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Though widely reported in the general population, pathological jealousy has not previously been reported in an individual with a mental handicap. We describe the case of a 39-year-old man with a borderline mental handicap and an abnormal premorbid personality who demonstrates the condition.
In a retrospective study of hospital records over a 50-year period, data on 32 patients who died as a result of intestinal obstruction are presented and compared with comparison groups and national mortality statistics. There was a higher incidence and lower mean age at death of fatal intestinal obstruction compared with the total national population. The mean age at death significantly increased over the study period. Intestinal volvulus was a common cause of obstruction particularly in those with cerebral palsy. There was a high prevalence of chronic constipation and megacolon. Foreign-body obstruction was de facto related to pica, but overall, there was a low prevalence of pica. Overall, mean IQ was low, but only significantly so in the male subjects. The length of acute illness was short; in 22 patients it was less than 24 h. Vomiting and abdominal distension were often absent and abdominal signs were recorded only in five patients. Pain or distress was recorded in only nine patients. Only eight patients were correctly diagnosed before death and only two had surgery. The results suggest that fatal intestinal obstruction is more common in mentally handicapped people and chronic constipation and megacolon are risk factors. Intestinal obstruction in mentally handicapped people can present late and with deceptively minimal signs and symptoms.
A representative sample of 260 Polish children, aged 5-14 years, identified between 1964 and 1965 in an epidemiological study as severely mentally handicapped (IQs ranging from 0 to 51) were followed up twice: (I) after 10 years (in 1975-1976); and (II) after 23 years (in 1987-1988). At both follow-ups, all surviving subjects were contacted, and psychological and sociological data were gathered; the findings presented here pertain mostly to follow-up II. The great majority of subjects (85%) lived with their families, and the remainder resided in an institution. Only 10% of subjects (living with one exception in families) currently had a higher level of intellectual functioning than that of severe mental handicap. Among this group were individuals of relatively better health, without speech disorders, who had attended schools, had some vocational training, had been or were employed, and had families of their own, i.e. were self-dependent with a life-style similar to that of other people of their age and social background. Of the remainder, about 40% retained the same relative level of intellectual and social functioning, and about 50% deteriorated, particularly those in institutions. This latter group has remained in the role of permanent children, depending on others for care and maintenance.
We examined serum-free carnitine (SFC) concentrations and serum acylcarnitine (SAC)/SFC ratios in 40 severely handicapped patients, aged 2 to 36 years, and 69 age-matched control subjects. SFC levels in the patients treated with valproic acid (VPA) and/or receiving carnitine-deficient elemental diets (ED) were significantly lower, and their SAC/SFC ratios were significantly higher than in the other patients or in control subjects. There were 6 patients whose SFC levels were less than the -2SD level (15.8 +/- 6.7 microM, range 6.3-25.5) of those in control subjects (52.1 +/- 11.5 microM). They had no clinical symptoms of carnitine deficiency such as non-ketotic hypoglycemia, hepatomegaly, muscle weakness or cardiac function impairment, and showed normal transaminase, lipid and ammonia levels. In two cases (SFC = 11.0, 13.4 microM), the ketogenic responses to intravenous administration of fat-emulsion were impaired, but they were restored after D-,L-carnitine supplementation (30 mg/kg/day, po) for 1 month. However, in one case with the lowest SFC level (6.3 microM), the ketogenic responses to fat-emulsion infusion or fasting were normal, and dicarboxylic aciduria was not detected. These results indicate that 1) SFC levels are reduced in handicapped patients receiving VPA and/or ED, although clinical symptoms of carnitine deficiency do not easily develop, 2) some of these hypocarnitinemic cases show a subclinical impairment of hepatic fatty acid metabolism, not always correlated with the degree of SFC reduction, which can be restored by exogenous carnitine supplements, and therefore 3) in patients with acquired hypocarnitinemia, carnitine therapy should be considered, although a low SFC level alone may not imply an immediate indication.
Recent research which examines the effects of mentally handicapped children upon families is reviewed. The studies are grouped into three categories based on the underlying conceptions which appear to guide them. The first category examines which families are most vulnerable to the presumed stress of a mentally handicapped child. The second category emphasises the material and practical problems families experience. The third category stresses the competence of families and describes the resources used to develop coping strategies. Links are drawn between these three categories and to parallel developments in related areas, and implications for future research are discussed.
