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Chapter 232Secondly, GPs are expected to fulfil an important role in the diagnostic assessment of MHDs, which is described as challenging for GPs. 50 Indications of inaccurate diagnoses 48, 51 and underdiagnosis in primary care are frequently reported 4, 31, 41, 42, 48, 49, 52-56 and may result in inappropriate care and progression of the disorder to a more severe stage that is less responsive to treatment. 23, 52, 57-59 Overdiagnosis, however, occurs as well, leading to unnecessary prescriptions of medication. 53, 57 Diagnostic failure is seen as related to communication problems, with patients with ID described as less able to label their feelings and communicate their needs, 44, 53, 57, 60-62 resulting in an atypical presentation of symptoms 29, 43, 44, 57, 63-65 and a more complicated assessment. 42, 48, 52, 54, 61, 66 It is deemed important for the GP to exclude somatic, environmental, and other causes of symptoms before considering an MHD, 43, 44, 48, 51, 53, 64, 65, 67-73 which requires a holistic, multidimensional approach. 29, 44Thirdly, regarding GPs’ treatment role, it is indicated that GPs should be able to handle less complex MHDs in people with ID. 40, 44, 68 For this patient group the same requirements and treatment guidelines apply as for patients with MHD without an ID, 44, 57, 65, 71, 73 with the necessity to refer patients with more complex disorders to specialised care. 44, 68 GPs prescribe psychotropic medication to a higher number of patients with ID (17–63%) than other patients. 4, 74, 75 In addition, a higher number of patients with ID are reported with psychotropic prescriptions than with recorded MHDs, indicating offlabel prescription. 4, 39, 44, 49, 75-80 Behavioural problems are often described as an indication to start medication, 4, 39, 59, 73, 74, 78, 79 specifically in cases of limited access to alternative treatment strategies. 4 Prescribed medication is reported as predominantly long-term medication, 75 and a large proportion (62–70%) is prescribed without a psychiatrist’s involvement. 50, 51, 81 Medication prescription can be considered part of a multidisciplinary and holistic care plan; 65 however, in primary practice, GPs are less likely than psychiatrists to provide psychosocial interventions. 72Finally, follow-up by GPs is considered an essential element in the treatment of patients with ID and MHD. 48, 50, 65, 69, 73, 82-84 It enables the monitoring of treatment responses and possible adverse side effects, leading to early adjustment of the treatment plan. 50, 73 However, a lack of effective monitoring of psychotropic medication by GPs is often described. 28, 42, 51, 55, Katrien Pouls sHL.indd 32 24-06-2024 16:26