As a director of Community Living BC (CLBC), I am disappointed that the authors of “The other dual diagnosis: Developmental disability and mental health disorders” [BCMJ 2008;50:319-324] did not contact CLBC management to discuss, or provide notice of, their serious criticisms of the organization prior to publishing this article. CLBC embraces the vision of a community that recognizes and meets the needs of people with developmental disabilities, including their medical needs. CLBC is pleased to work with health care professionals to that end.
As a parent and a lawyer, I find that the article is defensive. The authors admit that persons with developmental disabilities who are unable to communicate the source of physical pain, and who self-aggress or aggress toward others because of pain, are frequently misdiagnosed as having a psychiatric condition and receive psychotropic drugs. The authors suggest this is partly because misguided and inexperienced caregivers “ask” for drugs to treat behavioral difficulties.
The suggestion that a highly trained medical professional accedes to the request of a caregiver to prescribe drugs rather than diagnosing and treating the patient in accordance with medical standards is a strange criticism of their professional colleagues. However, in my experience, the more likely scenario is the medical professional ascribing aggression to “behaviors” and refusing to pursue the request of family members or caregivers to search for a physical cause. In my experience, some practitioners are only too willing to recommend and even insist upon prescribing psychotropic drugs or simply tranquilizing developmentally disabled patients who are in distress. I have met caregivers who frequently lament this reality.
The authors are correct in concluding that there are too few clinicians with training and expertise in the area of developmental disabilities. Changing the way CLBC administers services will not affect this gap—it is up to the medical profession to turn its collective attention to meeting the health care needs of this population.
—Joan L. Rush, LLB
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
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