Imperial College London

Professor Saumitra (Shoumitro) (Shoumi) Deb

Faculty of MedicineDepartment of Brain Sciences

Visiting Professor
 
 
 
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Contact

 

+44 (0)20 3313 4161s.deb CV

 
 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Publication Type
Year
to

111 results found

Deb S, Limbu B, 2021, Randomised controlled trials of antidepressant and anti-anxiety medications for people with autism spectrum disorder: a systematic review and meta-analysis., British Journal of Psychiatry Open

Background Although used widely the current evidence for the efficacy of antidepressant and antianxiety medications for people with autism spectrum disorder (ASD) is limited and conflicting.Aims We have carried out a systematic review and meta-analysis of the RCTs that assessed the effectiveness of these medications in people with ASD.Method We have searched the following databases: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, DARE, and ClinicalTrials.gov. Additionally, we have hand-searched 11 relevant journals. We used the Cochrane Risk of Bias and Jadad score to assess the quality of each included RCT. We have carried out a meta-analysis using a random-effects model.Results We have included 15 RCTs (13 on antidepressants and two on antianxiety medications) that included a total of 958 people with ASD. Data showed contradictory findings among the studies with larger studies mostly showing a non-significant difference in outcomes between the treatment and the placebo group. Meta-analysis of pooled Yale-Brown Obsessive Compulsive Scale and Clinical Global Impression Scale data from nine studies (60%) did not show any statistically significant intergroup difference on either of the outcome measures. The adverse effects reported were mild and, in most studies, their rates did not show any significant intergroup difference.Conclusions Given the methodological flaws in the most included studies and contradictory findings it is difficult to draw any definitive conclusion about the effectiveness of either antidepressant or antianxiety medications to treat either ASD core symptoms or associated behaviors. Robust large-scale RCTs are needed in the future to address this issue.

Journal article

Brizard BA, Limbu B, Baeza-Velasco C, Deb Set al., 2021, Association between epilepsy and psychiatric disorders in adults with intellectual disabilities: systematic review and meta-analysis, BJPSYCH OPEN, Vol: 7, ISSN: 2056-4724

Journal article

Deb S, Limbu B, Acharya R, Retzer A, Roy M, Roy Aet al., 2020, The effectiveness of parent training for children with autism spectrum disorders: a systematic review and meta-analyses, BMC Psychiatry, Vol: 20, ISSN: 1471-244X

BackgroundVarious parent training interventions have been shown to have some effect on the symptoms of children with autism. We carried out a systematic review and meta-analyses to assess effectiveness of parental training for children with autism on their symptoms and parental stress.MethodsFour electronic databases, CINAHL, EMBASE, MEDLINE and PsycINFO were searched until March 2020 for relevant literature. Two reviewers independently screened bibliographies using an eligibility checklist and extracted data using a structured proforma. We have also carried out meta-analyses when data were available for pooling.ResultsSeventeen papers from 15 studies were included for data analysis. Fifteen papers showed a positive treatment effect when compared with the control group, although not always significant. Meta-analysis based on pooled data from only two studies in each respective intervention, showed small to moderate treatment effects for three interventions, DIR/Floortime, Pivotal Response and Parent focused training respectively.ConclusionsAs in previous systematic reviews there was a mild to moderate treatment effects of three specific types of interventions respectively. However, it was difficult to draw any definitive conclusion about the effectiveness and generalisability of any intervention because of the wide variation in the interventions, control groups, outcome measures, small sample size, small number of studies in meta-analysis, overlap between the intervention and control procedures used in the included studies. There is an urgent need for experts in various international centres to jointly standardise a parent training intervention for children with autism and carry out a large scale RCT to assess its clinical and economic effectiveness.

