Biomedical subjects

S A Cooper

Publications and source records attributed to S A Cooper.

At least 37 records · Page 2Linked to original sources

PubMed1998

Maladaptive behaviours and symptoms of dementia in adults with Down's syndrome compared with adults with intellectual disability of other aetiologies.

Dementia commonly occurs in elderly people with intellectual disability, especially those with Down's syndrome. The non-cognitive symptoms of dementia can be of greater significance to individuals and carers than the cognitive changes caused by this condition. It is not known whether there are differences between people with Down's syndrome and those with intellectual disability of other causes with regard to the prevalence of such symptoms. The present study was undertaken to draw a comparison between a group with Down's syndrome and dementia (n = 19), and a group with intellectual disability of other causes and dementia (n = 26). Maladaptive behaviours and psychiatric symptomatology were assessed in both groups. The group with Down's syndrome had a higher prevalence of low mood, restlessness/excessive overactivity, disturbed sleep, being excessively uncooperative and auditory hallucinations. Aggression occurred with greater frequency in those subjects with intellectual disability of other causes. These findings are of epidemiological importance in terms of service planning and understanding psychiatric presentation.

Adult↗

PubMed1998

Affective psychosis and Prader-Willi syndrome.

Previous studies have demonstrated that maladaptive behaviours are common amongst adults with Prader-Willi syndrome (PWS). Case reports have also previously demonstrated that psychosis can occur amongst adults with PWS. The present study was undertaken in order to gain a better understanding of the psychopathology of the psychosis of PWS. Twenty-three out of 25 adults identified with PWS living in Northamptonshire, UK, agreed to participate. Comprehensive psychiatric assessments (using the PPS-LD), and measures of adaptive and maladaptive behaviours (using the AAMR-ABS) were completed. Comparisons were made for the prevalence of psychiatric disorders against those from a previous epidemiological study of adults with intellectual disability of other aetiologies from a neighbouring county. The PWS group was found to have higher rates of affective disorders (a point prevalence of 17.4%), in which psychotic symptoms were common, but similar rates of schizophrenia/delusional disorders (4.3%) compared with the comparison group. Behaviour disorders were also common. Surprisingly, none of the PWS group was found to have generalized anxiety or phobic disorders. The diagnostic criteria for the episodes including psychotic symptoms are explored. The high rates of affective disorders is of clinical (i.e. treatment) importance as well as being of academic interest with regard to the genetics of psychiatric disorders.

Adult↗

PubMed1998

Behaviour phenotype for Down's syndrome.

BACKGROUND: For more than a century, the idea of particular personality/behavioural characteristics being associated with people with Down's syndrome has been explored, but with inconclusive results. METHOD: The Disability Assessment Schedule was used to ascertain the behavioural profiles of 360 adults with Down's syndrome and 1829 adults with learning disabilities of other aetiologies, who were the whole identified population within a defined geographical area. Comparison was made between the two total groups and additionally for the subgroups aged < 35 years and aged > or = 35 years. Comparison was also made with regards to cluster analysis findings. RESULTS: Despite an equal age and developmental quotient, the Down's syndrome group were less likely to demonstrate maladaptive behaviours. The behaviour characteristics of the adults with Down's syndrome remained constant in the younger and older age groups. Cluster analysis demonstrated adults with Down's syndrome to have an increased prevalence in cluster groupings with lower rates of maladaptive behaviours. CONCLUSIONS: This study confirms there to be a behaviour phenotype among adults with Down's syndrome. The reasons for this (e.g. genetic/psychological/social) require further research. Such research may establish a better understanding of the aetiologies of maladaptive behaviours among people with learning disabilities in general.

Adult↗

PubMed1998

Epidemiology of self-injurious behaviour in adults with learning disabilities.

