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Neuroleptics and epilepsy in mentally handicapped patients.

A retrospective investigation of mentally handicapped inpatients showed that neuroleptic treatment did not precipitate fits in patients without a past history of convulsions when low to moderate dosages were used. However, neuroleptic treatment did increase the number of fits in certain patients with a history of epilepsy who were receiving inadequate anticonvulsant medication or whose fits were poorly controlled despite adequate anticonvulsant levels. Guidelines for clinical practice drawn from these findings are presented.

Adult↗

Patterns of use of a mental handicap register in its first 5 years.

After its first 5 years in full operation, the requests for information made to a mental handicap register were examined. It was found that the register had been used extensively by a large number of people requesting a variety of information, both statistical and personal, relating to groups and individuals, and used both to gain an increased understanding of the present situation and to plan for change. Questionnaires sent to those people who had used the register in the first 6 months of 1985 revealed a high level of satisfaction with the register's ability to provide the information they requested. The uses and limitations of the register are discussed.

England↗

The syndrome of mental handicap, cataracts, muscle wasting and skeletal abnormalities: report of a second case.

A severely mentally handicapped Caucasian male with cataracts, deafness, distal muscle wasting and skeletal abnormalities, including calcification of the pinnae, is described. The findings in this patient strongly resemble those in a male described in 1982 by Primrose, and it suggested that this unusual pattern of abnormalities constitutes a discrete entity, which we propose should be known as 'Primrose syndrome'.

Adult↗

Neuropathology and clinical practice in mental handicap.

Neuropathological examination of post-mortem material in cases of mental handicap may give valuable clues to aetiology, natural history and the effects of long-term medication. The dating of neuropathological changes may have implications for treatment and parental counselling. A coordinated procedure to obtain such information in a routine manner is recommended. Feedback to nursing and medical staff underlines the importance of this work. Such a procedure has been instituted in Ely Hospital and the results from the first 12-month period are reported.

Adolescent↗

Adults who are mentally handicapped and living with their parents: satisfaction and perceptions regarding their lives and circumstances.

This study describes the circumstances of 12 adults who are mentally handicapped who are residing with their parents. The results are derived from a content analysis of interviews. The analysis explores the reliability of a procedure for rating people's satisfaction. It also investigates people's views regarding the following: money, cooking, laundry, shopping, cleaning, home, neighbours, friends, support, interests and the ATC.

Activities of Daily Living↗

Self-injurious behaviour in people with mental handicap: a total population study.

A survey of self-injurious behaviour in people receiving services for mental handicap was carried out in one health region. Six hundred and sixteen adults and children were found to have engaged in self-injurious behaviour sufficient to have caused tissue damage in the previous 4 months and 596 of these were screened. Half were resident in hospital while 28% were in non-hospital residential care and the remainder (21%) were living at home. Nearly one-fifth (19%) showed self-injurious behaviour, of one or more types, at a rate of at least once per hour and a further 13% wore protective or restraining devices for all or part of the day or night. Only 2% were enrolled on formal psychological treatment programmes but nearly half were receiving psychotropic drugs (excluding anticonvulsants).

Adolescent↗

Folate metabolism and problem behaviour in mentally handicapped epileptics.

Two groups of mentally handicapped residents were studied consisting of 32 epileptics on anti-epileptic medication and 32 non-epileptic controls. The epileptic group showed a significantly low serum folate level compared with the non-epileptic control group. Serum vitamin B12 and behaviour rating did not show any significant difference between two groups. Comparison of patients receiving phenytoin and those who were not showed significantly lower serum folate in the sub-group receiving phenytoin, but there was no significant difference between the sub-groups with respect to vitamin B12 or behaviour problem rating.

Adolescent↗

Research on mental handicap, 1957-1987: a selective review.

Some of the major advances in research over the last 30 years are outlined. While primarily offering an account of the behavioural sciences as applied to this field, some attention is devoted to major biomedical findings which have revolutionized our potential for preventive action. Mental handicap research has been a powerful influence in changing practices.

Behavior Therapy↗

The biochemical approach to mental handicap: 30 years of achievements and disappointments.

In the past half century, biochemistry has emerged as an independent discipline that provides essential and fundamental information for medical science. It has an increasingly important role in various branches of medicine and the biochemist is frequently called upon to apply his expertise to the solution of clinical problems, amongst them the role of biochemical disturbances in the aetiology of disorders associated with mental handicap, and the investigation of factors affecting their severity and clinical course. The expectation has been that the understanding of biochemical defects will lead promptly to the suggestion of remedies.