Journal article

Deb S, Limbu B, 2020, Association between epilepsy and problem (challenging) behaviour in adults with intellectual disabilities: a systematic review and meta-analysis, BJPsych Open, Vol: 6, Pages: 1-17, ISSN: 2056-4724

BackgroundThe exact relationship between aggression and epilepsy is a matter of ongoing debate. AimsIdentify whether there is an association between epilepsy and problem behaviour among adults with intellectual disabilities by carrying out a systematic review of published data.MethodWe searched for relevant articles using five relevant databases and hand searched six relevant journals, reviews and papers for cross referencing. Two authors have independently screened titles, abstracts and full articles using a standardised eligibility checklist. The data were extracted by two authors who also completed Cochrane risk of bias tool and SIGN-50 checklist. Several meta-analyses were carried out.ResultsThirty-four articles from 32 studies provided data on 14,168 adults with intellectual disabilities. Of the 19 controlled studies, 13 did not show any statistically significant intergroup difference in the rate of problem behaviour. A meta-analysis showed no statistically significant intergroup difference when data from 16 studies were amalgamated, but when data from nine studies were pooled after a sensitivity analysis, epilepsy group showed a significantly higher rate of overall problem behaviour (effect size: 0.16). Aggression and self-injurious behaviour both showed a statistically significant higher rate in the epilepsy group with a very small effect size (0.16 and 0.28 respectively). No significant intergroup difference was observed in the rate of stereotypy.ConclusionsThe included studies assessed only inter-ictal behaviour. However, problem behaviour may be manifested during pre-ictal, ictal and post-ictal phase which needs to be addressed by exploring factors leading to problem behaviours in adults with intellectual disabilities.

Journal article

Deb S, Crawford M, Sharp D, Leeson V, Aimola L, Li L, Weaver T, Bodani M, Bassett Pet al., 2020, Risperidone versus placebo for aggression following traumatic brain injury: a feasibility randomised controlled trial, BMJ Open, Vol: 10, ISSN: 2044-6055

Objectives: To conduct a feasibility randomised controlled trial of risperidone for the treatment of aggression in adults with traumatic brain injury (TBI).Design: Multi-centre, parallel design, placebo controlled (1:1 ratio) double-blind feasibility trial with an embedded process evaluation. No statistical comparison was performed between the two study groups.Setting Four neuropsychiatric and neurology outpatient clinics in London and Kent, UK. Participants Our aim was to recruit 50 TBI patients over 18 months. Follow up participants at 12 weeks using a battery of assessment scales to measure changes in aggressive behaviour (MOAS-primary outcome, IRQ) as well as global functioning (GOS-E, CGI) and quality of life (EQ-5D-5L, SF-12), mental health (HADS) and medication adverse effects (UKU).Results: Six participants were randomised to the active arm of the trial and eight to the placebo arm over a 10-month period (28% of our target). Two participants withdrew because of adverse events. Twelve out of 14 (85.7%) patients completed a follow up assessment at 12 weeks. At follow up, the scores of all outcome measures improved in both groups. Placebo group showed numerically better score change according to the primary outcome MOAS. No severe adverse events were reported. The overall rate of adverse events remained low. Data from the process evaluation suggest that existence of specialised TBI Follow-up clinics, availability of a dedicated database of TBI patients’ clinical details, simple study procedures and regular support to participants would enhance recruitment and retention in the trial. Feedback from participants showed that once in the study, they did not find the trial procedure onerous.Conclusions: It was not feasible to conduct a successful randomised trial of risperidone versus placebo for post-TBI aggression using the methods we deployed in this study. It is not possible to draw any definitive conclusion about risperidone’s efficacy from such a s

Journal article

Deb S, Nancarrow T, Limbu B, Sheehan R, Wilcock M, Branford D, Courtenay K, Perera B, Shankar Ret al., 2020, UK psychiatrists' experience of withdrawal of antipsychotics prescribed for challenging behaviours in adults with intellectual disabilities and/or autism, BJPSYCH OPEN, Vol: 6, ISSN: 2056-4724

Journal article

Deb S, Crawford M, Limbu B, Weaver Tet al., 2020, Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities (SPECTROM): study protocol, BMJ Open, Vol: 10, ISSN: 2044-6055

