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PubMed1984

Diagnosis and drug use in mentally retarded, emotionally disturbed adults.

Inpatient and outpatient, emotionally disturbed, borderline to severely mentally retarded adults (N = 110) were assessed to evaluate the relationship of medication to psychiatric diagnosis and symptomatology. Patients were assessed on the Psychiatric Instrument for Mentally Retarded Adults, the Beck Depression Inventory, the Zung Self-Rating Depression Scale, the Hamilton Rating Scale for Depression, and the Social Performance Survey Schedule--a measure of social adaptation. All these instruments had been modified for use with mentally retarded persons. Comparisons were made evaluating patients receiving major tranquilizers, anticonvulsant and antianxiety drugs, by diagnostic category. Furthermore, an assessment was made of inpatients versus outpatients, based on amount of medication prescribed. It was found that considerable variation in the numbers of drugs and the amount of drug used occurred, based on the type of psychiatric condition, particularly those on informant data on schizophrenia, affective disorder, and adjustment reaction disorder. Implications of these and related results for psychotropic drug use with mentally retarded emotionally disturbed persons are discussed.

Adult↗
PubMed2001

ECT in mental retardation: a review.

The use of electroconvulsive therapy (ECT) in patients with mental retardation and a psychiatric disorder seems to be infrequent, and controlled studies are not available. We reviewed the literature on the use of ECT in mental retardation, using Medline, Embase, and the Cochrane Library. References were checked and ECT experts consulted. The reported case studies were examined on patients' characteristics and illness, treatment, and outcome variables. Forty-four patients, mostly with a diagnosis of psychotic depression, were found. In 84% (n = 37) of them, ECT was effective and without important side effects. However, relapse occurred frequently, in 48% (n = 21) of the patients. In 16% (n = 7), side effects and/or no improvement were noted. The reported case studies suggest that ECT may be of value in treating severe psychiatric disorders in mentally retarded patients, with similar indications as in general psychiatry. However, the lack of strong scientific evidence, besides complicated psychiatric assessment as well as ethical and legal issues, probably cause an unnecessarily limited use of ECT in these patients. Further controlled trails are needed to firmly establish the efficacy and safety of ECT in mental retardation.

Adolescent↗
PubMed1996

[Treatment with antiepileptics of mentally retarded patients. Experiences from the 1980s a challenge in the 1990s].

Epilepsy is the most frequent additional handicap in mentally retarded persons. Brain injury and mental retardation may predispose to side effects of antiepileptic drugs (AEDs) on the central nervous system. 63 institutionalized mentally retarded patients were treated for epilepsy in the 1980s. AED treatment was carefully monitored, aiming at the lowest effective dose and an optimal balance between seizure control and adverse effects. In 15 patients, AEDs could be withdrawn. Drugs with less cognitive side effects, such as carbamazepine and valproate, were preferred to longer established drugs, such as phenobarbital and phenytoin. A pronounced decrease in the frequency of seizures was achieved during the study. Based on the calculated Defined Daily Doses, the prescription of AEDs was reduced by 18%. Phenobarbital constituted 39% of the AED consumption at the beginning and 7% at the end of the study. The corresponding figures for phenytoin were 20 and 16%. The fraction of carbamazepine increased from 31 to 44% and that of valproate from 6 to 32%. Less sedative side effects were reported. Several factors other than AEDs may have modified control of seizure in this long term study. These issues are discussed. After the reform of the system of care for the mentally retarded in Norway, it is a challenge to the health authorities to provide an adequate comprehensive epilepsy service to this group of patients.

Adolescent↗
PubMed1992

Mental retardation and psychiatric illness.

