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Query: UMLS:C0025362 (mental retardation)
 15,878 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Studies in adults have indicated a significant relationship between high serum creatine kinase levels on admission and acute psychosis. However, data on children are sparse. The files of 183 hospitalized children and adolescents (93 boys, 90 girls) with severe psychiatric disorders were reviewed for serum creatine kinase activity on admission, psychomotor agitation, Clinical Global Impression Score, need for intramuscular injection, number of neuroleptic medications and presence of neuroleptic malignant syndrome. Serum creatine kinase levels > 201 IU/ml were considered abnormal. Boys had significantly higher creatine kinase activity than girls. Division of the cohort by diagnosis yielded significantly higher levels in those with schizophrenia, affective disorders and mental retardation. Higher levels were also associated with higher Clinical Global Impression score on admission, use of injections and physical restraint, and nonresponse to neuroleptic medication. There were no cases of neuroleptic malignant syndrome. This first large-scale investigation of serum creatine kinase activity in young psychiatric inpatients shows a significant association between high creatine kinase activity and acute psychosis, similar to that in adults. Furthermore, high creatine kinase levels on admission are predictive of the severity of the psychosis, but are not associated with neuroleptic malignant syndrome. Because psychotic adolescents with high admission creatine kinase levels tend to be nonresponders, clinicians should consider the early use of atypical antipsychotics in this subgroup.
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PMID:Elevated serum creatine kinase activity in adolescent psychiatric inpatients on admission. 986 77

The need to access the internal mental life of a patient during the diagnostic process is essential and is ordinarily accomplished through self-report data during the psychiatric diagnostic interview. Because of cognititve and verbal limitations, persons with mental retardation, however, are ill-equipped to fully participate in the psychiatric interview. The ability of projective tests to access the patient's inner mental life provides a very helpful diagnostic aid, especially for persons with mental retardation. Psychologists may erroneously assume that such patients may not be able to comply with the testing format. This article addresses the literature on this subject, as well as providing new research data on the use of these instruments from a psychiatric clinic population, and presenting relevant case examples. The Rorschach is especially useful in identifying psychotic processes and thought disorder in persons with mental retardation. The Rorschach and Thematic Apperception Test are also useful in providing generalized treatment planning, but also in identifying problems in aggression and sexually aberrant behavior. Guidelines for using projective tests will be given, as well as recommendations for the psychological evaluation of persons with mental retardation presenting with psychiatric disorder.
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PMID:Use of the Rorschach and Thematic Apperception Test in Persons With Mental Retardation. 1032 Apr 8

The identification of psychotic features in persons with mental retardation is challenging as the presence of hallucinations and delusions are disclosed through verbal self-report. In persons with mental retardation, self-report data is limited in utility because of the neuropsychological impairments that are uniformly reflected in limited communication and linguistic functions. Two major areas of misdiagnosis occur when interpreting reported hallucinations and delusions. First, the patient with mental retardation may experience a true hallucination or delusion, the content of which is very bizarre or disjointed, leading clinicians to identify schizophrenia or psychotic disorders when the condition is far less severe. Second, the patients's reported phenomena are not true hallucinations or delusions, but are instead self-talk, imaginary friends, or fantasy, similar to normal coping mechanisms of children. Mental health professionals must give priority to vegetative symptoms and mood states during the diagnostic assessment. It is also recommended that multiple sources of caregiver data be collected and that psychological projective testing be used as part of the evaluation process. Further, a false-positive strategy should be adopted when initiating treatment, favoring underdiagnosis of psychotic disorders.
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PMID:The Misdiagnosis of Hallucinations and Delusions in Persons with Mental Retardation: A Neurodevelopmental Perspective. 1032 Apr 11

Reports on use of electroconvulsive therapy (ECT) in persons with mental retardation (MR) and mental illness are meager. We describe the successful use of ECT in the management of medication-resistant mental illness in persons with mental retardation. Details of the treatment of five patients with MR and psychotic disorders are reported. ECT was successful after the failure of adequate trials of traditional pharmacotherapy. Persons with MR did not have disproportionate adverse effects of ECT as a consequence of the MR. Four of the five cases reported received maintenance ECT. ECT should be considered in the affective and psychotic disorders occurring in persons with MR when traditional pharmacotherapy fails.
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PMID:Electroconvulsive therapy and mental retardation. 1037 53

