Always remember akithisia and the long list of non antipsychotic drugs and conditions that resemble it.|
The field of IDD and dual diagnosis requires that the clinician maintain a good working knowledge of ongoing research in the behavioral and developmental neurosciences and psychopharmacology. As more data become available on behavioral phenotypes, epigenetics, and behavioral pharmacology, the clinician will be required to synthesize this new data with existing behavioral and mental health practices. The old approaches relying upon behavior/psychiatric disorder, nature/environment versus nurture/genetic risk, organic/functional disorders will need to be revised. These changes will bring us to conclude:
Brain behavioral relationships are too complex to be conceptualized in terms of single anatomical sites or neurotransmitters. Treating based on suspected neurotransmitter abnormalities are woefully reductionist and may lead to unnecessary polypharmacy.
Challenging behaviors and psychiatric disorders are heterogeneous phenomena that cannot be fully captured by a traditional behavioral analysis or psychiatric diagnosis. We will need to adapt our thinking to ongoing work on subtyping challenging behaviors and endophenotypes of primary psychiatric disorders. We will need to sharpen our diagnostic skills to meet this challenge and adapt our treatment planning to match this new knowledge.
Alternative treatments such as transcranial magnetic stimulation, deep brain stimulation and models of neuropharmacology that focus on intracellular mechanisms and alterations in gene regulation are on the horizon. This shift will require us to understand the basic neurobiology of developmental disorders; how it differs from neuro-typical patients, and what special adjustments we will need to make to accommodate these differences (35, 45).