Atypical Presentation of Anxiety in a patient with Intellectual Disability: A case report and brief review of literature

OBJECTIVE: The diagnosis of psychiatric illness in patients with Intellectual Disability remains clinically challenging in several clinical situations owing to the patient’s limited intellectual functioning and adaptive behavior. Hence, this may lead to different and atypical manifestation of psychiatric symptoms and signs in these patients. METHOD: We present a case of a 17-year-old boy with moderate intellectual disability who presented to us with chief complaints of dysphagia for 2 months. Personal history indicative of delayed milestones and difficulty in learning simple tasks. Premorbid temperament revealed anxious traits in the child. On MSE affect was distressed, speech was decreased in volume, psychomotor activity was increased and thinking revealed pre-occupation with symptom. Intelligence revealed poor general fund of knowledge and poor arithmetic ability. Insight was absent (Grade I). RESULTS AND DISCUSSION: On the basis of history and MSE a provisional diagnosis of anxiety disorder, unspecified (F41.9) was kept. The patient was started on treatment Tab Mirtazapine 7.5mg ½ BD. The patient showed significant improvement following initiation of treatment. Patients with intellectual disability have difficulty in expressing their psychological symptoms in words at times and present with atypical symptoms of the underlying disorder. This delays their diagnosis and appropriate management. Due to lack of reporting of psychological symptoms patient often continues seeking treatment from general practitioners which leads to loss of time as well as money. CONCLUSION: Physicians and psychiatrists themselves need to be more watchful when evaluating a patient with intellectual disability due to the atypical presentation of symptoms.