This paper reports a fine-grained analysis of interaction between 21 mothers and fathers and their young mentally handicapped children. Parent-child dyads were videotaped at home on two occasions with a 'roundabout' toy. The sessions were analysed by means of a detailed coding system which reflected the reciprocal nature of interaction and which attended to sequences of behaviour. Results are reported on short-term stability of various features of communication and comparisons of dyads involving mothers and fathers. Implications of the results are outlined for interventions designed to help parents to teach their young mentally handicapped children.
This paper reviews the current policies and programs of adoption and foster care of handicapped and other "hard-to-place" children in the United States. The results of a survey of 42 States revealed a variety of approaches and attitudes towards recruitment of parents and placement of handicapped children. It is concluded that successful programmes related directly to careful selection of families, to educating the parents and to adequate staff support.
A classical conditioning procedure was used with five profoundly retarded children with multiple handicaps in order to investigate basic learning processes in such children. Their chronological ages ranged from 48 to 108 months and their mental ages from 0 to 5.5 months. The procedure used a sound as the conditioned stimulus, a puff of air to the cornea as the unconditioned stimulus, and eye-blink as the conditioned response. Conditioning was established for the two most developmentally advanced children, and the intermediate pair showed different patterns of orienting response to the conditioned stimulus but no evidence of conditioning. The fifth and most developmentally delayed child did not respond to the stimuli. The extent to which these results can be generalised to the conditioning of profoundly retarded, multiply handicapped children is discussed.
The relationship between the onset of seizures, immunisation dates and degree of mental handicap was reviewed among children with tuberous sclerosis. Profound handicap occurred in those children who had an early onset of seizures. There was no evidence that pertussis vaccine caused additional brain-damage.
Observations were made of people with physical impairments, disabilities and handicaps during a two-month journey in remote, mountainous areas of Nepal where traditional forms of village life have been maintained. Descriptions are given of the types and frequency of visible physical impairments and their distribution according to age, sex and altitude. From descriptions of the activities of impaired people, inferences are made about disability and handicap and their consequences in a traditional society.
From a retrospective epidemiological survey, the prevalence of major mental handicap among seven- to 10-year-old children in the Maritime region of Canada in 1980 was estimated to be 36.5 per 10,000 children. Based on information obtained for 221 of the 307 children ascertained by the survey, prenatal origins dominated (58 per cent), followed by perinatal (10 per cent) and postnatal (4 per cent). No specific cause could be determined for 27 per cent of the children, but 41 per cent of this group had epilepsy and/or cerebral palsy in addition to major mental handicap. Significant differences were found in the causal spectrum between the Maritime region of Canada and regions studied in other developed countries. The results of this survey have implications for planning prevention programs, and for epidemiological surveillance and monitoring of adverse reproductive outcomes.
Fifty-five subjects with epilepsy were identified in the first 36 years of the 1946 birth cohort study. In 37 cases there was neither evident cause for the epilepsy nor associated brain-damage and these are referred to as 'uncomplicated', the rest as 'complicated'. Subjects with epilepsy came from poorer social backgrounds than the rest of the cohort. Mortality for both the complicated and uncomplicated groups was high. The educational and occupational achievements, marriage and parenthood, self-esteem and psychiatric morbidity of those surviving to adult life were compared with individually matched controls drawn from the same population. For the uncomplicated group there was no evidence of handicap at age 26, but 10 years later handicap was evident in this group in the economic sphere and in self-esteem.
This paper reports the results of interviews with 190 parents of severely mentally handicapped children. Questions were asked about parents' satisfaction with the way they were first informed of the child's impairment. Most parents were informed by a doctor, and almost two-thirds were dissatisfied with the first information given. Satisfaction was associated with being told early in the child's life. There was a significant association between the time of telling and the diagnostic condition of the child: parents of children with handicap of no known pathology were more likely to be told during or after the second year of the child's life, while parents of children with Down's syndrome were most likely to be told at birth. The authors discuss ways in which parents can be helped through this difficult time and suggest procedures for breaking the news to parents in a sensitive way.