Introduction Psychotropic medications that are primarily licenced for the treatment of psychiatric disorders are used widely (32%–85%) among people with intellectual disabilities (ID) often for the management of problem (challenging) behaviour in the absence of a psychiatric disorder. Care staff play a pivotal role in the prescribing process. Currently, no staff training programme exists to address the issue of overprescribing of psychotropic medication in people with ID, thus highlighting an urgent need for developing a psychoeducational programme (PEP) specifically designed to address this issue. We propose to develop a PEP for care staff using the methodology described in the UK Medical Research Council guide for complex interventions.Methods and analysis The development of the PEP will involve (1) gathering information on available relevant training programmes, (2) running four focus groups with care staff and other professionals to establish the content and format of the PEP, and (3) organising a co-design event involving all relevant stakeholders to discuss the format of the PEP. A core project team will develop the PEP under guidance from the PEP Development Group which will consist of 10–12 relevant stakeholder representatives. Feedback from selected stakeholders on a draft PEP will allow us to refine the PEP before implementation. The PEP will have web-based modules supplemented by face to face training sessions. When the final draft is ready, we will field test the PEP on six to eight care staff from community care homes for people with ID. After completing the field test, we will run a focus group involving participants in the PEP to get feedback on the PEP.Ethics and dissemination Ethics approval for this study was waived by the UK Health Regulatory Authority as the study does not collect any patient related information and only include care staff outside the UK NHS. This will be the first ever such universally freely available PEP supported

Journal article

Shankar R, Wilcock M, Deb S, Goodey R, Corson E, Pretorius C, Praed G, Pell A, Vujkovic D, Wilkinson E, Laugharne R, Axby S, Sheehan R, Alexander Ret al., 2019, A structured programme to withdraw antipsychotics among adults with intellectual disabilities: The Cornwall experience, JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Vol: 32, Pages: 1389-1400, ISSN: 1360-2322

Journal article

Tarrant N, Roy M, Deb S, Odedra S, Retzer A, Roy Aet al., 2018, The effectiveness of methylphenidate in the management of Attention Deficit Hyperactivity Disorder (ADHD) in people with intellectual disabilities: A systematic review, RESEARCH IN DEVELOPMENTAL DISABILITIES, Vol: 83, Pages: 217-232, ISSN: 0891-4222

Journal article

Deb S, Leeson V, Aimola L, Bodani M, Li L, Weaver T, Sharp D, Crawford M, Deb S, Crawford M, Leeson V, Aimola L, Weaver T, Sharp D, Li L, Bodani Met al., 2018, Aggression following traumatic brain injury: effectiveness of Risperidone (AFTER): study protocol for a feasibility randomised controlled trial, Trials, Vol: 19, ISSN: 1745-6215

BackgroundTraumatic brain injury (TBI) is a major public health concern and many people develop long-lasting physical and neuropsychiatric consequences following a TBI. Despite the emphasis on physical rehabilitation, it is the emotional and behavioural consequences that have greater impact on people with TBI and their families. One such problem behaviour is aggression which can be directed towards others, towards property or towards the self. Aggression is reported to be common after TBI (37–71%) and causes major stress for patients and their families. Both drug and non-drug interventions are used to manage this challenging behaviour, but the evidence-base for these interventions is poor and no drugs are currently licensed for the treatment of aggression following TBI. The most commonly used drugs for this purpose are antipsychotics, particularly second-generation drugs such as risperidone. Despite this widespread use, randomised controlled trials (RCTs) of antipsychotic drugs, including risperidone, have not been conducted. We have, therefore, set out to test the feasibility of conducting an RCT of this drug for people who have aggressive behaviour following TBI.Methods/designWe will examine the feasibility of conducting a placebo-controlled, double-blind RCT of risperidone for the management of aggression in adults with TBI and also assess participants’ views about their experience of taking part in the study.We will randomise 50 TBI patients from secondary care services in four centres in London and Kent to up to 4 mg of risperidone orally or an inert placebo and follow them up 12 weeks later. Participants will be randomised to active or control treatment in a 1:1 ratio via an external and remote web-based randomisation service. Participants will be assessed at baseline and 12-week follow-up using a battery of assessment scales to measure changes in aggressive behaviour (MOAS, IRQ) as well as global functioning (GOS-E, CGI), quality of life (EQ-5D-5L

