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

This study was conducted to compare DSM-II and DSM-III in the diagnosis of childhood and adolescent psychiatric disorders. Twenty psychiatrist-raters completed standardized diagnostic questionnaires for 24 actual case histories. This report, the first of four, presents the rater agreement with the "expected diagnosis," ie, the diagnosis that we considered most appropriate for each case. The average rater agreement with the expected diagnosis was less than 50%. It was highest in cases of mental retardation, psychosis, hyperactivity, and conduct disorder. In only five cases did the most common diagnosis of the raters differ from the expected diagnosis. Analyses of these cases and those we selected to present specific diagnostic problems to the raters have produced suggestions to improve the reliability of DSM-III.
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PMID:A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders. I. Agreement with expected diagnosis. 48 78

A case-history format was utilized to compare interrater agreement on childhood and adolescent psychiatric disorders, using DSM-II and DSM-III. The average interrater agreement was 57% for DSM-II and 54% for axis I (clinical psychiatric syndrome) of DSM-III. There was high agreement in both systems on cases of psychosis, conduct disorder, hyperactivity, and mental retardation, with DSM-III appearing slightly better. There was noteworthy interrater disagreement in both systems for "anxiety" disorders, complex cases, and in the subtyping of depression. Overall, the reliability of DSM-III appears to be good and is comparable with that of DSM-II and other classification systems of childhood psychiatric disorders.
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PMID:A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders. II. Interrater agreement. 48 79

Although this article focuses on psychopharmacology, pharmacotherapy is only part of a comprehensive treatment program. Treatment should be individualized to the patient's condition and level of intellectual functioning (e.g., conduct disorder, mental retardation). Clinicians should be acquainted with the Food and Drug Administration's regulations and the Physician's Desk Reference's guidelines. Psychoactive agents should be prescribed judiciously under careful clinical and laboratory monitoring, especially when given on a long-term basis. Knowledge of potential short- and long-term side effects is imperative to minimize impairment (cognitive, sedation) and to maximize achievement of adaptive behaviors. Aggressiveness is a low-frequency behavior and therefore difficult to assess. Aggressiveness with an explosive affective component and rage seems to be more responsive to pharmacotherapy than aggressiveness alone. Children who present with covert conduct disorder symptoms, such as stealing and lying, might not be as responsive to psychoactive agents as the conduct disorder with explosive characteristics. The neuroleptics are considered the standard drugs for the treatment of aggression but sedation and concern over tardive dyskinesia have led investigators to explore and study other classes of drugs. Lithium carbonate has been studied in short-term clinical trials and has been shown to be an effective alternative to the neuroleptics. Carbamazepine and propranolol seem to be promising agents but require further critical assessment in children and adolescents. Stimulants should be considered the first choice of treatment in coexisting conduct disorder and ADHD or in milder forms of aggression. In conclusion, there is a need for systematic investigation of the effectiveness and safety of psychoactive agents in children and adolescents with aggressiveness, explosiveness, and rage outbursts. There is some supportive evidence that some patients with these target symptoms are good responders to certain drugs. Future research should compare pharmacotherapy to psychosocial treatment and the combination of both.
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PMID:The pharmacologic treatment of conduct disorders and rage outbursts. 154 49

A cross-sectional and longitudinal epidemiological study of children institutionalised for psychiatric disorders has been carried out. The differences of discharge distribution allows to describe an entanglement of three differents logics: the medical logic: diagnostic (Emotional and conduct disorder, Mental retardation, Psychosis), etiological organic factors, associated somatic disorder. the social logic: father's occupational level and etiological environnemental factors. the institutional logic: child's age when admitted, institutional categories.
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PMID:Epidemiological study of children institutionalised for psychiatric disorders. 158 3

