Dual-Diagnosis Psychiatry of the Developmental Disabilities

Elective: Dual Diagnosis: Psychiatry of the Developmental Disabilities Elective for Residents

Place: Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON L1N 5S9
Inquiries: Dr. T. Gofine gofinet@ontarioshores.ca, or by phone at 905.430.4055, ext. 6641.
Supervisor: Dr. T. Gofine, MD, FRCPC, Head of Medical Services, Dual Diagnosis Service, Ontario Shores and Assistant Professor, Department of Psychiatry, U of T


The Dual Diagnosis Service (DDS) at Ontario Shores is one of the largest dual diagnosis services in Canada. The interested resident, through an elective experience, can gain expertise in this fascinating subspecialty; expertise that is in demand locally, nationally and internationally. Few psychiatrists realize the incidence of schizophrenia in the intellectually disabled is estimated to be three times that of the general population, or that anxiety disorders are estimated to be found in 75% of the mildly intellectually disabled. The challenge of discerning psychiatric symptoms within the severely disabled, or distinguishing autistic spectrum disorder from schizophrenia can be one of the most exciting clinical situations in contemporary psychiatry. The treatment philosophy of the service is based on the primary importance of crafting a diagnostic formulation that considers biologic, psychodynamic and social factors with detailed accuracy so treatment plans can be rational and effective. Less common syndromes that have disordered behaviour, such as Smith-Magenis syndrome, fall within the dual diagnosis population and are seen in both the inpatient and outpatient components of the service.

The psychiatric assessment of the dually diagnosed includes clarifying complex medical issues, investigating the root cause of the disability from a clinical genetic point of view, and exploring developmental factors first seen in childhood and adolescence. The resident will have the opportunity to be directly involved in the assessment of patients via outpatient consultation and in the treatment of inpatients on the dedicated inpatient unit. Opportunities to be with patients in the community can be enlisted. The treatment team is interdisciplinary and as a result, opportunities to learn how the allied professions integrate into psychiatric care will be first hand. This elective will enhance the training of a resident following a variety of care interests, from child and adolescent psychiatry (what is the natural course of autism in the adult?) to general psychiatry (how does bipolar disorder present in the deaf intellectually disabled individual?) to geriatrics (what are the needs of the aging person with mild intellectual disability and chronic health issues?).

The elective can be tailored for any duration. Academic interest through readings and participation in rounds and interest in a research project, would be supported. As well, blending an elective with a related clinical area within Ontario Shores such as adolescents or forensics would certainly be open for discussion.