Journal article

Singh SP, Paul M, Parsons H, Burns T, Tyrer P, Fazel S, Deb S, Islam Z, Rugkasa J, Gajwani R, Thana L, Crawford MJet al., 2017, A prospective, quantitative study of mental health act assessments in England following the 2007 amendments to the 1983 act: did the changes fulfill their promise?, BMC Psychiatry, Vol: 17, ISSN: 1471-244X

Background:In 2008, the Mental Health Act (MHA) 2007 amendments to the MHA 1983 were implemented in England and Wales. The amendments were intended to remove perceived obstacles to the detention of high risk patients with personality disorders (PDs), sexual deviance and learning disabilities (LDs). The AMEND study aimed to test the hypothesis that the implementation of these changes would lead to an increase in numbers or proportions of patients with these conditions who would be assessed and detained under the MHA 2007.Method:A prospective, quantitative study of MHA assessments undertaken between July–October 2008–11 at three English sites. Data were collected from local forms used for MHA assessment documentation and patient electronic databases.Results:The total number of assessments in each four month period of data collection varied: 1034 in 2008, 1042 in 2009, 1242 in 2010 and 1010 in 2011 (n = 4415). Of the assessments 65.6% resulted in detention in 2008, 71.3% in 2009, 64.7% in 2010 and 63.5% in 2011. There was no significant change in the odds ratio of detention when comparing the 2008 assessments against the combined 2009, 2010 and 2011 data (OR = 1.025, Fisher‘s exact Χ 2 p = 0.735). Only patients with LD and ‘any other disorder or disability of the mind’ were significantly more likely to be assessed under the MHA post implementation (Χ2 = 5.485, P = 0.018; Χ2 = 24.962, P > 0.001 respectively). There was no significant change post implementation in terms of the diagnostic category of detained patients.Conclusions:In the first three years post implementation, the 2007 Act did not facilitate the compulsory care of patients with PDs, sexual deviance and LDs.

Journal article

Perry BI, Champaneri N, Griffiths F, Paul M, Islam Z, Rugkåsa J, Burns T, Tyrer P, Crawford M, Deb S, Singh SPet al., 2017, Exploring professionals' understanding, interpretation and implementation of the 'appropriate medical treatment test' in the 2007 amendment of the Mental Health Act 1983., BJPsych Open, Vol: 3, Pages: 57-63, ISSN: 2056-4724

BACKGROUND: The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as amended 2007), aims to ensure that detention only occurs when treatment with the purpose of alleviating a mental disorder is available. AIMS: As part of the Assessing the Impact of the Mental Health Act (AMEND) project, this qualitative study aimed to assess professionals' understanding of the ATT, and its impact on clinical practice. METHOD: Forty-one professionals from a variety of mental health subspecialties were interviewed. Interviews were coded related to project aims, and themes were generated in an inductive process. RESULTS: We found that clinicians are often wholly relied upon for the ATT. Considered treatment varied depending on the patient's age rather than diagnosis. The ATT has had little impact on clinical practice. CONCLUSIONS: Our findings suggest the need to review training and support for professionals involved in MHA assessments, with better-defined roles. This may enable professionals to implement the ATT as its designers intended. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Journal article

Gomiero T, Bertelli M, Deb S, Weger E, Marangoni A, De Bastiani E, Mantesso U, De Vreese LPet al., 2017, A Multicentre Italian Validation Study in Aging Adults with Down Syndrome and Other Forms of Intellectual Disabilities: Dementia Screening Questionnaire for Individuals with Intellectual Disabilities, CURRENT ALZHEIMER RESEARCH, Vol: 14, Pages: 709-721, ISSN: 1567-2050

