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PubMed2000

Evaluating the effectiveness of progressive muscle relaxation in reducing the aggressive behaviors of mentally handicapped patients.

This article reports the results of a study on the evaluation of the effectiveness of muscle relaxation training in reducing aggressive behavior in mentally handicapped patients (MHPs). A pretest and posttest study design was used. Findings showed that there was a reduction of 14.7% of aggressive behavior in the subjects after the muscle relaxation training. Muscle relaxation training appeared to be effective in reducing the frequency of some aggressive behaviors. The strengths and limitations of using muscle relaxation training in reducing aggressive behaviors are discussed.

Adolescent↗
PubMedDate not supplied

Validity of the mania subscale of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II).

We attempted to establish the internal consistency and validity of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) to screen for the presence of mania (bipolar disorder) in severely and profoundly mentally retarded adults, Subjects included 22 individuals residing in a large developmental center in Central Louisiana. The Mania subscale of the DASH-II was internally consistent. Additionally, the DASH-II could be used to accurately classify manic and control individuals. Specific items on the subscale were examined to identify those items most associated with a diagnosis of mania.

Adult↗
PubMedDate not supplied

Characteristics of stereotypic movement disorder and self-injurious behavior assessed with the Diagnostic Assessment for the Severely Handicapped (DASH-II).

The first experiment involved 143 individuals with severe and profound mental retardation. Individuals with Stereotypic Movement Disorder, Self-Injurious Behavior (SIB), and Stereotypic movement disorder with self-injurious behavior as assessed by the Diagnostic Assessment for the Severely Handicapped-II DASH-II were validated against Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) criteria. In a second study DASH-II scores for 1480 individuals with severe and profound mental retardation were compared on demographic variables, core and associated features of each disorder. Characteristics of persons in each group were reviewed. Persons with profound mental retardation were more likely to evince stereotypies or self-injury compared to their severely impaired counterparts. Also, those with stereotypies were more likely to present with Pervasive Developmental Disorder (PDD)/autism, organicity, and eating disorders, while persons with SIB were more likely to evince sleep, sexual, and eating disorders.

Adult↗
PubMedDate not supplied

Characteristics of depression as assessed by the Diagnostic Assessment for the Severely Handicapped-II (DASH-II).

Fifty-seven individuals with severe and profound mental retardation (18 with a DSM-IV diagnosis of depression, 19 with a Diagnostic Statistical Manual, 4th edition diagnosis of autism, and 20 who meet no criteria for an emotional disorder) were studied. The validity of the Diagnostic Assessment for the Severely Handicapped II depression subscale was evaluated to determine its value in categorizing individuals in these two groups. Suggestions were made for diagnosing depression in persons with severe and profound mental retardation. In a second study the above individuals were compared on symptomology to assess comorbidity with related symptoms. These "core," peripheral, or associated features of depression were identified. Implications of the findings for describing and defining depression in these persons are discussed.

Adult↗
PubMed2000

Voice handicap index change following treatment of voice disorders.

Outcome measurements of voice disorders is an important new area for both the evaluation of voice-disordered patients and evaluation of treatment efficacy. The Voice Handicap Index (VHI) measures the patient's perception of the impact of his or her voice-disorder. The VHI was used in this study to measure the changes of the patient's perception following treatment for four different voice disorders. The VHI showed a significant change following treatment for unilateral vocal fold paralysis, vocal cyst/polyp, and muscle tension dysphonia. Results of this paper indicate that the VHI is a useful instrument to monitor the treatment efficacy for voice disorders.

Disability Evaluation↗
PubMed2000

Revision of the International Classification of Impairments, Disabilities, and Handicaps: developmental issues.