Nonconvulsive status epilepticus (NCSE) is characterized by behavioral or cognitive change from baseline for at least 30 minutes with EEG evidence of seizures. Categorized into complex partial status epilepticus (with lateralized seizures), and generalized nonconvulsive status epilepticus (bilateral diffuse synchronous seizures), there is debate regarding the diagnosis and morbidity of NCSE. Because EEG is needed for diagnosis, only a high index of suspicion leads to a request for the study, whereas EEG is often unavailable after hours or on weekends. Furthermore, the cognitive changes during NCSE are often incorrectly ascribed to a postictal state, intoxication, psychogenic or psychotic states, and mental retardation. Regarding categorization, present classifications address EEG features but fail to distinguish among depths of coma. Deeply comatose patients (with coma etiologies that themselves carry poor prognoses) are mixed with lightly obtunded patients with no morbidity, confusing the prognosis. Thus, a classification that subsumes depth of coma, and possibly etiology, is sorely warranted. Regarding treatment, comatose NCSE patients treated with benzodiazepines may worsen, whereas generalized nonconvulsive status epilepticus patients may suffer iatrogenically from aggressive treatment (hypotension and respiratory depression) necessitating balancing the potential neurologic morbidity of NCSE against the possible morbidity of IV antiepileptic drugs. A high index of suspicion is needed to initiate EEG studies. Better stratification of level of consciousness will be needed to distinguish among morbidity due to underlying conditions, treatment, and the effects of status epilepticus, proper.
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PMID:Assessing the outcomes in patients with nonconvulsive status epilepticus: nonconvulsive status epilepticus is underdiagnosed, potentially overtreated, and confounded by comorbidity. 1047 7

Using a database of all Missouri insanity acquittees committed on July 1, 1997 (N = 873) and all insanity acquittees unconditionally released from 1986 through 1997 (N = 193), this study calculated the lengths of commitment and identified variables associated with the unconditional release of insanity acquittees from indefinite commitment by the mental health and criminal justice systems. The study found that 85 percent of insanity acquittees were still under commitment 5 years after acquittal and 76 percent 10 years after acquittal. Factors that decreased the odds of being unconditionally released included never having been married; having a psychotic disorder, a mood disorder, a substance abuse disorder, or mental retardation/borderline intellectual functioning; and having committed a serious crime. These results support achievement of the intended goal of Missouri's insanity acquittee statute, which is to maximize public safety considerations, but have had the unintended effect of increasing the inpatient insanity acquittee population, resulting in fewer resources for voluntary patients.
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PMID:The unconditional release of mentally ill offenders from indefinite commitment: a study of Missouri insanity acquittees. 1063 84

Norrie disease is an X-linked recessive disorder characterized by congenital blindness and in some cases mental retardation and deafness.(1) The variability of signs among patients often complicates diagnosis. Signs such as an ocular pseudoglioma, progressive deafness, and mental disturbance are considered classic features.(2) Only one third of patients with Norrie disease have sensorineural deafness, and approximately one half of the affected individuals exhibit mental retardation, often with psychotic features.(3) Histologic analysis has suggested that retinal dysgenesis occurs early in eye development and involves cells in the inner wall of the optic cup.(4) The gene associated with Norrie disease was identified in 1992. (5,6) We report a novel mutation identified in a patient in whom Norrie disease was diagnosed.
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PMID:A novel mutation in the Norrie disease gene. 1077 14