BACKGROUND: There have been few epidemiological studies of the disabling and poorly understood disorder self-injurious behaviour among adults with learning disabilities. METHOD: Interviews were undertaken with the carers of adults known to the Leicestershire Learning Disabilities Register (n = 2277). The Disability Assessment Schedule was used and information was also collected on demographic characteristics, developmental and physical status. RESULTS: Self-injurious behaviour was present in 17.4% of the population. In 1.7% self-injurious behaviour occurred frequently and was severe. There was no gender difference between those with and without self-injurious behaviour. Both the chronological age and developmental quotient of individuals with self-injurious behaviour were lower than those of individuals without self-injurious behaviour. Autistic symptoms were more common among those with self-injurious behaviour. The association of self-injurious behaviour with a wide range of other maladaptive behaviours was highly significant. Logistic regression analysis retained age, developmental quotient, hearing status, immobility and number of autistic symptoms as explanatory variables for self-injurious behaviour. CONCLUSIONS: Self-injurious behaviour is a prevalent and disabling disorder among adults with learning disabilities.

Adjustment Disorders↗

PubMed1998

Clinical study of the effects of age on the physical health of adults with mental retardation.

Physical disorders and pharmacotherapy for all 134 people with mental retardation ages 65 years and over living in Leicestershire, United Kingdom, were examined. Results were compared with a randomly selected group of 73 younger adults with mental retardation. Group comparisons revealed higher rates of urinary incontinence, immobility, hearing impairments, arthritis, hypertension, and cerebrovascular disease among the older group. The younger group had higher rates of dermatological disorders; congenital heart disease; ear, nose, and throat (ENT) disorders; and neurological disorders (excluding Parkinson disease). The older group took more drugs for physical illness. The effect of ageing on physical morbidity outweighs the effect of people with more severe mental retardation dying younger: Older people with mental retardation have significant physical health needs.

Activities of Daily Living↗

PubMed1997

High prevalence of dementia among people with learning disabilities not attributable to Down's syndrome.

BACKGROUND: For many years, it has been known that dementia can occur in people with learning disabilities, but there have been few research studies. Studies that do quote rates for dementia show these to be high, but this important fact has received remarkably little attention. METHOD: Comprehensive psychiatric and medical assessments were undertaken on the whole population (ascertained as far as is possible) of people with learning disabilities aged 65 years and over living in Leicestershire, UK (N = 134), in order to ascertain rates of DCR defined dementia, and associated factors. RESULTS: Dementia was diagnosed in 21.6%, against an expected prevalence of 5.7%, for a group with this age structure. The rate of dementia increased in successive age cohorts: 15.6% aged 65-74 years; 23.5% aged 65-84 years; and 70.0% aged 85-94 years. People with dementia tended to be older, female, with more poorly controlled epilepsy, a larger number of additional physical disorders, less likely to be smokers and had lower adaptive behaviour scores than did the elderly people without dementia. They were more likely to live in health service accommodation. CONCLUSIONS: Dementia occurs at a much higher rate among elderly people with learning disabilities than it does among the general population; this is independent of the association between dementia and Down's syndrome. Whether this relates aetiologically to genetics, lack of brain 'reserve' or history of brain damage is yet to be determined.

Age Factors↗

PubMed1997

The current provision of specialist health services to people with learning disabilities in England and Wales.

Considerable change has taken place in the provision of specialist health services to people with learning disabilities with the move away from institutions and an emphasis on care in the community. There is diversity between services in different parts of the country, but no existing source of information by which NHS Trusts can benchmark their own services against the national norm. This project was undertaken in order to ascertain the current provision of specialist health services in England and Wales. A questionnaire was returned by 83.9% of 161 NHS Trusts, who quantified their service in terms of in-patient and community resources. Results were analysed and presented where possible as cumulative frequencies, to facilitate benchmarking.

England↗

PubMed1997

Deficient health and social services for elderly people with learning disabilities.

Elderly people with learning disabilities have greater psychiatric morbidity than younger individuals, but a previous report has suggested that the majority of the former do not receive treatment. All people with learning disabilities aged 65 years and over living in Leicestershire, England (n = 134), and a random sample of adults with learning disabilities aged between 20 and 64 years (n = 73) were assessed for psychiatric disorders and service use. Elderly people received less day care, less respite care and were less likely to have a social worker and receive input from most health services than the younger group. Chiropody was an exception. Those receiving psychiatric services did so through the learning disabilities specialist services only. Those with an additional psychiatric disorder were more likely to receive services, but results still favoured the younger group. Services were better accessed by those living in residential care. Failure to access services may relate to carers attitudes and beliefs: in learning disability settings, morbidity was attributed to 'it's just old age; in the elderly settings, morbidity was attributed to 'it's because s/he has learning disabilities'. The specialist health and social services need to take the lead in health promotion and education.