Although traditional diagnostic criteria are accepted for use with mentally retarded persons, diagnosis of psychiatric disorders in this population is often complicated by clinicians' ignoring or underestimating such disorders and by patients' communication problems. The revision of DSM-III and changes in policies of third-party payers have sensitized clinicians to the presence of psychopathology among mentally retarded persons. The authors discuss the relationship between mental illness and mental retardation and review recent research on the diagnosis of specific psychiatric disorders in these patients. Some problems, such as behavioral disruptiveness, psychoses, and phobias, are more prevalent among mentally retarded persons than among other populations, whereas other problems, such as alcoholism and suicide, may be less common.

Comorbidity↗
PubMed1996

Regional localization of an X-linked mental retardation gene to Xp21.1-Xp22.13 (MRX38).

A gene responsible for X-linked mental retardation with macrocephaly and seizures (MRX38) in a family with five affected males in three generations was localized to Xp21.1-p22.13 by linkage analysis. Recombination events placed the gene between DXS1226 distally and DXS1238 proximally, defining an interval of approximately 14 cM. A peak lod score of 2.71 was found with several loci in Xp21.1 (DXS992, DXS1236, DXS997, and DXS1036) at a recombination fraction of zero. The map intervals of 5 X-linked mental retardation loci, MRX2 (Xp22.1-p22.2), MRX19 (Xp22), MRX21 (Xp21.1-p22.3), MRX29 (Xp21.2-p22.1), and MRX32 (Xp21.2-p22.1), and two syndromal mental retardation loci, Partington syndrome (PRTS; Xp22) and Coffin-Lowry syndrome (CLS; Xp22.13-p22.2), overlap this region. As none of these display the same phenotype seen in the family reported here, this X-linked mental retardation locus may represent a new entity.

Adolescent↗
PubMed1989

Prevalence of psychopathology among mentally retarded adults.

The prevalence of psychopathological disorders was determined in a random, stratified sample of 165 adults, 110 males and 55 females, with mental retardation using the Psychopathology Instrument for Mentally Retarded Adults. Stratified variables included mental retardation level and living environment (institutional, family, independent). Results showed that 35.9% of the sample had at least one significant psychopathological disorder. Presence of pathology was related to level of retardation, but not to living environment, sex, or age. Difficulties associated with assessing pathology in persons with mental retardation are described.

Adult↗
PubMed1997

Sexual abuse prevention for persons with mental retardation.

The problem of sexual abuse among persons with mental retardation, skills for preventing sexual abuse, and methods for assessing prevention skills were discussed. Because very little research on teaching sexual abuse prevention skills exists, research on abduction prevention programs for persons with mental retardation as well as on sexual abuse prevention programs for children, was reviewed. Suggestions for future research in the area of sexual abuse prevention for persons with mental retardation were discussed.

Adolescent↗
PubMedDate not supplied

A criterion validity study of the schizophrenia subscale of the Psychopathology Instrument for Mentally Retarded Adults (PIMRA).

Sixty-five mildly to moderately mentally retarded adults from institutional and community placements in Louisiana and Texas with DSM diagnoses of schizophrenia, depression, or no psychopathology were recruited. The primary goal was to establish the validity of the PIMRA's schizophrenic subscale for diagnosing mentally retarded adults. In addition, validity of the depression subscale was replicated. Assessment measures included the informant version of the Psychopathology Instrument for the Mentally Retarded (PIMRA), DSM-III-R checklists for schizophrenia and depression, and a drug response rating. Univariate and multivariate analyses were conducted, as were interrater reliability on all measures. The schizophrenia and depression subscale of the PIMRA were validated. Implications of the research and directions for future study are presented.

Adult↗
PubMed1981

Pathogenic factors in idiopathic mental retardation.

Pathogenic factors in a mentally retarded population were evaluated by comparing their frequency among three groups of patients: a control group with predominantly genetic retardation and consanguineous parents; a group with severe idiopathic retardation and unrelated parents; and a group with mild idiopathic retardation and unrelated parents. Seven factors were found to be significantly more common among the patients with idiopathic retardation than in the genetic control group: a history of maternal reproductive inefficiency; bleeding during pregnancy; toxemia during pregnancy; signs of perinatal stress; neonatal anoxia; neonatal jaundice; and seizures during the first year of life. A history of repeated maternal abortions was particularly associated with mild retardation, and infantile seizures were particularly associated with severe retardation. The latter association remained significant even after exclusion of all infantile spasms, neonatal seizures and symptomatic seizures. Since the control group in this study was composed mainly of genetically retarded patients, the associations observed seem likely to be related to the causes of retardation rather than simply being the effects of a damaged fetus.

