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Trace metal abnormalities in long-stay hyperactive mentally handicapped children and agitated senile dements.

Gross metal poisoning as a causative factor in mental handicap is now relatively rare although historically it was important. Currently attention is being focused on the importance of chronic metal poisoning, there being much debate on, for instance, the possible effects of low levels of lead on intelligence in childhood. This paper examines the levels of a number of metals, both toxic and essential, in two groups of agitated patients in a long-stay psychiatric hospital in the UK. The two groups examined comprise 'hyperactive' mentally handicapped children and senile dementia patients, all of whom showed moderate to severe agitation. Blood and hair tissue were used to assess the body status of a number of metals and the results were compared with controls matched as closely as possible and from a similar hospital environment. The most significant findings are the raised levels of aluminium in the agitated senile dementia patients and the low levels of zinc and raised levels of lead in the hyperactive children.

Child↗

Auditory brain stem response and electrically elicited blink reflex in handicapped children.

The auditory brain stem response and the blink reflex were studied in 35 handicapped children in order to evaluate brain stem function. The auditory brain stem response and the blink reflex were abnormal in 20 and 16 cases, respectively. Of these, 14 had both auditory brain stem response and blink reflex abnormalities. The prevalence of auditory brain stem response and blink reflex abnormalities was high in severely handicapped children with difficulty in chewing or swallowing. The blink reflex was abnormal in four of 32 sides with a normal auditory brain stem response and 15 of 23 sides with an abnormal auditory brain stem response threshold, which reflects hearing loss or brain stem dysfunction. We conclude that the combined application of these two noninvasive tests is useful not only to delineate the extent of brain stem lesions but also to determine whether or not patients with an abnormal auditory brain stem response threshold have brain stem dysfunction.

Acoustic Stimulation↗

The discharge of mentally handicapped patients to residential care.

The present policy of reducing the number of patients in hospitals for the mentally handicapped involves the discharge of many patients to residential care outside hospital. This paper considers 89 patients discharged from a hospital in the five years 1971-1975. 64 (70%) went to facilities controlled by the Social Services Department, ten to other residential homes, eleven to lodgings and four to other institutions. Thirty five (40%) were subnormal (WAIS Full Scale IQ 55-69); the remainder, an unexpectedly high proportion, severely subnormal (WAIS Full Scale IQ under 55). The majority of the patients discharged were the normal-looking mentally handicapped, few of whom had a specific cause for their condition. The suitability of patients for discharge in relation to the services available was more relevant than their ages or their years in hospital.

Adolescent↗

Residential needs in hospital and the community for mentally handicapped people.

Using successive analyses of hospitalized mentally handicapped people from a geographically defined Welsh catchment area, this article attempts to evaluate changes in cohorts of such patients. It suggests the likelihood that the level of hospital accommodation predicted in the White Paper "Better Services for the Mentally Handicapped" will be sufficient.

Adolescent↗

Ammon's horn or hippocampal sclerosis without epilepsy in mental handicap.

Neuropathological examination of the brain of eight adult mentally handicapped patients showed mesial temporal sclerosis. Three patients had cerebral palsy, one had Down's syndrome, three were retarded, and one had an unspecific mental handicap. Although there was a suspicion of fits in most patients, temporal lobe epilepsy was not diagnosed in life.

Adult↗

Why are the mentally handicapped admitted to hospital? A ten-year survey.

Admissions of mentally handicapped patients over a ten-year period to a hospital group with a catchment area population of 213,000 are described and discussed. During this time, there was a progressive increase in temporary admissions for assessment, day care, and for both planned and emergency respite care. There were also 89 admissions for permanent care associated with conditions such as psychiatric disorder, multiple handicap, and changed family circumstances.

Adolescent↗

Psychiatric disorder in the middle-aged and elderly mentally handicapped.

In a study of 357 long-stay hospital residents aged 40 years and over, 30% had significant psychiatric disorder, while a retrospective survey of 215 new admissions over a seven-year period to a psychiatric unit for the mentally handicapped revealed that 20% of patients were aged 40 years and over. Both similarities and differences were found in the overall pattern of disorders between the two groups and a non-handicapped population in a comparable age-range.

