Prevalence of mental illness among mentally handicapped people.
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Biomedical subjects
Publications and source records attributed to A H Reid.
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A double-blind, placebo controlled, crossover trial of carbamazepine in 12 severely and profoundly mentally retarded, overactive adult patients is described. The trial lasted 7 months and those patients in whom overactivity was the dominant problem responded to some degree to carbamazepine with a reduction in overactivity. This was particularly so in patients in whom overactivity was accompanied by some elevation of mood. Patients in whom overactivity was part of a wider spectrum of multiple behaviour disorders showed a scatter of responses. There was no relationship between response to carbamazepine and the presence or absence of epilepsy. The trial identified a small group of mentally retarded patients in whom carbamazepine might be clinically useful.
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The relationship between herpes simplex virus type 1 and mental retardation is explored by studying the antibody levels to this virus in a group of 86 severely and profoundly retarded adults. A tendency towards higher antibody levels is found in patients whose retardation is of unknown aetiology. The relationship of these observations to previous research findings and the possible significance of herpes simplex virus in the aetiology of mental retardation are discussed.
The clinical psychiatric syndromes encountered in sixty mentally retarded children treated in a child psychiatric out-patient clinic setting are described. It was possible to classify these syndromes according to the multi-axial classification scheme for psychiatric disorders in childhood and adolescence. The children were followed-up for some years in many cases and the natural history of these disorders was in the main comparable to that of similar disorders in children of normal intelligence, although there was a tendency for some of the disorders to prove unusually persistent. Sometimes the persistence of these disorders seemed to be related to the children's continuing dependency needs arising from their mental retardation and to stresses within the family circle. The disorders responded reasonably satisfactorily to standard child psychiatric treatment techniques, and child psychiatric services should include the assessment and treatment of psychiatric disorders in mentally handicapped children within their remit.
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Very little is known about psychiatric disorders in severely and profoundly retarded adults. We have investigated these disorders by systematically recording and collecting data about the behaviour of 100 severely and profoundly retarded hospitalized adults and subjecting the data thus derived to cluster analysis. Eight clusters were isolated. The clinical psychiatric significance of these clusters is discussed and their relationship to cause retardation, duration of stay in hospital and visiting is considered. A diagnostic framework for psychiatric disorder in severely and profoundly retarded adults is put forward and some possible treatment approaches are suggested.
A follow-up clinical and neuropathological study of eleven mentally subnormal subjects diagnosed in life as suffering from either senile, cerebral arteriosclerotic or pre-senile dementia is reported. Of the original cohort seven have died and neuropathological examination has confirmed the diagnosis of cerebral arterisclerotic dementia in three, senile dementia in one and senile dementia of unusually early onset in another mongol patient. Autopsy was refused in one patient and in the other patient neuropathological examination revealed a diffuse sclerosis of Pelizaeus-Merzbacher type. In the four survivors the clinical diagnosis of dementia would appear to be probably correct in one patient, partially correct in another, and wrong in two patients. The study has confirmed that dementia can be diagnosed in mental defectives with a reasonable degree of accuracy and draws attention to the potential interest of neuropathological examinations in decreased psychiatrically disordered mentally subnormal subjects.
Seventy-five mentally handicapped adult individuals attending a training centre were compared with 75 adult patients in a mental subnormality hospital using a standardized psychiatric interview. Ten of the individuals at the training centre were rated in the pathological range for overall psychiatric disturbance compared with 23 patients in hospital. Details are presented for the various psychiatric symptoms.
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The clinical features of four cases of short-cycle manic depressive psychosis occurring in mentally defective patients are described. Behavioural fluctuations are correlated with alterations in sleep pattern, pulse rate and temperature. The diagnostic problems and significance of the observations are discussed.
Four mentally defective patients who were suffering from short-cycle manic-depressive psychosis were each studied under metabolic ward conditions for about six months. Weekly estimations of erythrocyte Na-K ATPase activity, ouabain sensitive potassium influx, sodium concentration, whole blood cell ATP concentration and blood haematocrit were made. The findings in each patient differed, but the erythrocyte Na-K ATPase activity, sodium and ATP concentration appeared to show cyclic changes related to, though out of phase with, the clinical state.
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This study attempted to assess the applicability of the Clinical Interview Schedule (Goldberg et al., 1970) to mentally handicapped patients in a hospital. Twenty-seven patients were rated simultaneously by three raters. Of the 31 items assessed for reliability, 11 were completely satisfactory, 8 were satisfactory, 6 unsatisfactory and 6 'not proven'. Ratings made by all raters for overall severity of psychiatric illness correlated significantly with similar ratings made by the consultants responsible for the patients.
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