The purpose of this review has been to examine the hypothesis that the Attention Deficit Hyperactivity Disorder (ADHD), formerly also referred to as the Hyperactive Syndrome or Minimal Brain Dysfunction (MBD), is a precursor of criminality and abuse of alcohol and illicit drugs. This has been done by reviewing findings from follow-ups. Most reviewed projects suffer from methodological weakness. In most materials, few if any of the cases had ADHD according to present criteria. Some had ADHD and conduct problems. Many probably had exclusively conduct problems, but were too young to fulfill the criteria of Conduct Disorder (CD). Methodological limitations of the examined projects have been pointed out. It has been discussed how weaknesses regarding research design might have influenced the results. As a consequence of methodological shortcomings of most projects, the reviewed studies do not give definite answers. However, they show some rather convincing trends. By early adulthood, ADHD appears to remain present in at least one third of the subjects. Subjects with prior ADHD did not have more mental problems than controls in adolescence and early adulthood, provided they had normal intelligence, and no additional disabilities or mental disorders. Those with mental retardation, cerebral dysfunction or psychosis in addition to ADHD have a poor prognosis. A high percent become psychotic, and some end up in institutions. Although there seems to be an increased rate of delinquency and lawbreaking in prior hyperactives compared to controls, these differences disappear when the results are analyzed. The initially impressive differences between cases and controls are probably consequences of bias. Cases with a childhood history of conduct and educational problems have been compared to controls without a history of such problems. Thus, the reported differences are not related to ADHD. Hyperactives without conduct problems do not have an increased frequency of delinquency. Problems of conduct, CD and Antisocial Personality Disorder, but not psychosis characterize cases with a childhood history of conduct problems (with or without ADHD). In subjects with ADHD as well as conduct problems in childhood, conduct problems and not ADHD predict the prognosis, which is worse than for those with CD without ADHD. ADHD combined with delinquency indicates a high rate of subsequent lawbreaking. Usually, cases have more problems than controls with alcohol and illicit drugs, but this might be the consequence of selection of cases (subjects with school and conduct problems) and controls (subjects without such problems).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Follow-ups of children with attention deficit hyperactivity disorder (ADHD). Review of literature. 164 37

Estimates of the prevalence of comorbidity of psychiatric disorders and mental retardation in community and clinical populations range from 14.3 to 67.3 percent. A wide variety of disorders have been reported in this population, including schizophrenia, depression, and, commonly, conduct disorder. The incidence of specific disorders appears to be related to the level of retardation and the concomitant presence of seizure disorder. Accurate assessment of psychiatric disorders in this population is difficult because mentally retarded patients have poor communication skills and because most diagnostic instruments were developed for persons of normal intellectual functioning. Treatment includes educational, behavioral, and pharmacological interventions, but guidelines for safe use of psychotherapeutic drugs are needed.
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PMID:Mental retardation and psychiatric disorders. 205 Mar 50

A comparative analysis of new cases seen at the Child Psychiatric Clinic in 1975 and 1985 is made in this study. There was a three and a half fold increase in the number of patients seen from 245 to 893. There was no significant change in sex ratio or ethnic groups. However, in 1985 more younger children (aged less than 6 years) were seen at the Clinic. The waiting time remained short with half the number of cases seen within one week of appointment. The commonest conditions besides Normal Variation were Adjustment Reaction, Mental Retardation, Conduct Disorder and Neurosis. Three-fifths of cases were discharged from follow-up within three months of therapy. Most cases (90%) did not require pharmacological therapy whilst family therapy was prescribed for a fifth of cases seen in 1985.
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PMID:A comparative study of new cases seen at the Child Psychiatric Clinic in 1975 and 1985. 263