Adult↗

PubMed1997

A population-based health survey of maladaptive behaviours associated with dementia in elderly people with learning disabilities.

Maladaptive behaviours are known to present as a feature of dementia amongst people from the general population, but there has been little research to examine whether this has implications for people with learning disabilities who develop dementia. Out of 143 people with learning disabilities aged 65 years and over living in Leicestershire, England, 134 (93.7%) participated in the study. Twenty-nine people diagnosed as having dementia were compared against 99 people without dementia; six people with possible dementia were excluded from the analysis. Comparisons were made on the results of a checklist of maladaptive behaviours. Seventeen out of the 22 maladaptive behaviours examined were found to be more prevalent amongst the people with dementia. The behaviours which were significantly more prevalent in the group with dementia included lack of energy, lack of sense of danger, sleep disturbance, agitation, incontinence, excessively uncooperative, mealtime/feeding problem, irritability and aggression. Dementia is becoming more prevalent amongst people with learning disabilities because of their increasing life span. Maladaptive behaviours are commonly associated with dementia. This can cause a significant burden for individuals and their carers, which may influence the viability of a person's residential placement.

Adult↗

PubMed1997

Epidemiology of psychiatric disorders in elderly compared with younger adults with learning disabilities.

BACKGROUND: The literature regarding psychiatric illness among elderly people with learning disabilities is limited and conflicting because of methodological differences. There have been no recent studies comparing psychiatric epidemiology between younger and older adults with learning disabilities, using the same methodology and definitions. METHOD: Comprehensive psychiatric examination using a semi-structured rating scale was undertaken on everyone with learning disabilities, aged 65 years or over (n = 134), living in a defined geographical area. Comparison was made with a randomly selected control group of adults with learning disabilities aged 20-65 years (n = 73) drawn from the same geographical area. RESULTS: Elderly people with learning disabilities have a greater prevalence of psychiatric morbidity than younger controls (68.7 v. 47.9%). Rates for depression and anxiety disorders are high, and dementia is common: there are equal rates for schizophrenia/delusional disorders, autism and behaviour disorders in the two groups. CONCLUSIONS: The higher psychiatric morbidity among elderly (compared with younger) people with learning disabilities has not previously received adequate recognition. This warrants further investigation by service planners and clinicians.

Adult↗

PubMed1997

Psychiatric symptoms of dementia among elderly people with learning disabilities.

OBJECTIVE: To determine the rate of psychiatric symptoms among elderly people with learning disabilities who have dementia. DESIGN: Survey. SETTING: The general community of a county in the UK. PARTICIPANTS: The whole population of people with learning disabilities who were 65 years or over. The total population was 143, of whom 134 participated (93.7%). From the total population, those with dementia were determined (N = 29). MEASURES: Description of psychopathology, using a semi-structured psychiatric rating scale. RESULTS: Psychotic symptoms occurred in 27.6%, with the most common types being delusions of thefts, other persecutory delusions and visual hallucinations of strangers in the house. The onset of other psychiatric symptoms as part of the dementia was also common, in particular changed sleep pattern, loss of concentration, worry, reduced quantity of speech, change in appetite and onset of or increase in aggression. CONCLUSIONS: People with leaming disabilities are living longer, and so the number with dementia is rising. Psychiatric symptoms occur commonly in dementia, can cause significant distress and require recognition, understanding and the development of effective managements.

Aged↗

PubMed1997

Adverse effects of summer amongst people with learning disabilities: neuroleptic malignant syndrome.

The existing literature regarding neuroleptic malignant syndrome (NMS) amongst people with learning disabilities is limited. We describe three case reports of people with learning disabilities from the same geographical area who developed NMS within 3 weeks of each other. This was during the hottest part of a very hot summer. The presentation of NMS is discussed. The importance of carers attending to adequate hydration for people with learning disabilities and poor communication skills during the summer months is stressed.

Adolescent↗

PubMed1996

Analgesic efficacy of the kappa-receptor agonist, enadoline, in dental surgery pain.