Adult↗

Manic-depressive psychosis in a mentally handicapped person: diagnosis and management.

The diagnosis of manic-depressive psychosis in mentally handicapped people can be easily overlooked, partly because its presentation differs from that in people with normal intelligence. This report illustrates some of the difficulties involved in making the diagnosis of manic-depressive psychosis in a mentally handicapped person and in planning for her future care.

Bipolar Disorder↗

Prevalence of the fragile X syndrome in an institution for the mentally handicapped.

In an investigation to find the prevalence of the fragile X (Martin Bell) syndrome in a mental handicap hospital, chromosomal investigations were carried out in 196 males selected out of a total of 512, and also in 20 female patients who were related to some of the selected males. Fragile X cells were found in 41 of the males and two of the females; in 21 of the males it was associated with macro-orchidism. The overall prevalence in the hospital for males (8.0%) ranks this syndrome next in importance to Down's syndrome as a known cause for mental handicap.

Adult↗

A standardised assessment of personality disorder in mental handicap.

Forty patients with mild or moderate mental handicap were assessed by two psychiatrists using the scale devised by Mann et al, 1981 which describes abnormalities of personality. Analysis by weighted Kappa showed excellent agreement for some items (introversion, hysterical explosive, sociopathic, anankastic and affective). This questionnaire may be useful in the evaluation of personality in the mentally handicapped.

Adult↗

Anticonvulsant medication in a mental handicap hospital: 1972-1982.

The prescription sheets for all patients in a mental handicap hospital on one day in 1972 and on the same date in 1982 were examined to identify trends in anticonvulsant medication over a 10-year period. There was a reduction in size of the hospital population associated with fewer very young and milder handicapped persons. Prescription of anticonvulsants fell slightly during the decade under study with a dramatic fall in the use of phenobarbitone, and a parallel increase in the prescription of carbamazepine. Other changes included the use of sodium valproate in a significant minority of patients and the occasional use of clonazepam in 1982, while phenytoin remained a first-rank anticonvulsant throughout the period under review. The proportions of patients on polytherapy did not change over the 10-year period, though the contribution of phenobarbitone to the combined drug regimes was significantly reduced.

Anticonvulsants↗

A case of affective psychosis following bereavement in a mentally handicapped woman.

Mentally handicapped people are increasingly being subjected to the stresses of everyday life, and bereavement represents a particularly potent stress. This report considers the case of a mentally handicapped woman whose difficulty in mourning and expressing and sharing grief had a profound effect on her recovery from bereavement and led to her developing an affective psychosis.

Affective Disorders, Psychotic↗

Short-cycle manic-depressive psychosis in a mentally handicapped child without family history. A case report.

Diagnosis of classic psychiatric illness in mentally handicapped individuals remains difficult. Manic-depressive illness has previously been reported in both pre-pubertal and pubertal children with a mental handicap and with a family history. This paper reports a case of manic-depressive psychosis in childhood, with no family history, short-cycle mood swings and good response to lithium therapy.

Adolescent↗

Behavioural disorder in the mentally handicapped. The role of life events.

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.

Adolescent↗

Intoxicated by water. Polydipsia and water intoxication in a mental handicap hospital.

A cross-sectional survey of the drinking habits of 877 mentally handicapped in-patients revealed 31 patients (prevalence 3.5%) who, in the opinion of nurses, drank five litres or more daily. Low urine specific gravity was a less useful indicator of polydipsia. Polydipsia appeared to be significantly associated with a borderline level of handicap and with a diagnosis of schizophrenia, autism or severe personality/behaviour disorder. Of five cases of water intoxication associated with polydipsia, one was fatal. In two cases excess drinking improved with increased neuroleptic medication. Lithium and demeclocycline were used in two cases to prevent hyponatraemic episodes.

Adult↗

Systemic lupus erythematosus in a woman with mental handicap.

A woman with a mental handicap developed SLE. This magnified the level of her handicap, and because of her difficulties in giving a history, mildly abnormal results of tests in any one system were dismissed over long periods of time. This resulted in very late diagnosis of a potentially treatable disease.

Adult↗