Journal article

Ratti V, Hassiotis A, Crabtree J, Deb S, Gallagher P, Unwin Get al., 2016, The effectiveness of person-centred planning for people with intellectual disabilities: A systematic review, RESEARCH IN DEVELOPMENTAL DISABILITIES, Vol: 57, Pages: 63-84, ISSN: 0891-4222

Journal article

Deb S, 2016, Psychopharmacology, Handbook of Evidence-Based Practices in Intellectual and Developmental Disabilities, Editors: Singh, Publisher: Springer, Pages: 347-381, ISBN: 978-3-319-26581-0

Psychotropic medications are used regularly for the management of problem behavior including aggression and self-injurious behavior (SIB) in individuals with intellectual disabilities (ID) in the absence of a diagnosed psychiatric disorder. This practice is controversial because these medications are not licensed for this purpose, the scientific evidence to support their use is often lacking, these medications could potentially cause long-term adverse effects, and once started withdrawal of these medications are difficult. Psychotropic medications used for this purpose include antipsychotics, antidepressants, mood stabilizers including antiepileptics, psychostimulants, opioid antagonists, beta blockers, and antianxiety medications. Evidence for the efficacy of psychotropic medication based on systematic reviews is presented in this chapter. It appears that there are only three RCTs involving risperidone among adults with ID, of which two showed risperidone being effective when compared with placebo but one study showed no significant difference in the efficacy among placebo, risperidone, and haloperidol. Six RCTs involving children with ID and with and without autism spectrum disorder (ASD) showed risperidone being significantly more effective compared with the placebo. A number of open label longitudinal continuation studies following RCTs of risperidone have shown that the efficacy of risperidone had lasted over many months and the adverse effects were tolerable. In two pharmaceutical company run studies aripiprazole was shown to be significantly effective compared with placebo in children with ASD, some of whom also had ID. The improvement lasted for many weeks in an open label extension study. There is concern about adverse effects from risperidone such as somnolence and weight gain. It is, therefore, suggested that the use of psychotropic medication in this context should be monitored carefully and regularly using national and international guides.

Book chapter

Unwin G, Deb S, Deb T, 2016, An Exploration of Costs of Community-Based Specialist Health Service Provision for the Management of Aggressive Behaviour in Adults with Intellectual Disabilities, Journal of Applied Research in Intellectual Disabilities, ISSN: 1468-3148

BackgroundIn the UK, people with intellectual disabilities who exhibit aggressive behaviour often receive community-based specialist health services from a community learning disability team (CLDT). Our aim was to estimate costs associated with this provision and to identify predictors of higher costs.MethodCosts were estimated for 60 adults with intellectual disabilities and aggressive behaviour who attended specialist psychiatric outpatient clinics in the West Midlands region of the UK, including contact time with members of the CLDT and use of psychotropic medication over a 12-month period.ResultsMean total cost of 12-month service provision was £418 (95% confidence interval [CI] £299–557). Mean total cost of 12-month psychotropic medication was £369 (95% CI £256–492). Amongst individual members of the CLDT, mean costs were highest for psychiatrists (£181) and relatively lower for community nurses (£70) and clinical psychologists (£30), and lowest for physiotherapists (£13). Male sex, presence of expressive verbal communication and presence of epilepsy were independently associated with 12-month medication and service use costs, accounting for 23% of the variance in cost.ConclusionsIt seems that in terms of costs, there is an overreliance on medication and psychiatrists and a relatively lesser reliance on other CLDT members such as community nurses and clinical psychologists for the management of aggressive behaviour in adults with intellectual disabilities within community settings. Health commissioners may wish to explore this relative cost discrepancy further and try to redress the balance where appropriate.