The parents of 150 children and adolescents, evaluated at a university psychiatry outpatient clinic and a mental health center, were surveyed to determine the frequency of various sleep-related behaviors. This clinic sample was compared with a nonclinic sample of 309 subjects from the general population. A significantly higher incidence of restless sleep, limb movements, nightmares, night terrors, reluctance going to sleep, sleeping with others, fear of dying, fears of dark, and daytime overactivity differentiated the clinic population from the nonclinic population. There were no significant differences in the frequencies of sleep behaviors in the clinic sample due to chronic ear-nose-throat (ENT) problems, sex, or social class. However, bedwetting, sleeping with others, bedtime rituals, need for security objects, fears of the dark, and daytime overactivity were significantly more frequent in the younger age population. Nightmares and restless sleep were more likely to occur in patients having anxiety-affective disorder or conduct disorder DSM III diagnosis, as compared to clinic patients without psychiatric diagnoses. Patients with mental retardation were more likely to experience fears of the dark. A significantly greater number of patients with attention deficit disorder manifested problems with snoring, head banging, restless sleep, and nighttime awakening. There appeared to be an association between chronic ENT problems and daytime overactivity.
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PMID:Sleep behaviors and disorders in children and adolescents evaluated at psychiatric clinics. 660 35

A high prevalence of psychiatric illness exists in persons with mental retardation. Among children with mild to moderate retardation, psychiatric illnesses resemble those seen in the general population. Major affective disorders, ADHD, and conduct disorder are common and respond to the same interventions used in children without mental retardation. Persons with severe to profound retardation are more likely to engage in stereotypies and self-injurious behaviors. In addition, certain specific syndromes associated with mental retardation present with particular neurocognitive, behavioral, and psychiatric profiles. Common examples are fetal alcohol syndrome, Down syndrome, fragile X syndrome, and Rett syndrome. Specific challenges exist for pediatricians who diagnose and treat patients with mental retardation and psychiatric illness. The child's impaired ability to communicate his or her thoughts and feelings with words makes clinical history taking difficult. The clinician must frequently rely on the observation of family members and teachers. An understanding of developmental profiles and interpersonal, peer, and family dynamics is important. Specific behaviors must be targeted and realistic objectives set in treatment planning, which may include psychotherapy, medication, behavior management techniques, and rehabilitation therapy.
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PMID:Dual diagnoses. Psychiatric disorders in developmental disabilities. 768 22

Behavioral deficits are often noted in children with fetal alcohol syndrome (FAS) and other individuals with prenatal alcohol exposure, including mental retardation, learning problems, social problems, and deficits in attention. Because attention deficit, hyperactivity disorder (ADHD) has been diagnosed so frequently in children with FAS and other alcohol related birth defects, there has been speculation that alcohol is an etiological factor in ADHD. To examine the relationship between behavior characteristics of children with fetal alcohol exposure and those seen in children with a diagnosis of ADHD, 149 low socioeconomic status (SES), African-American children (mean age = 7.63 years) were given a battery of neuropsychological and behavioral tests. One hundred and twenty-two were a sub-sample from a longitudinal study of prenatal alcohol exposure, whereas twenty-seven were identified in an ADHD Clinic. Children were given two sets of tests: (1) "traditional model" of conventional behavioral and psychiatric measures of ADHD and externalizing behavior; and (2) measures of neurocognitive functioning reflecting a four-factor model of the neurological basis of the components of attention (Mirsky AF, in Integrated Theory and Practice in Clinical Neuropsychology, Hillsdale, NJ, Lawrence Erlbaum Associates, 1989). Results indicated that children with the physical characteristics associated with prenatal alcohol exposure and those with a diagnosis of ADHD had equivalent intellectual abilities with both clinical groups performing more poorly than contrast children from the same SES and ethnic groups. However, there were clear distinctions on behavioral and neurocognitive measures between the two clinical groups with those with ADHD performing more poorly on conventional tests sensitive to attentional problems and conduct disorder. When these two groups were compared on measures designed to measure the model of the four factors of attention by Mirsky, they were noted to have distinct patterns of deficits. These results suggested that the alcohol-affected children did not have the same neurocognitive and behavioral characteristics as children with a primary diagnosis of ADHD.
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PMID:A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder. 904 88


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