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15 2 Important Issues in the Psychopharmacological Treatment of Deaf and Hard of Hearing People with Mental Health Disorders: Theory and Practice Ines Sleeboom-van Raaij Deaf and hard of hearing people are not a group of patients with a specific mental or physical disorder but rather a heterogeneous group of people within society for whom one sense organ is not working properly. In many countries around the world diagnosis and treatment of deaf and hard of hearing people with mental health problems in a specialized facility is still an unfulfilled wish. In the past 50 years services and networks have been developed by pioneers in several countries in Europe, North and South America, South Africa, Australia, and Japan (Queensland Health, 2008; du Feu & Fergusson, 2003; Denmark, 1994; Sleeboom-van Raaij, 1991, 1999; Basilier, 1973; Remvig, 1969; Rainer & Altshuler, 1966). During that time, however, no specific psychopharmacological research was carried out on deaf and hard of hearing patients (Munro, Knox, & Lowe, 2008; Sleeboom-van Raaij, 1997). The experience of other colleagues in the field has often been the only guideline. In international meetings specific and severe side effects of psychiatric medication have been cited (Sleeboom-van Raaij, 1997). The cause of these specific side effects is still unknown, as they occur in the whole group of deaf people, although it can be assumed that they are more prevalent among specific causes of deafness, such as brain damage and infectious diseases. Factors that contribute to particular mental health disorders related to prenatal rubella deafness (Brown et al., 2001, 2005; Chess, Korn, & Fernandez, 1971) and deafness due ara86542_02_ch02.indd 15 ara86542_02_ch02.indd 15 12/10/15 6:57 PM 12/10/15 6:57 PM Ines Sleeboom-van Raaij 16 to other prenatal infections (Brown et al., 2005; Buka, 2001) and the consequences for the psychopharmacological treatment are still unknown. Often hearing mental health providers assume that a “hearing” service and hearing professionals working together with a sign language interpreter for deaf patients should be sufficient (Landsberger & Diaz, 2010; du Feu & Fergusson, 2003; Ebert & Heckerling, 1995). However, both psychopharmacological treatment and psychoeducation of deaf people require specialized knowledge of many aspects related to deafness that can influence this part of the psychiatric treatment (Fellinger, Holzinger, & Pollard, 2012; Black & Glickman, 2006; Gorlin, Toriello, & Cohen, 1995). To understand these factors and interpret the questions and answers adequately specialized professionals are needed (Landsberger & Diaz, 2010; du Feu & Fergusson, 2003). GENERAL ASPECTS OF PSYCHOPHARMACOLOGY IN MENTAL HEALTH AND DEAFNESS In adult psychiatry the results of what went physically, psychologically, socially, mentally, and educationally wrong in the life of the patient are evident. Frequently observed biopsychosocial factors can show the hazards, the risks, and the positive effects of these factors on the mental health of the individual (van Gent, 2012; Hindley & Kitson, 2000). Experience has taught that several aspects that are directly or indirectly related to deafness play a role in the diagnostic process and treatment of deaf and hard of hearing patients (van Gent, 2012; Fellinger et al., 2012; Sleeboom-van Raaij & Knoppert-van der Klein 2003; du Feu & Fergusson, 2003). During psychopharmacological treatment the following factors are important: aetiology (cause) of the deafness, age of onset, additional handicaps and comorbidity, means and level of communication and language abilities, general knowledge, and cultural issues. For a summary, see Table 1. Language Abilities Unfortunately, not all deaf people are able to learn to sign, lip-read, or read adequately (Landsberger & Diaz, 2010). Black and Glickman (2006), experienced clinicians in the field of mental health and deafness, found that two-thirds of their deaf inpatients were dysfluent in any language. Several of the deaf inpatients in the Netherlands have severely limited communication skills such as some signing, gesturing, and/or inadequate lipreading and speech; some of the patients had no language skills at all. These limited language skills were caused by the following: • delayed diagnosis of the deafness (doctor’s delay, parents’ delay) • nonacceptance/denial of the deafness by the parents and other family members ara86542_02_ch02.indd 16 ara86542_02_ch02.indd 16 12/10/15 6:57 PM 12/10/15 6:57 PM 17 Psychopharmacological Treatment of Deaf and Hard of Hearing People • nonacceptance of the deafness in the community • noncommunicative family or other environment in which the individual grew up • mainstreaming of the individual in a hearing school without special provisions • lack of schooling In the Netherlands, patients specifically of foreign origin, such as those from the Middle East, Africa, Surinam, and the Dutch Caribbean, are highly represented in this group. Their...


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