WPA MADRID 2014

XVI WORLD CONGRESS OF PSYCHIATRY

Angeles Torres
Albert Torres

Sessió de congressos 18-12-14

El Congrés Mundial de la World
Psychiatric Association en xifres
•XVI edició
•9.000 congressistes
•2.000 espanyols
•23 países
•3.878 comunicacions
•602 simposyums
•3.276 exposicions orals
•2,5 kg de programa
•Un poster sobre DI
•Una comunicació oral sobre DI i FIL
BORDERLINE INTELLECTUAL
FUNCTIONING:
A complex picture of deficits and problems in no-man´s land

A.Torres 1, M. Fernández 1, M.J. Cortés2, A. Folch2, L. Salvador-

Carulla3, R. Martínez-Leal 2

1. Villablanca Serveis Assistencials, Reus, Spain.

2. Fundació Villablanca, Reus, Spain; IISPV, URV, CIBERSAM.
3.University of Sydney, Sydney, Australia.
DEFINITION
 It’s not a medical condition, neither a disease, there is no
code for diagnosis in any classification (DSM or ICD-10).
 It could be considered a health metacondition (like
pregnancy) where special attention is required at certain
times.
 There are concerns in health services about where and
how these people must be attended.
 There are not enough data about the complications that
occur in Borderline Intellectual Functning (BIF), and the
prevalence of added disorders and other problems is not
well-known
 Salvador-Carulla L, Ruiz Gutierrez-Colosía M, Nadal M, Grupo CONFIL. Documento
de Consenso sobre el funcionamiento intelectual límite. Madrid: Obra Social Caja
Madrid; 2010
PREVALENCE
 Prevalence and justification of those not being
classificated in an important part of society:13-18%
(Hassiotis, A. Et al, 2001; Seltzzer, MM. 2005)

 Gallén (2005) speech about 41000 people in Spain, data

from INE, although she cites could be up to 1 to 1.5 per
cent of Spanish population
(Gallén C., 2005, Las Fronteras de la normalidad, Una aproximación en clave social a las personas
con inteligencia limite o Borderline))

IQ
Mounting evidence suggest...
 Mental health problems in people with BIF are not well addressed by
general psychiatry (Wieland, J. Et al, 2014)
 A reduced sleep duration, an increased rate of stage shifts and awakenings.
(Esposito, M. 2014, 2010)

 Emotional and behavioural problems as well as a lack of social competence

in youngers (Nestler, J. & Goldbeck, L., 2011)
 Increased rates of suicidal behaviour in young people with BIF and social
disadvantages (Hassiotis, A. 2011)
 Problems with motor skill performance and higher-order executive
functions (Hartman, E. Et al; 2010;Vuijk P et al, 2010)
 More emotional, substance use, personality, adaptation and social problems
in adults (Hassiotis, A, 1999)
 Higher rates of mental health problems in children (Emerson, E., 2010)
 Worse prognosis of mental health problems in BIF population (Chaplin, R; 2006)
Background
 Data about BIF are very scarce.
 Are there real differences among BIF and mild ID regarding
functioning and adaptive behaviour?
 Is functioning taken into account for the differential diagnosis?

OBJECTIVES
-To compare the level of impairments presented by BIF and ID.
-To present information about mental health conditions in BIF.
 Methodology: NATIONAL SURVEY
(EDAD 2008)
 Specific for disability
 Interviewed more than 33000 people with disability
 2840 had intellectual disability –including BIF-
 Geographical representation, taking into account residences
and private homes in the community.
 The interview included a modified version of the International
Classification of Functioning (WHO).
 Variables:
-Sex -ID/BIF
-Age -ICF areas of functioning
-Living arrangements

Instituto Nacional de Estadística, 2010. Encuesta de Discapacidad, Autonomia Personal y

Dependencia EDAD-2008.
Sample Representation
Sample 2192

122
Borderline Intellectual
Functioning: BIF
431

Mild Intellectual
Disability: Mild ID

Several Mental
1639 Disorder: SMD
 BIF Mild ID SMD
n:122 n:431 n:1639
Male 56.1% 54.9% 51.3%

Age x:41.40(21) x:43.03(17.62) x:57.26(17.51)**

Family home 35.3% 63.9% 45.8%

Single 91% 92.8% 48%**

Disability certificate 65.6% 83.1% 57.8%

**Significant differences in age among SMD and the other

groups being the SMD group older, there are not difference
between BIF and Mild ID
RESULTS
Persons with BIF have similar problems to those with mild
ID in important areas such as:
 VISION and HEARING
 COMMUNICATION
 TASK PERFORMANCE and LEARNING
 SOCIAL INTERACTIONS

Persons with BIF are more independent in areas such as:

 AUTONOMY and SELF CARE
 DOMESTIC SKILLS

More than 60% of persons with BIF living in the

community presented some type of Mental Disorder.
 IMPAIRTMENTS IN VISION

12

10

8 BIF
Mild ID
6
SMD
4
SMD
2
Mild ID
0 BIF
BLIND DIFFICULTY
DIFFICULTY AT LEAST 1
READ
SEE FACES DIFFICULTY
NEWSPAPER
AT DISTANCE AT VISION
 IMPAIRTMENTS IN HEARING

12

10

8 BIF
5,7**
Mild ID
6
SMD
4
SMD
2
Mild ID
0 BIF
DEAF DIFFICULTY
DIFFICULTY AT LEAST 1
LOUD
CONVERSATIONS DIFFICULTY
SOUNDS
AT HEARING
 IMPORTANT IMPAIRTMENTS IN
COMMUNICATION

70
60
50
BIF
40
Mild ID
30 SMD
20
10 6,6*
SMD
0 Mild ID
DIFFICULTIES TO
UNDERSTANDING WRITTEN
OTHERS LANGUAGE GESTURES, MANTEIN A
BIF
PRODUCE
UNDERSTANDABLE DRAWS AND CONVERSATION USING THE AT LEAST 1
AND MEANINFULL SYMBOLS OR INTERCHANGE TELEPHONE COMMUNICATION
TALKING IDEAS USING ANY PROBLEM
KIND OF
LANGUAGE
 IMPORTANT IMPAIRTMENTS IN TASK
PERFORMANCE AND LEARNING

60

50

40 BIF
30 Mild ID
SMD
20

10 SMD
Mild ID
0
DIFFICULTIES
DIFFICULTIES
BIF
AT TASK
PERFORMANCE LEARNING TO DIFFICULTIES DIFFICULTIES AT LEAST 1
READ, COUNT, WITH EASY TASKS WITH COMPLEX DIFFICULTY WITH
WRITTING, USING TASKS TASKS
TOOLS, ETC PERFORMANCE
IMPORTANT IMPAIRTMENTS IN MOBILITY

70
60
50
BIF
40 36,1**
Mild ID
30
23** SMD
20 18,9**

10
SMD
0 Mild ID
POSTURAL MAINTAIN
CHANGE BODY
WALK
AT WALK PUBLIC
DRIVING LIFT AND
BIF
POSITION HOME OUTSIDE TRANSPORTS
CARRY OBJECTS MANIPULATES
MANIPULATES SMALL
AND MOVES OBJECTS
OBJECTS
IMPORTANT IMPAIRMENTS IN AUTONOMY
ANS SELF-CARE

80
70
60
50 50,8* BIF
40 39,3** Mild ID
30 SMD
19,7* 19,7**
20 21,3**
10,7*
10
2,5* SMD
0 Mild ID
WASHING/
DRYING
BASIC
BODY URINATION DRESS/
BIF
SELF-CARE DEFECATION UNDRESS EATING/ TAKING
DRINKING MEDICATION GENERAL AT LEAST 1
SAFETY IMPORTANT
IMPAIRMENT IN
AUTONOMY
 IMPORTANT IMPAIRMENTS IN SOCIAL
INTERACTIONS

80
70
60
50 BIF
42,5**
40 Mild ID
30 26,2** SMD
20
10 SMD
Mild ID
0
EXPRESSING
RELATIONS FRIENDS,
BIF
AFFECTION, FAMILY
RESPECT, AT WORK, NEIGHBOURS, LOVE,
SERVICES MATES RELATIONSHIPS AT LEAST 1
EMOTIONS SEXUAL
PARTNERS IMPAIRMENT IN
SOCIAL
INTERACTIONS
IMPORTANT IMPAIRMENTS IN DOMESTIC
LIFE

80
70
60
50
48,4** BIF
38,5** 41**
Mild ID
40 32,8**
SMD
30
20 SMD
10 Mild ID
0 BIF
SHOPING AND
CARRYING PREPARING
MEALS HOUSE KEEPING
AT LEAST 1
IMPAIRMENT IN
DOMESTIC LIFE
MENTAL DISORDERS IN PERSONS LIVING
AT HOME n=230

100

80 68.4

60 BIF
Mild ID
40 SMD

20
SMD
Mild ID
0
SCHIZOPHRENIA DEPRESSION
BIPOLAR
BIF
DISORDER CHRONIC ANXIETY OTHER MENTAL
ILLNESSES AT LEAST 1
MENTAL ILLNESS
CONCLUSSIONS
 There is a large number of persons classified as having
BIF that present limitations in important areas of
functioning at the same level as persons with mild ID

 A high proportion of people with BIF living in the

community present some type of Mental Disorder

 Controversy about the delimitation of the entities of

BIF and ID and the relative importance of the
intelligence coefficient is supported by these results.

 Further research and better proffesional training are

needed in order to dillucidate whether and when
more intensive services or care should be available for
persons with BIF.
THANK YOU