Variability in approaches to define and classify disability has constituted persistent problems in documenting the epidemiology of disability and providing appropriate services. The major institutions of health care, mental health, and welfare often have separate systems of classification and terminology related to defining eligibility for programs and funding for services. In 1980, the International Classification of Impairments, Disabilities and Handicaps-ICIDH was published by the World Health Organization as a companion document of the International Classification of Disease to document the consequences of illness or injury. Current problems concerning the classification of childhood disability in health, education, and related services have resulted in growing interest in the revision of the ICIDH as a classification tool. The strengths and limitations of the ICIDH are examined in general, as well as with specific reference to its ability to document the nature and epidemiology of childhood disability. This paper (1) describes the ICIDH taxonomy and representative contributions; (2) reviews issues and concerns contributing to its revision; (3) summarizes changes in the revised ICIDH2 draft document, and (4) identifies issues of particular relevance to children and public health applications.

Activities of Daily Living↗
PubMed1998

[A new look at dyslexia-dysorthography. Plea for an early recognition of that handicap].

Dyslexia is a primary development disorder characterized by reading and writing disability. Although frequent, it remains underdetected at school and badly known by practitioners. As a consequence, many children remain severely handicapped in their school life, and later on in their adult social life, although being fairly intelligent. Pediatricians must be involved in its early detection and management. ERTL4 test is a useful test of detection to be applied in 5-7-year-old children.

Adult↗
PubMed1988

Abnormal antepartum fetal heart rate patterns and subsequent handicap.

In this paper data on abnormal antepartum FHR patterns are related to the state of fetal oxygenation, fetal brain abnormalities and to neurological outcome. It is concluded that in IUGR fetuses changes in heart rate (and movement) patterns are late signs of impairment. Antepartum heart rate decelerations are usually the first of the abnormalities detected and are associated with fetal hypoxaemia. A fixed or flat FHR pattern might be indicative of congenital malformations of the brain or of prenatally acquired encephalopathy. Several studies have shown that antepartum FHR abnormalities (usually late decelerations) are associated with an increased risk of subsequent handicap. This risk is related to the degree of FHR abnormality, and especially applies to infants born preterm and/or growth-retarded. Late (ante partum) FHR decelerations seem to be more important than 'asphyxia' at birth in determining (neonatal) neurological outcome. In IUGR hypoxaemia is probably associated with deprivation of other nutrients, and thus brain damage in these infants is more likely to be due to chronic malnutrition (including hypoxaemia) than to hypoxaemia alone. This reasoning is supported by morphological findings in IUGR infants. In general fetuses should be delivered before antepartum signs of hypoxaemia appear. Doppler blood--velocity waveform analyses of fetal vessels may detect fetuses at risk for antepartum decelerations, but until now there has been insufficient information about false-positive abnormal velocity waveforms to depend absolutely on these. Furthermore, delivery at an earlier age may increase the risk of other neonatal complications.

Brain↗
PubMed1989

Recent experience in the control and management of tuberculosis in a mental handicap hospital.

Sixteen cases of tuberculosis (14 in inmates, only one of whom was female) occurred in a mental handicap hospital of some 400 inmates during the period 1973-85. This represents an annual incidence of 269 per 100,000, substantially higher than that in the surrounding community. In 1980, 29% of inmates had Grade 3 or 4 positive Heaf tests. Widespread chemoprophylaxis was successfully undertaken in 1980/81, the only problem encountered being interaction of isoniazid with carbamazepine. One Down's syndrome patient had recurrent disease, and a second developed disease despite chemoprophylaxis. Immunological investigation of a small number of Down's syndrome patients with tuberculosis showed no consistent defect.

Adult↗
PubMed1989

Patterns of impairment and disability related to social handicap in young people with cerebral palsy and spina bifida.

This paper explores the inter-relationships between impairment and disability in a sample of 119 teenagers in relation to their psychological adjustment and quality of social life. Poor psychological adjustment and extreme social isolation are associated not so much with individual functional limitations as with particular configurations of impairments and disabilities. It seems that social handicap is not a direct consequence of any impairment or disability but arises generally from severe functional loss and is shaped by dependency on others, restricted choices, physical barriers and adverse reactions of others.

Activities of Daily Living↗
PubMed1977

Psychiatric disorder in an adult training centre and a hospital for the mentally handicapped.

Seventy-five mentally handicapped adult individuals attending a training centre were compared with 75 adult patients in a mental subnormality hospital using a standardized psychiatric interview. Ten of the individuals at the training centre were rated in the pathological range for overall psychiatric disturbance compared with 23 patients in hospital. Details are presented for the various psychiatric symptoms.

