Bipolar Affective Disorder in Intellectual Disability

People with Intellectual Disability (ID) experience Bipolar Affective Disorder (BPAD) at a rate probably similar to that of the general population, though diagnosis may be delayed or missed owing to numerous factors, including communication deficits and atypical clinical presentations, especially in those with more severe ID. BPAD is caused by an interaction of genetic and environmental factors, and associated with numerous other forms of psychiatric and physical illness. Diagnostic criteria used for the general population may have clinical utility for those with milder ID, though ID-specific classification systems may be more useful in those with moderate-severe ID. There has been limited research regarding treatment of BPAD in individuals with ID. However, NICE guidelines have recommended treatment in line with that of the general adult population. Treatment decisions should be a collaborative process wherever possible, involving the patient, carer, clinician, and other health professionals. Factors specific to the individual patient should be taken into account in any subsequent therapeutic approach, including the acceptability of blood test monitoring and comorbid illness, among other factors.