Brain Diseases, Metabolic↗

Leaving home: the experience of people with a mental handicap.

Open-ended interviews were conducted with 12 people with a mental handicap who had left parental homes in order to live as tenants in community residential hostels. Parents and hostel staff were also interviewed. The nature of life in the family home, and the tenant's role in the move, reasons for leaving home and expectations for the future were explored. It was found that social life, autonomy and opportunities to develop self-help skills had been limited at home. The tenants who had the widest social experience and the greatest use of self-help skills at home were the most active in changing their situation. Tenants hoped to gain more freedom by leaving home, although they were also in agreement with parents and staff about the value of learning new skills.

Activities of Daily Living↗

Criterion-related versus non-criterion-related prompt training with severely mentally handicapped children.

Thirty-three severely mentally handicapped children were involved in a study to evaluate the effectiveness of three training programmes in teaching visual discriminations. Three matched sets of subjects each received both a size and an intensity discrimination with either: (1) size prompting; (2) intensity prompting; or (3) no prompting (trial-and-error training). The prompted groups therefore received both criterion-related (CR) and non-criterion-related (NCR) training. Order of presentation of the discriminations was counterbalanced across subjects. There was a significant main effect of training group with both size and intensity prompting groups making significantly fewer errors than the trial-and-error group (P less than 0.05 in both cases), but not differing significantly from each other. Significant linear trends for increasing errors across CR, NCR and trial-and-error training programmes were found for both the size discrimination (P less than 0.01), and intensity discrimination (P less than 0.05). More children acquired the discriminations when trained with a CR prompt than with a NCR prompt or trial-and-error procedure, and all four children who failed to acquire discriminations with NCR prompts subsequently acquired them when trained with a CR programme. The results are discussed in relation to cue discriminability and theoretical explanations involving overshadowing are considered.

Adolescent↗

Referral of mentally handicapped patients to the psychiatrist: a community study.

In a retrospective study, 98 consecutive psychiatric referrals of mentally handicapped persons living in the community were examined. By far the commonest cause of referral was behaviour disturbance, followed by requests for disposal, placement or respite care. The referring agents were mostly general practitioners and social workers. Factors affecting the pattern of referral such as degree of mental retardation and life events are discussed.

Adaptation, Psychological↗

Neuroleptic-induced parkinsonian side effects in the mentally handicapped.

Sixty-seven neuroleptic-mediated mentally handicapped subjects in a hospital were studied to determine the prevalence of Parkinsonian side effects. A Parkinsonism scale was devised and administered. Sixty-one per cent of the sample had mild to moderately severe side effects. Sex, age, cumulative and current chlorpromazine doses, cumulative and current anticholinergic doses and anti-epileptic medication status did not predict the Parkinsonism scores. Overt brain damage was not a predictor. The difference between the neuroleptic medicated group and neuroleptic free matched controls was highly significant indicating that the Parkinsonian type of movement disorder was related to neuroleptic medication.

Adult↗

The view from Walter's window: social environment and the communicative competence of adults with a mental handicap.

This paper reports on a study of the communicative competence of adults with a mental handicap living in hospital and community settings. One hundred and twenty subjects, half from hospital settings and half from community settings, were assessed on the Communication Assessment profile (CASP). Significant differences were found between the hospital and community groups on pragmatic competence. The communication environment was shown to be an important determinant of pragmatic skills. The implications of this finding are discussed.

Adaptation, Psychological↗

Assessing the understanding of emotional states in a population of adolescents and young adults with mental handicaps.

This study investigated emotional awareness, the recognition and understanding of different emotional states, among a non-clinical population of adolescents and young adults with mental handicaps. While emotional awareness showed a high positive correlation with language comprehension, the results suggest that many of these individuals have specific emotional awareness deficits which are not in line with their language comprehension abilities. This finding suggests that the assessment of emotional awareness would be an important step in the choice of a self-report measure to assess an individual's emotional state.

Adolescent↗

A behavioural intervention for Gilles de la Tourette syndrome in a severely mentally handicapped girl.

This paper describes an attempt to treat Gilles de la Tourette syndrome (GTS) in a severely mentally handicapped girl, using a cue-controlled relaxation technique. Response to treatment followed a pattern frequently found in the general clinical literature. Namely tic frequency decreased during relaxation sessions but there was no generalization of effects outside of relaxation sessions. Pharmacological intervention, using clonidine, also did not reduce tic frequency. However, pimozide proved immediately effective in suppressing tics and this improvement was maintained at follow-up. Medication side effects were noted and implications for long-term treatment of GTS are discussed.

Adolescent↗