Journal article

Unwin G, Deb S, Rose J, 2016, Carer and family perspectives, Psychiatric and Behavioral Disorders in Intellectual and Developmental Disabilities, Publisher: Cambridge University Press (CUP), Pages: 269-278, ISBN: 9781107645943

Book chapter

Didden R, Lindsay WR, Lang R, Sigafoos J, Deb S, Wiersma J, Peters-Scheffer N, Marschik PB, O'Reilly MF, Lancioni GEet al., 2016, Aggressive Behavior, Handbook of Evidence-Based Practices in Intellectual and DevelopmentalDisabilities, Evidence-Based Practices in Behavioral Health, Publisher: Springer, ISBN: 978-3-319-26581-0

Book chapter

Deb S, 2015, Diagnosing Alzheimer’s Dementia in People with Down Syndrome, Recent Advances in Alzheimer Research, Publisher: Bentham Books, Pages: 42-68, ISBN: 978-1-68108-139-7

There are difficulties in making an early and accurate diagnosis of dementiain individuals with DS; in screening instruments such as the Mini Mental StatusExamination that are used in the general population often show floor effects when usedfor individuals with Down syndrome (DS) because of their pre-existing cognitiveimpairment, the level of which varies depending on the severity of intellectual disability(ID). Both informant-rated scales and direct neuropsychological tests have been usedfor the case detection of dementia for individuals with DS. However, directneuropsychological tests cannot be used for those who have severe ID and their validitycould still be questionable in a number of cases of mild to moderate ID. Therefore, useof informant-rated scales is desirable for screening purposes.There are many similarities and some differences in the clinical expression of dementiain individuals with DS and the general population who do not have ID. Impaired recentmemory and confusion in the context of relatively intact distant memory is likely to bean early symptom in individuals with DS who have mild ID, whereas loss of skills andbehavior changes are likely to be an early feature for those with more severe ID. Manysymptoms, including features of ‘frontal lobe dysfunction’ that tend to appear late in thedementing process in the general population, may appear early in individuals with DS.An important early sign is any change in behavior or functioning, and dementia mustalways be considered as a possible cause for the change.Ideally, individuals with DS should be screened for signs of dementia from before theage of 30-35. A multi-disciplinary approach should be taken for diagnosis of dementiain individuals with DS using a combination of informant-rated scales andneuropsychological tests in a longitudinal fashion over time. Important differentialdiagnoses include hypothyroidism, depression, and sensory impairment. Assessmentshould include physical, psycholog

Book chapter

Deb S, 2015, Managing Problem Behaviors in People with Down Syndrome and Alzheimer’s Disease, Recent Advances in Alzheimer Research, Publisher: Bentham Books, Pages: 69-89, ISBN: 978-1-68108-139-7

Behavioral and psychological symptoms of Alzheimer’s disease and otherdementias may create a considerable burden of care in the general population, yetrelatively little research has been carried out in this area. Although problem behaviorsmay be relatively less frequent in people with Down syndrome who developAlzheimer’s dementia, nevertheless they cause additional caregiver burden. Bothpharmacological and non-pharmacological interventions are used for the managementof problem behaviors in people with intellectual disability in general. Similarly, bothpharmacological and non-pharmacological interventions are used to manage symptomsof dementia including behavioral symptoms in the general population. Treatmentapproaches used in both these groups could equally be used to manage problembehaviors in people with Down syndrome who develop dementia. Extrapolatedevidence from studies on children with autism spectrum disorder and intellectualdisability possibly supports use of risperidone for management of problem behavior inadults with Down syndrome and dementia. RCT-based evidence exists to support use ofantipsychotics, mood stabilizers, and cholinesterase inhibitors for the management ofbehavioral and psychological symptoms of dementia in the general population but nospecific evidence for Down syndrome exists. Clinicians have to be mindful of potentialserious central nervous system adverse effects of antipsychotics in people withdementia. Similarly, evidence for efficacy of non-pharmacological interventions forproblem behaviors both in the general population with dementia and people withintellectual disability in general is too equivocal to make any definitiverecommendation at this stage for people with Down syndrome and dementia. Recentlythere has been an emphasis on providing person-centered service specifically designedfor people with dementia. Another important aspect of management is training andsupport for caregivers and care staff to help people with dem

Book chapter

Li RSY, Kwok HWM, Deb S, Chui EMC, Chan LK, Leung DPKet al., 2015, Validation of the Chinese Version of the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID-CV), JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Vol: 59, Pages: 385-395, ISSN: 0964-2633

