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A study of the historical development of nosological conceptions of schizophrenia of children in parallel with the development of pedopsychiatry shows that these conceptions closely follow the lines of adult psychiatry. The description of psychosis-like conditions such as infantile dementia and autism also did not yet lead to a fundamental change in pathogenetic conceptions. There is then described the heuristic approach to considering schizophrenia of children and schizophrenia-like pictures of childhood as a disturbance of adaptation to reality, the development of which can be due to dispositional factors, minimal cerebral lesions acquired in early childhood, and environmental conditions in the sense of a constellatory genesis.
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PMID:[Development of nosological conceptions of child psychoses]. 35 60

The problem of differential diagnosis of childhood schizophrenia versus gross brain pathology is a difficult one. The clinical picture, for instance, of dementia infantalis (Heller's Disease) is indistinguishable from that of schizophrenia (Shaw & Lucas, 1970). The same is true of some major metabolic disorders (Bray,1970). Coexisting neurological and EEG findings for seizures are not helpful since these are often seen in schizophrenia (Bender, 1947; Fish, 1977). Mental retardation may coexist with schizophrenia or any of the other disorders. The following is an unusual case illustration of a child presenting symptoms of schizophrenia, seizures, and retardation without neurological abnormalities. Until his gross anatomical brain pathology was found by neurologic evaluation, he was subjected to the inappropriate treatment of psychotherapy.
J Autism Dev Disord 1979 Mar
PMID:Davidoff-Dyke-Masson syndrome presenting as childhood schizophrenia. 57 29

The total number of adults with Down's syndrome living in Leicestershire, ascertained by widespread enquiry, was found to be 378. Of these, 371 were matched with adults with mental handicap due to other pathologies, on the basis of age, sex, and type of residence. Those with Down's syndrome were found to have a different spectrum of mental disorders from those without the syndrome. In particular, Down's syndrome patients were more likely to have been diagnosed as having depression and dementia; the controls were more likely to have been diagnosed as suffering from conduct disorder, personality disorder, or schizophrenia/paranoid state. The same proportion of each group had been given a diagnosis of autism.
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PMID:Differential rates of psychiatric disorders in adults with Down's syndrome compared with other mentally handicapped adults. 833 Jan 25

We report the neuropathological evaluation of a 24-year-old autistic woman suffering from a residual state of infantile autism and presenting with self-injury behavior since childhood. Her behavior included head-banging, eye-gouging and self-biting. All intended therapeutic measures remained without effect, including high doses of psychotropic drugs. At autopsy, numerous neurofibrillary tangles were found in the perirhinal and entorhinal cortex where they were frequently grouped in nests or clusters. A few neurofibrillary tangles were also observed in the amygdala and in the prepiriform and orbito-frontal cortex. In the cortex, tangles were located in both layers II and III. There were no neuritic plaques or amyloid deposits. Interestingly, neurofibrillary tangles have been described in brains of individuals who had experienced repeated head injuries such as boxers (dementia pugilistica) and soccer players, suggesting that in our case a similar mechanism induced tangle formation and resulted in the loss of selective neuronal populations.
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PMID:Neuropathological observations in a case of autism presenting with self-injury behavior. 175 63

1. Although clinicians have been quick to adopt magnetic resonance imaging (MRI) in the search for brain pathology in psychiatric disorders, the clinical utility of MRI is only now being well defined. 2. Numerous past computerized tomography or post-mortem tissue reports in patients with schizophrenia, affective disorders, dementia, autism, and many other psychiatric illnesses have suggested neuroanatomical substrates for these disorders. However, these techniques have several limitations. 3. The advent of MRI has allowed a high resolution method for examining the brain in vivo. It is important for psychiatrists to know the clinical utility, and the advantages/disadvantages of MR compared with CT. 4. In this article, the authors review the relevant MR literature with some illustrative cases where MRI provided clinically useful information. Recent advances in MRI technology that will have future applications in psychiatry are also discussed.
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PMID:Magnetic resonance imaging in biological psychiatry. 195 87

Rett syndrome consists of a progressive encephalopathy and psychomotor deterioration in young females who have appeared clinically normal until between six and eighteen months of age. The syndrome has incidence similar to that of phenylketonuria and autism in females. It has been widely recognised only since 1983. After six months of age head growth decelerates associated eventually with severe dementia, and autism, apraxia, stereotypic "hand washing" movements and loss of previously acquired skills occurs. Supportive symptoms may include breathing dysfunction, seizures, EEG abnormalities, and growth retardation. Occurrence indicates sporadic new mutations as a cause. The case histories of two patients diagnosed in New Zealand are described.
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PMID:Rett syndrome: case reports and review. 218 54

Rett syndrome is a neurological disorder of females characterized by dementia, autism, movement disorders and an abnormality of respiratory control. A 14-year-old girl with Rett Syndrome underwent spinal fusion surgery under general anaesthesia. No exacerbation of the respiratory control defect with surgery and anaesthesia was observed. Hypothermia, ongoing blood loss and a normal anion gap acidosis were encountered, but were not attributable to features of this disorder.
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PMID:Anaesthesia and Rett syndrome: a case report. 275 49

Children with developmental regression and emerging symptoms of autism have been given a variety of classifications. The authors compare two boys with Heller dementia with six girls with Rett syndrome. They all differed from children with classic autism in that they had normal prenatal and perinatal periods, followed by marked developmental regression, after which they acquired few or no skills. The boys differed from the girls in terms of estimated prevalence, age at onset, stereotypic breathing patterns, midline hand stereotypies, hand and gait apraxia and speech development. It is suggested that these children should be distinguished from those with classic autism, and should be classified as 'pervasive disintegrative disorder, Heller type' and 'pervasive disintegrative disorder, Rett type'.
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PMID:Pervasive disintegrative disorder: are Rett syndrome and Heller dementia infantilis subtypes? 280 42

In a survey study of psychiatric morbidity, based on a representative sample from the Danish mental retardation register, 44 adults with Down's syndrome (DS) were compared with 258 other mentally retarded adults. Assessed by the parameters psychiatric disorder, behaviour problems, neurotic traits, and deviant social interaction, the DS group functioned better on all parameters. However, male and female DS patients were very different, the females constituting a superior well-functioning group while the males had major problems in every area. High prevalence rates of dementia and infantile autism were found in the DS group. General function rapidly decreased with age in DS patients.
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PMID:Psychiatric aspects of Down's syndrome. 297 26

It has been argued that there is an important group of conditions, seen for the first time in late infancy and early childhood, which are both remarkably persistent and pervasive in their influence on cognitive and social development. They combine features of childhood autism, mental retardation and cognitive deterioration and the term 'disintegrative' most precisely characterizes their impact on development. The term 'psychosis' is only usually appropriate in describing the severity of the psychiatric symptoms. In order to avoid confusion with the psychoses or dementia of adult life, the term 'disintegrative disorder of development' may be preferred. While specific pathology is being identified in an increasing number of cases, the combined use of psychiatric and physical diagnostic categories perhaps best serves to draw attention to this important group of disorders. It is likely that, with increasing knowledge, the need for such an interim diagnostic category may become unnecessary.
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PMID:Development, disintegration and dementia. 332 49


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