To study the analgesic efficacy of enadoline, a selective agonist of the kappa-opioid receptor, a double-blind, randomized comparison was made of enadoline versus placebo and a combination of acetaminophen-codeine in patients with pain after surgical extraction of impacted molar teeth. An initial study involving a comparison of enadoline, a combination, and placebo failed to show any analgesic effect of enadoline. Therefore, a second study with the same design but using higher doses of enadoline was conducted. Despite continued safety and tolerability even at the higher doses, enadoline could not be shown to be superior to placebo. The acetaminophen-codeine combination was significantly more effective than enadoline or placebo. Enadoline did not show analgesic efficacy in this study. Possible reasons for this lack of efficacy are discussed.

Acetaminophen↗

PubMed1996

Prevalence and cluster typology of maladaptive behaviors in a geographically defined population of adults with learning disabilities.

BACKGROUND: Maladaptive behaviours are frequently present in individuals with learning disabilities; however, their prevalence varies between studies and the aetiology, classification and most appropriate management of such behaviors remain unclear. The aims of the study were twofold: firstly to determine the prevalence of maladaptive behaviours, and secondly to develop a classification typology. METHOD: A population of 2202 adults with learning disabilities was surveyed to determine the prevalence of maladaptive behaviours. These were subjected on the basis of 13 behavioural characteristics to cluster analysis. The clusters were further examined in respect of secondary variables. RESULTS: Over 60% of individuals demonstrated the presence of at least one maladaptive behaviour and in 40% this problem was of either severe degree or frequent occurrence. Men were more likely to demonstrate physical aggression, property destruction, tantrums and verbal abuse than women. Although some severe maladaptive behaviours diminished with age, many persisted through all age groups. Six behavioural clusters were devised which demonstrated face validity and which differed in respect of demographic and developmental variables, and the prevalence of maladaptive habits and autistic symptoms. CONCLUSIONS: These findings demonstrate a high prevalence of maladaptive behaviours and 'objectionable habits' among people with learning disabilities. A classification of behavioural symptoms may be possible on the basis of symptom clusters.

Adolescent↗

PubMed1996

Analgesic efficacy and safety of an intraoral lidocaine patch.

The effectiveness of intraoral II-docaine patches was tested by asking participants to rate the pain experienced after insertions of a 25-gauge needle. Needlesticks were performed at baseline and at various time points after patch placement. Each needlestick included contact with the periosteum. Lidocaine patches achieved significantly better analgesia than the placebo within 2.5 to five minutes after placement. Drug-related side effects were minimal and venous blood levels of lidocaine were low, averaging 10 to 14 times less than those achieved with a typical injection of lidocaine plus epinephrine. The authors conclude that the lidocaine patches used in this study are effective and safe in reducing needle insertion pain in adults.

Administration, Topical↗

PubMed1995

Urine fetish in a man with learning disabilities.

Urine fetishes are uncommon. A 30-year-old man with learning disabilities and a fetish for observing women urinate is described, and the possible dynamic aspects of his paraphilia are discussed.

Adult↗

PubMed1995

The effect of age on language in people with Down's syndrome.

It has been previously suggested, in a small-sized study of 60 people with Down's syndrome, that receptive language skills were lower, the older the individual, whereas expressive language skills did not correlate with age (Carter-Young & Kramer 1991). By assessing language skills on 345 Down's syndrome adults living in Leicestershire (91% of the total population), the present authors have been able to confirm this finding, using the AAMD Adaptive Behaviour Scale. This may have clinical relevance with regard to communication with older people with Down's syndrome, and also for estimation of an individual's skill level when he or she was younger.

Adult↗

PubMed1995

Adaptive behaviour after schizophrenia in people with Down's syndrome.

Seven individuals with Down's syndrome and a past history of schizophrenia were matched for age, sex and residence to adults with Down's syndrome but no past psychiatric history. The AAMD Adaptive Behaviour Scale was completed for all individuals in both groups, at a mean follow-up period of 6.4 years after the schizophrenic episode. The skill level of the subject group was found to be the same as for the control group, which rejects the notion of a 'defect state' occurring post-schizophrenia in Down's syndrome. The importance of accurate diagnosis and treatment for this group is stressed.

Adaptation, Psychological↗