Journal article

Roy A, Roy M, Deb S, Unwin G, Roy Aet al., 2015, Are opioid antagonists effective in attenuating the core symptoms of autism spectrum conditions in children: a systematic review, JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Vol: 59, Pages: 293-306, ISSN: 0964-2633

Journal article

Deb S, Unwin G, Deb T, 2015, Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour, JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Vol: 59, Pages: 11-25, ISSN: 0964-2633

Journal article

Roy A, Roy M, Deb S, Unwin G, Roy Aet al., 2014, Are opioid antagonists effective in reducing self-injury in adults with intellectual disability? A systematic review, Journal of Intellectual Disability Research, Vol: 59, Pages: 55-67, ISSN: 1365-2788

BackgroundSelf-injury in people with intellectual disability (ID) may be due to variety of factors both environmental and biological. As the drive in UK is to manage people with ID and problem behaviours in the community, it is important to critically examine all treatment options available. As abnormalities in the endogenous opioid system may be a factor in some people with ID, we undertook a systematic review to evaluate the evidence for the effectiveness of opioid antagonists.MethodsFour electronic databases were searched for relevant journal articles. In addition, cross-referencing of pertinent reviews and a hand search for articles in major international ID journals between the years 2010 and 2012 was carried out to ensure that all relevant articles were identified. We also searched databases for unpublished clinical trials to overcome publication bias. Each database was searched up to present (February 2013) with no restrictions on the date of publication. The search terms consisted of broad expressions used to describe ID and autistic spectrum disorder as well as terms relating to opioid antagonists and specific drugs. All studies identified by the electronic database search and hand search were examined on the basis of title alone for relevance and duplication. The abstracts of the remaining papers were then scrutinised against the inclusion criteria. Where abstracts failed to provide adequate information, the full texts for these papers were obtained. All the full texts were then evaluated against the inclusion proforma. Two reviewers carried out all the stages of the process independently. The reviewers met to discuss their selections and where disagreements arose, these were settled by discussion with a member of the study group. Data from each study meeting the inclusion criteria was extracted on a pre-piloted data extraction form. The quality of each study was further assessed using the Jadad scale, a tool developed to assess the quality of randomised c

Journal article

Unwin G, Deb S, 2014, Caregiver's concerns-quality of life scale (CC-QoLS): development and evaluation of psychometric properties., Res Dev Disabil, Vol: 35, Pages: 2329-2340

We have developed a Caregiver's Concerns-Quality of Life Scale (CC-QoLS) for adults with intellectual disabilities (ID) who exhibit aggressive behaviour. The CC-QoLS is a brief (8 items in each subscale, CC and QoL respectively) proxy measure completed by caregivers. This is a specific health related quality of life instrument (HRQoL) combined with measures of caregiver's concerns for use as an outcome measure to assess clinical and cost effectiveness of interventions for aggression in adults with ID. The CC-QoLS was found to have good face validity and very good test-retest reliability with an ICC of 0.81 for CC (range 0.46-0.83 across items) and 0.80 for QoL (range 0.65-0.81 across items). Similarly, the scale had good inter-rater reliability with an ICC of 0.67 for CC (range 0.31-0.63 across items) and 0.63 for QoL (range 0.31-0.65 across items). Internal consistency for each subscale was also good (Cronbach's alpha was 0.85 for CC and 0.80 for QoL; Split-half Spearman-Brown was 0.81 for CC and 0.70 for QoL). Furthermore, the scale showed good concurrent validity with measures of severity of aggressive behaviour, namely Modified Overt Aggression Scale (MOAS) (CC: r=0.4; p≤0.01 and QoL: r=-0.2; p≤0.05) and Aberrant Behavior Checklist-Irritability subscale (ABC-I) (CC: r=0.5; p≤0.01 and QoL: r=-0.02; p≤0.05) as well as Caregiver's Uplift and Burden Scale score (<0.05). We believe that the CC-QoLS is a user friendly, easy to complete, first-ever HRQoL measure for adults with ID and aggressive behaviour with very good psychometric properties.