New hopes for cloning susceptibility genes for schizophrenia and bipolar affective disorder followed the discovery of a novel type of DNA mutation, namely unstable DNA. One class of unstable DNA, trinucleotide repeat expansion, is the causal mutation in myotonic dystrophy, fragile X mental retardation, Huntington disease and a number of other rare Mendelian neurological disorders. This finding has led researchers in psychiatric genetics to search for unstable DNA sites as susceptibility factors for schizophrenia and bipolar affective disorder. Increased severity and decreased age at onset of disease in successive generations, known as genetic anticipation, was reported for undifferentiated psychiatric diseases and for myotonic dystrophy early in the twentieth century, but was initially dismissed as the consequence of ascertainment bias. Because unstable DNA was demonstrated to be a molecular substrate for genetic anticipation in the majority of trinucleotide repeat diseases including myotonic dystrophy, many recent studies looking for genetic anticipation have been performed for schizophrenia and bipolar affective disorder with surprisingly consistent positive results. These studies are reviewed, with particular emphasis placed on relevant sampling and statistical considerations, and concerns are raised regarding the interpretation of such studies. In parallel, molecular genetic investigations looking for evidence of trinucleotide repeat expansion in both schizophrenia and bipolar disorder are reviewed. Initial studies of genome-wide trinucleotide repeats using the repeat expansion detection technique suggested possible association of large CAG/CTG repeat tracts with schizophrenia and bipolar affective disorder. More recently, three loci have been identified that contain large, unstable CAG/CTG repeats that occur frequently in the population and seem to account for the majority of large products identified using the repeat expansion detection method. These repeats localize to an intron in transcription factor gene SEF2-1B at 18q21, a site named ERDA1 on 17q21 with no associated coding region, and the 3' end of a gene on 13q21, SCA8, that is believed to be responsible for a form of spinocerebellar ataxia. At present no strong evidence exists that large repeat alleles at either SEF2-1B or ERDA1 are involved in the etiology of schizophrenia or bipolar disorder. Preliminary evidence suggests that large repeat alleles at SCA8 that are non-penetrant for ataxia may be a susceptibility factor for major psychosis. A fourth, but much more infrequently unstable CAG/CTG repeat has been identified within the 5' untranslated region of the gene, MAB21L1, on 13q13. A fifth CAG/CTG repeat locus has been identified within the coding region of an ion transporter, KCNN3 (hSKCa3), on 1q21. Although neither large alleles nor instability have been observed at KCNN3, this repeat locus has been extensively analyzed in association and family studies of major psychosis, with conflicting findings. Studies of polyglutamine containing genes in major psychosis have also shown some intriguing results. These findings, reviewed here, suggest that, although a major role for unstable trinucleotides in psychosis is unlikely, involvement at a more modest level in a minority of cases cannot be excluded, and warrants further investigation.
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PMID:The unstable trinucleotide repeat story of major psychosis. 1081 8

There is a now a substantial body of evidence that suggests the new antipsychotic agent, risperidone, may be safe and effective for treating psychotic, affective or behavioural symptoms associated with various disorders other than schizophrenia, schizophreniform disorder or schizo-affective disorder. These conditions include bipolar disorder, obsessive-compulsive disorder, Tourette's syndrome, dementia, Lewy body disease, mental retardation, Parkinson's disease, idiopathic segmental dystonia and organic catatonia. Although much of the data is anecdotal or in the form of open studies, there is now emerging a small number of well controlled investigations supporting efficacy for mania, dementia, behavioural disturbance in mental retardation and conduct disorder. Conventional antipsychotics have long been used, either in a primary capacity or as an adjunct to treat these disorders; however, they have limited benefit, pose significant risks of extrapyramidal side-effects, and may cause the potentially life-threatening neuroleptic malignant syndrome. In contrast, risperidone at the recommended low doses may be efficacious and pose reduced risk of motor side-effects. This article reviews the evidence that risperidone may be an effective new treatment for disorders other than schizophrenia.
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PMID:Does risperidone have a place in the treatment of nonschizophrenic patients? 1119 55

The paper describes a case of neurocutaneous melanosis (NM), with mental retardation, chronic psychosis, and epilepsy possibly due to a temporal focus. This is the first report of NM associated with a severe and chronic psychosis. It is likely that such an association has not previously been described because of the ominous prognosis of most cases of NM with early involvement of the central nervous system.
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PMID:Neurocutaneous melanosis and psychosis: a case report. 1128 85


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