Dual Diagnoses Mental Health/Mental Retardation

I am a R.N.,C. (Psych/Mental Health).  I work in an ICF/MR environment dealing with Severe/Profound MR, some of whom are dually diagnosed with a psychaitric dx.

One of our most difficult patients is a woman who seems to respond to no treatment.  She cycles through violent phases which include self restraining and biting pieces of flesh from her arms, pulling out her hair and pinching herself.  She is non-verbal and legally blind. She self-restrains herself by tightly wrapping her arms in her shirt or holding them behind her back
and is resistive to staff attempts to "unrestrain" her in order to have her partake in ADL like dressing, eating, exercise, etc.

She has been like this all of her life which necessitated the need for institutionalization about 30 years ago.  Direct care staff become very frustrated in their attempts to deal with her behaviors.    They expect and "instant cure" and of course feel very badly for this individual's internal turmoil.  She has had numerous psychiatric evaluations and we have a dedicated staff of psychologists physicians, pharmacists, nurses, direct care aides and mental health assessment team on board who have not been able to find peace for this woman.  Any suggestions would be greatly appreciated.

She is involved in programming during the day.  These behaviors break through unexpectedly and last for weeks at a time.  

Any insight would be greatly appreciated.  She is diagnosed as bipolar and is on Navane, Depakote, Lithium, Tegretol and recently added Klonopin.

A private response would be greatly appreciated.

[HFHS.MD-AJ]

Your patient appears to be quite a difficult case. Without being directly involved in her care, it would be impossible for me to offer any specific suggestions, other than to defer to her team of treating clinicians.

[tracey]

Joyce

Wow, it sounds as if you have a very perplexing case.  I know I don't know this woman but I would be interested in what you are able to find out - of course keeping with confidentiality.  I am a social worker in the mental health field.  In my program we have 6 teams which are designated to different areas.  The team I am on is the Dually Diagnosed team.  Probably very similiar to what you are doing.  This is a relatively new field in my area.  People think of dually diagnosed as having a psych illness as well as an addiction (which we call concurrent disorder).  Therefore it makes it very difficult to find information on people with a psych illness as well as a developmental disorder.  If you have any info, you can share that would be greatly appreciated.  My e-mail address is ***@****

I don't know much in this area - most of my knowledge is in psych but I know one of the reasons people seem to bite themselves is to feel some form of stimulation.  Has this woman also been assessed for an eating disorder?  Good luck with this.  I hope you get the info you are looking for.

Tracey