Journal article

Njomboro P, Deb S, 2014, Distinct neuropsychological correlates of cognitive, behavioral, and affective apathy sub-domains in acquired brain injury, Frontiers in Neurology, Vol: 5, Pages: 73-73, ISSN: 1664-2295

Apathy has a high prevalence and a significant contribution to treatment and rehabilitation outcomes in acquired brain damage. Research on the disorder's neuropsychological correlates has produced mixed results. While the mixed picture may be due to the use of varied assessment tools on different patient populations, it is also the case that most studies treat apathy as a unitary syndrome. This is despite the evidence that apathy is a multifaceted and multidimensional syndrome. This study investigates the neuropsychological correlates of apathy in 49 patients with acquired brain damage. It further fractionates apathy symptoms into affective, cognitive, and behavioral sub-domains and investigates their individual relations with standard measures of affective, cognitive, and behavioral functioning. Global apathy scores were not related to any of these measures. Affective apathy was associated with emotion perception deficits, and cognitive apathy was associated with executive deficits on the Brixton test. These results demonstrate that treating apathy as a single entity may hide important correlates to apathy symptoms that become visible when the disorder is fractionated into its sub-domains. The study highlights the research and clinical importance of treating apathy as a multidimensional syndrome.

Journal article

Deb S, Farmah BK, Arshad E, Deb T, Roy M, Unwin GLet al., 2014, The effectiveness of aripiprazole in the management of problem behaviour in people with intellectual disabilities, developmental disabilities and/or autistic spectrum disorder - A systematic review, RESEARCH IN DEVELOPMENTAL DISABILITIES, Vol: 35, Pages: 711-725, ISSN: 0891-4222

Journal article

Bertelli MO, Salvador-Carulla L, Scuticchio D, Varrucciu N, Martinez-Leal R, Cooper S-A, Simeonsson RJ, Deb S, Weber G, Jung R, Munir K, Adnams C, Akoury-Dirani L, Girimaji SC, Katz G, Kwok H, Walsh Cet al., 2014, Moving beyond intelligence in the revision of ICD-10: specific cognitive functions in intellectual developmental disorders, WORLD PSYCHIATRY, Vol: 13, Pages: 93-94, ISSN: 1723-8617

Journal article

Njomboro P, Humphreys GW, Deb S, 2014, Exploring social cognition in patients with apathy following acquired brain damage, BMC Neurology, Vol: 14, ISSN: 1471-2377

BACKGROUND: Research on cognition in apathy has largely focused on executive functions. To the best of our knowledge, no studies have investigated the relationship between apathy symptoms and processes involved in social cognition. Apathy symptoms include attenuated emotional behaviour, low social engagement and social withdrawal, all of which may be linked to underlying socio-cognitive deficits. METHODS: We compared patients with brain damage who also had apathy symptoms against similar patients with brain damage but without apathy symptoms. Both patient groups were also compared against normal controls on key socio-cognitive measures involving moral reasoning, social awareness related to making judgements between normative and non-normative behaviour, Theory of Mind processing, and the perception of facial expressions of emotion. We also controlled for the likely effects of executive deficits and depressive symptoms on these comparisons. RESULTS: Our results indicated that patients with apathy were distinctively impaired in making moral reasoning decisions and in judging the social appropriateness of behaviour. Deficits in Theory of Mind and perception of facial expressions of emotion did not distinguish patients with apathy from those without apathy. CONCLUSION: Our findings point to a possible socio-cognitive profile for apathy symptoms and provide initial insights into how socio-cognitive deficits in patients with apathy may affect social functioning.

Journal article

Ward F, Tharian P, Roy M, Deb S, Unwin GLet al., 2013, Efficacy of beta blockers in the management of problem behaviours in people with intellectual disabilities: A systematic review, RESEARCH IN DEVELOPMENTAL DISABILITIES, Vol: 34, Pages: 4293-4303, ISSN: 0891-4222

Journal article

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