Brief report: violence in Asperger syndrome, a critique.
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Biomedical subjects
Publications and source records attributed to M Ghaziuddin.
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Despite the known association of folie à deux with low intelligence, very few reports of its occurrence in people with documented mental retardation have been published. A case of folie à deux in a 32 year old man with moderate mental retardation is described and the clinical implications discussed. The need for an increased awareness of the existence of mental illness in the mentally handicapped is also emphasized.
Erotomanic delusions occurred in a depressed mentally handicapped woman. Although erotomania is generally classified with paranoid disorders, in people with mental handicap, depression may be the more commonly associated illness.
Depressive illness in a patient with Down's syndrome and autism responded to fluoxetine. The importance of diagnosing superimposed depression in people with developmental disorders is emphasised.
In a study of the prevalence of life events in recurrent depression, 40 patients with recurrent episodes were compared to 33 who were experiencing their first depressive illness. Thirty out of 33 (90.9%) first episode cases experienced life events prior to the onset of illness whereas only 20 out of 40 (50%) of the recurrent group gave such as history. Patients with a first episode had an average of 2.2 life events in the six months prior to onset, whereas recurrent patients experienced average of only 0.8 life events (p less than 0.05). Negative as well as exit events were also significantly more frequent among the first episode group. Although life events, age and sex all contributed to the recurrence of depression, most of the variance was not accounted for by any of these factors.
Symptoms resembling mania following withdrawal of diazepam in a mentally handicapped woman are described. The importance of considering benzodiazepine withdrawal in the assessment of acute behavioural disorders of the mentally handicapped is emphasized. Attention is also drawn to the paucity of research regarding the use of antianxiety drugs in the mentally handicapped.
Presence of polycystic ovary disease is described in a mentally retarded woman who later developed features of manic-depressive illness. The possibility that the three conditions might interrelate pathophysiologically is discussed.
In a retrospective study, 98 consecutive psychiatric referrals of mentally handicapped persons living in the community were examined. By far the commonest cause of referral was behaviour disturbance, followed by requests for disposal, placement or respite care. The referring agents were mostly general practitioners and social workers. Factors affecting the pattern of referral such as degree of mental retardation and life events are discussed.
A retrospective study of 65 consecutive referrals for behavioural disorder of mentally handicapped patients living in the community revealed that 31 of these were associated with life events sustained in the 12 months prior to the referral. These patients were usually mildly handicapped, while those who presented with behaviour disorder without a history of recent life events were usually more severely retarded. The differences between the two groups are discussed and the need for further research emphasised.
The use of lithium to treat child and adolescent psychiatric disorders is becoming more common. Since the publication of the report of The Committee on Biological Aspects of Child Psychiatry of the American Academy of Child Psychiatry in 1978, a considerable body of literature has accumulated on the efficacy of lithium in treating adolescent bipolar disorders, childhood aggression, and behavioral disorders associated with mental retardation and developmental disorders. Efforts to understand lithium's mechanism(s) and refinements in psychiatric diagnosis have contributed to its growing use.