Adult↗
PubMed1986

Behaviour problems in severely mentally handicapped children.

A population study was undertaken in two health districts of children with severe mental handicap. Prevalence figures for behaviour problems are presented. A stratified random sample of 200 families was drawn from the population. Detailed structured interviews were carried out with the children's parents. The children were divided into two groups, comprising those with behaviour problems and those with no problems. There was a significant association between behaviour disorder and incontinence, lack of self-help skills, poor reading, writing and counting skills, and poor communication skills. Environmental correlates were few. There were no differences between groups in family size, birth order, age of parents, marital discord, social class or income. However, behaviour problems were more common in one-parent families. An association was found between maternal stress and problem behaviour. The possible mechanisms underlying this association are discussed.

Adaptation, Psychological↗
PubMed1989

Schizophrenia and mental handicap: an historical review, with implications for further research.

The relationship between schizophrenia and 'mental handicap' has been obscured by historical changes and varying diagnostic criteria. It has been generally accepted that there is an increased incidence of psychotic illness among people with intellectual retardation, but detailed community surveys are limited. Catatonia, severity of illness and research potential are all to be found in this 'dual diagnosis' group. The value of an historical analysis is underlined.

England↗
PubMed1991

Psychometric assessment of psychiatric disorders in people with learning difficulties (mental handicap): a review of measures.

Instruments designed to assess psychiatric disorders in people with learning difficulties (mental handicap) were critically reviewed from a psychometric perspective. Major trends were found in the assessment of psychopathology related to DSM-III and depressive disorders although research in other areas was patchy. Although some psychometrically sophisticated measures were identified the area was characterized by an absence of important psychometric data for many measures. Future research should attend to developing assessments of schizophrenia, psycho-sexual disorders, adjustment disorders and the validation of screening procedures and instrument formats. Future studies should include more people with severe and profound learning difficulties.

Humans↗
PubMed1984

Sudden deaths in the mentally handicapped.

Trends in the incidence and causes of sudden deaths in a hospital group for the mentally handicapped were identified during a 50-year period, and the two halves of the period were compared. There were significantly more deaths in the second 25-year period than in the first. Longevity was greater during the second period, and a decrease in deaths due to status epilepticus was outweighed by an increase in deaths from arterial degenerative disease in the larger number of older patients. In the second period there was also a significant rise in sudden deaths due to asphyxia, probably attributable to modern medication with side-effects giving rise to feeding difficulties.

Adult↗
PubMed1984

Behaviour disturbance and mental handicap: typology and longitudinal trends.

Behaviour disturbance was investigated in mentally handicapped adults who were living in hospital or at home. The first part of the study describes an empirically derived typology of disturbed behaviour patterns and gives the details of a scale by means of which behaviour disturbance can be quantified along six dimensions: aggression, mood disturbance, communicativeness, antisocial conduct, idiosyncratic mannerisms, and self-injury. The second part of the study used the scale in a longitudinal study of behavioural disturbance. Different forms of disturbed behaviour exhibited different kinds of longitudinal stability, and the long-term changes in one aspect of disturbance depended on subjects' other disturbance scores.

Adolescent↗
PubMed1986

A comparison of patterns of disability in severely mentally handicapped children of different ethnic origins.

All severely mentally handicapped children aged 5-19 years from the city of Manchester were identified in a cross-sectional study. A standardized Disability Assessment Schedule was used to assess the variety and degree of disabilities experienced by each child and by specific subgroups of the children. This paper focuses upon differences between groups of European and Non-European ethnic origin. Boys showed more disabilities than girls in both groups, but non-European children had more severe disabilities in virtually all categories.

Activities of Daily Living↗
PubMed1990

Policy networks and the implementation of community care policy for people with mental handicaps.

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, 'in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great'. This paper examines the extent and causes of this 'implementation gap' in respect of services for people with mental handicaps--a consistent priority group for national policymakers. We examine centre-periphery relations in the health and personal social services in the light of Rhodes' power-dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve.

Community Mental Health Services↗