvithMental Handicap in Oldham Metropolitan Borough, Part 2.

Hester Adrian Research Centre, University ofManchester, Manchester.

Hogg J. & Moss S. C. (1995) The applicability of theKauftnan Assessment Battery for children (K-ABC) witholder adults (50+ years) with mental retardation. Joumalof Intellectual Disability Research 39, 000-000.

Moss S. C. (1991) Age and functional abilities of peoplewith mental handicap: evidence from the Wessex MentalHandicap Register. Joumal of Mental Deficiency Research35. 430-45-

Moss S. C, Hogg J. & Home M. (1992) Demographiccharacteristics of a population of people with moderatesevere and profound intellectual disability (mentalhandicap) over 50 years of age: age structure, IQ andadaptive skills. Joumal of Intellectual Disability Research36,387-401.

Moss S. C , Ibbotson B. & Prosser H. (^994) I'hePsychiatric Assessmern Schedule for Adults with aDevelopmental Disability (The PAS-ADD): InterviewDevelopment and Compilation of the Clinical Glossary.Heater Adrian Research Centre, University ofManchester, Manchester.

Moss S. C. & Patel P. (1993) Prevalence of mental illnessin people with learning disability over so years of age,and the diagnostic imponance of informaiion fromcarers. Irish Joumal of Psychology i^, 110-29.

Moss S. C , Patella P., Procure H., Goldbei^ D. P.,Simpson N., Rowe S. & Lucchino R. (1993) Psychiat-ric morbidity in older people with moderate and severeleaming disability (mental retardation). Part I: Develop-ment and reliabilit>' of the patient interview (the PAS-ADD). British Joumal of Psychiatry 163, 471-80.

Nihira K., Foster R., Shellhaas M. & Leland H. (1974)AAMD Adaptive Behavior Scale, 1974 revision. AmericanAssociation on Menta! Deficiency, Washington, DC.

Patel P., Goldberg D. P. & Moss S. C. (1993) Psychiat-ric morbidity in older people with moderate and severeleaming disability (mental retardation). Part U: Theprevalence study. British Joumal of Psychiatry 163, 481-91-

Sandifer M. G., Hordem A. & Green L. M. (1970) Thepsychiatric interview: the impact of the first three min-utes. American Joumal of Psychiatry 126, 968-73.

World Health Organization (1994) Schedules for ClinicalAssessment in Neuropsychiairy, Version 2. World HealthOrganization, Geneva.

Received 24 August 1995; revised 24 October 199$

€) 1996 Blackwell Science Led, Journal of Intellectual Disability Research 40^ 457-465