Abortion, Spontaneous↗
PubMedDate not supplied

A Dutch version of the Psychopathology Inventory for Mentally Retarded Adults (PIMRA).

Eighty-nine mildly mentally retarded adults were assessed using the Psychopathology Inventory for Mentally Retarded Adults (PIMRA). This study reports on the psychometric properties of the PIMRA in a Dutch population, the correlation between self-report and ratings-by-others forms, and the relationship of the PIMRA to both behavior problems and subject characteristics. It was revealed that internal consistency was good for both forms on total scores but modest for most of the subscales. Furthermore, interrater reliability was low to modest. Both forms of the PIMRA showed good criterion validity. The correlation between the two forms was modest. A strong relationship was found between PIMRA scores and behavior problems, as measured using the Reiss Screen of Maladaptive Behavior. Furthermore, the relationship between PIMRA scores and subject characteristics was weak.

Adult↗
PubMed2003

Involuntary sterilization of persons with mental retardation: an ethical analysis.

Legitimate concerns on the part of parents and guardians may lead to requests for sterilization of a mentally retarded person in their care. At the same time, mentally retarded persons must be protected from actions that do not serve their best interests. This paper will review the history of involuntary sterilization in the United States and evaluate the ethical arguments that are relevant to decisions about involuntary sterilization. While other, less permanent forms of contraception might be acceptable, involuntary sterilization ought not be performed on mentally retarded persons who retain the capacity for reproductive decision-making, the ability to raise a child, or the capacity to provide valid consent to marriage. Mentally retarded persons who lack capacity in those three areas should be considered for involuntary sterilization only when the procedure is necessary, sterilization would serve the best interests of the mentally retarded person, less intrusive and temporary methods of contraception or control of menstruation are not acceptable alternatives, and procedural safeguards have been implemented to assure a fair decision-making process.

Humans↗
PubMed1998

Developmental versus difference approaches to mental retardation: a theoretical extension to the present debate.

The developmental approach to mental retardation is based on the view that comparisons between individuals with mental retardation and individuals without mental retardation matched on cognitive level should indicate no substantive differences in cognitive functioning. In contrast, the difference approach states that such comparisons will often reveal major deficits in cognitive functioning related to IQ. I argued that aspects of the conceptual and methodological foundations of these theories are deficient. An analysis of the relationship between cognitive functioning and cognitive level within designated CA cohorts allows for more sensitive tests of the major propositions in these theories. A paradigm shift based on regression analysis was recommended as the starting point for further theoretical and methodological work in the area.

Cognition Disorders↗
PubMed2000

Strategies for reaching by individuals with mental retardation: empty and filled glasses.

The purpose of this study was to assess the reaching strategies of individuals with mental retardation under different conditions. Much about reaching has been studied from the points of view of the optimization of the reading performance and the adaptation to the object's attributes. Few studies, however, have concerned reaching among individuals with mental retardation. Eight right-handed individuals with mental retardation reached for two types of glasses, one empty and the other filled with water. We translated the position of the index finger into X-Y-Z coordinate values and examined movement time, length of trajectory, and tangential velocity under the empty and filled conditions. There was no difference between conditions on any of the variables thought in many studies for individuals without mental retardation to indicate differences between attributes. This suggests that the present individuals with mental retardation might have difficulty in using information or context for planning movement and in optimizing their reaching movement for different conditions.

Adult↗
PubMedDate not supplied

Weight survey on adult persons with mental retardation living in the community.