This article describing the first phase in the development of an assessment scale of nursing-care dependency (NCD) for Dutch demented and mentally handicapped patients focuses on the background to the study and the content validation of the nursing-care dependency scale. The scale aims to characterize the patients' nursing-care dependency as part of the assessment step in the nursing process, and is based on Henderson's 14 human needs. The Delphi technique, using two panels of experts (n = 44), was applied to reach consensus on significant indicators of nursing-care dependency. The experts' reasoning was used to develop criteria for the assessment of nursing-care dependency. Ultimately, the Delphi rounds generated 15 NCD items with their descriptions and item criteria. There was no fundamental difference between the NCD scales for demented and mentally handicapped patients. Nevertheless, there are two versions of the NCD scale because of the need to apply specific concepts in the nursing care of either population. The original Dutch version of the NCD is also available in English and in Norwegian.
The objective of this study was to evaluate the effect of twice-daily oral sprays of 2 ml chlorhexidine (0.2%) and 2 ml stannous fluoride (0.2%) as the sole oral hygiene measure on plaque and gingivitis in handicapped children. 52 institutionalized mentally handicapped individuals (aged 10-26 years) were divided into 4 groups to participate in a 9-week, double-blind, randomized clinically controlled trial, which included a cross-over. For the first 3 weeks, groups 3 and 2 had their mouths sprayed with chlorhexidine and stannous fluoride, respectively. Following a 3-week wash-out interval, groups 1 and 4 were sprayed with chlorhexidine and stannous fluoride, respectively. The alternate groups received a placebo, water. Plaque (PI) and gingival indices (GI) were recorded. Subgingival plaque samples were collected and counts of spirochaetes, motile rods and cocci were taken using darkfield microscopy. By the 9th week of trial, the PI and GI were reduced by 48% and 52% for the stannous fluoride group. In the chlorhexidine group, reductions of 75% (PI) and 78% (GI) were achieved. Pair-wise comparisons of placebo, stannous fluoride and chlorhexidine using the U-test of Mann-Whitney revealed significant (p less than 0.05) differences for both PI and GI scores in the placebo/stannous fluoride and placebo/chlorhexidine pair by the 9th week of the trial. In the stannous fluoride/chlorhexidine pair, only the PI was significantly reduced for those on chlorhexidine. Coccoid cells were more dominant at sites with low PI and GI scores (stannous fluoride and chlorhexidine groups), while spirochaetes and motile rods were more frequent at sites with high PI and GI scores (placebo group).
Caries, periodontal disease, oral hygiene and treatment needs were assessed in a group of handicapped adults. The study group comprised 199 individuals aged 17-64 yr, most of whom were mentally subnormal. The mean DMFT values ranged from 17.4 in the 17-24-yr-old age group to 26.9 in the 55-64-yr-old age group. Tooth loss increased rapidly with advancing age. In all age groups the F component was less than 20% and high numbers of untreated carious lesions were found. Of the group studied, 90% needed some conservative treatment. Oral hygiene was poor and a high prevalence of periodontal disease was found. Of the dentulous persons, 49% needed scaling and 34% complex periodontal treatment. The percentage of study group patients requiring dental treatment was very high, so that it can be concluded that dental care for the handicapped is insufficient. This situation must be improved and a suitable system for the delivery of preventive measures must be devised for this group of the population.
Treatment needs for caries, periodontal disease and dentures were assessed in 194 handicapped persons attending three institutions for the handicapped in Cork, Ireland. Criteria and methods of assessment used were those employed in the recently completed National Survey of Childrens' Dental Health in Ireland, which were based on (WHO) Oral Health Surveys--Basic Methods. The need for extractions and complicated restorations was highest in older patients, whilst the removal of sub- and supragingival calculus was the most common periodontal treatment need. Treatment was completed for 130 patients by final year dental undergraduates or junior hospital staff (primary care), while the remaining 64 were treated by consultant staff (secondary care).
In a unselected series of children born in 1959--70 with severe mental retardation (MR)---defined as IQ less than 50---in a Swedish county, the incidence, prevalence, gestational length, birth weight and associated CNS handicaps were analysed. The cumulative incidence at 1-16 years of age was calculated at 3.3% and the prevalence at 11-16 years at 2.8%. These figures were lower than in most other previous studies. In the great majority of cases the pathogenesis was of prenatal origin. The mean gestational lengths and birth weights were decreased compared with those of an average Swedish population. Severe MR affected large and small for date babies more often than could be expected. On the other hand, babies, with a low birth weight, appropriate for gestational age, and with an uncomplicated history, were found not to run a special risk of severe MR. Among the 122 children, 42% had one or more associated CNS handicaps---epilepsy (30%) and cerebral palsy (18%) being the most common.