Prevalence of underweight and obesity were investigated in 282 mentally retarded persons living on the West Coast of Norway. Data collected in this survey suggest that people with severe mental retardation were more likely to be underweight and people with mild mental retardation were more likely to be obese. Compared to persons of average intellectual levels, persons with mental retardation were found to be over-represented with both underweight and obesity. Food refusal and self-induced vomiting was more present among persons regarded as underweight and reduced control of food intake was related to obesity. Findings suggest that behavioral variables may have explanatory value with respect to both underweight and obesity. Further investigation using functional analysis of behavior is recommended.

Adult↗
PubMed1995

Zimmermann-Laband syndrome in a patient with severe mental retardation.

Zimmermann-Laband syndrome in a patient with severe mental retardation: The Zimmermann-Laband syndrome (ZLS) is a rare autosomal dominant disorder characterized by gingival hyperplasia or fibromatosis, various skeletal anomalies including dysplasia of the distal phalanges of thumbs and halluces, vertebral defects, and hepatosplenomegaly. Thus far, 23 cases, including 11 patients from 2 families, have been reported. Most cases of ZLS have a normal intelligence although some cases are mildly retarded. Differential diagnosis includes other causes of gingival hyperplasia. We report on a patient with ZLS and severe mental retardation and review the literature. We conclude that severe mental retardation is a feature of the syndrome.

Abnormalities, Multiple↗
PubMed1994

Milestones in the history of mental retardation.

This article is an overview of notable events in the history of mental retardation covering various epoch--Antiquity, Dark and Middle Ages, Renaissance, Reformation and the ensuing centuries to the present era. Society's attitude toward mental retardation is based on its needs, expectancies and social consciousness which frequently change. The plight of individuals with mental retardation had its nadir and acme; from abject treatment less than humane to recognition as rightful members of society. Nevertheless, there are still practices that restrict integration of the mentally retarded into the mainstream of society. Hopefully, these barriers will be broken down. This, however, will be contingent upon society's deference towards the inherent dignity of all men.

Education of Persons with Intellectual Disabilitie↗
PubMed2000

Motor task persistence of children with and without mental retardation.

Task persistence by 31 children with and without mental retardation during two challenging motor tasks was investigated. We used a 2 (group) x 2 (gender) MANOVA to analyze trials and seconds per trial. A main effect was found for group affiliation: Children without mental retardation attempted more trials over three sessions. No significant differences were found for seconds per trial, which indicated that all study participants experienced a comparable level of failure in regard to seconds completed before failure. Findings support the hypothesis that children with mental retardation are less persistent at challenging motor tasks than are peers without disabilities. These findings have both theoretical and practical implications.

Child↗
PubMed2004

Molecular diagnosis and genetic counseling for fragile X mental retardation.

The fragile X syndrome is the most frequent cause of inherited mental retardation. It is caused by a dynamic mutation: the progressive expansion of polymorphic (CGG)n trinucleotide repeats located in the promoter region of the FMRI gene at Xq27.3. The cloning of the FMRI gene and the elucidation of the molecular basis of the fragile X syndrome is of great importance for the diagnosis and understanding of this unusual type of mutation. Although extensively studied, the mechanism behind the transition from stable normal (CGG)n alleles to the carrier state (an unstable premutation) and from premutation to mutation is partially understood. The clinical diagnosis of fragile X mental retardation (FXMR) is not possible as dysmorphic features are subtle. Molecular diagnosis by Southern Blot is the confirmatory test that makes carrier detection and prenatal diagnosis possible. As the risk of recurrence of FXMR is high in the family and carrier relatives, an identification of fragile X positive children, and offering carrier detection and prenatal diagnosis to the families is very important. It is possible by screening mentally retarded children and adults even if there is no family history of mental retardation or typical behavioral or physical features associated with the fragile X phenotype. In this review we have discussed the method for the diagnosis and counseling of the families. The complexities due to premutation and the variable severity of manifestations in carrier females need to be understood while counseling fragile X families.

Animals↗