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Query: UMLS:C0025362 (mental retardation)
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Forty children with the following behavior characteristic were selected by observing the attachment behavior between them and their parents at the time of developmental exam in a 18 months' health checkup. The behavior in question is; 18 month old children scurry away from their parent without looking back on parent's calls and without confirming parent's positions. Then all the examined 978 children including the children who had shown the above scurrying away behavior were prospectively followed until before the entry to school. At age six, 6 children were diagnosed of Mental Retardation, 4 of Pervasive Developmental Disorder, and 28 of Attention-Deficit Hyperactivity Disorder (ADHD). Now these results (especially the relationships between this scurrying away behavior at 18 months and ADHD before the entry to school) were analyzed statistically and discussed, then the next conclusions were derived. 1. This scurrying away behavior, especially the behavior without confirming parent's positions, is significantly related to ADHD before the entry to school. 2. This scurrying away behavior is one of the characteristic behaviors at 18 months in ADHD and corresponds to hyperactivity at 18 months. 3. The conduct of throwing a toy block is one of the behaviors that indicates impulsivity at 18 months, when children are requested to hand over a toy block in the developmental exam. 4. Through behavioral observation, ADHDs before the entry to school are categorized to 3 subtypes by presence or absence of this scurrying away behavior at 18 months or by presence or absence of aggressivity before the entry to school. 5. Among the 3 subtypes, the type with this scurrying away behavior and aggressivity before the entry is most necessary to be treated continuously from early childhood. Because it has impulsivity and speech delay since 18 months and untreatable behavioral problems in day nurseries or kindergartens, and therefore it might have Conduct Disorder or Learning Disorder in the future.
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PMID:[Hyperactivity at 18 months of age and attention-deficit hyperactivity disorder before entry to school--follow up study from 18 months to 6 years]. 908 45

Several drugs are apparently effective in treating pathologic anger and aggression. Because many of the studies on aggressive populations allowed the use of concomitant medications, it is unclear whether the efficacy of each drug in a particular population is dependent on the presence of other medications, such as antipsychotic agents. Finally, one needs to be circumspect in inferring efficacy of a particular drug in aggressive patients with neuropsychiatric conditions other than the ones in which some efficacy has been established. Lithium appears to be an effective treatment of aggression among nonepileptic prison inmates, mentally retarded and handicapped patients, and among conduct-disordered children with explosive behavior. Certainly, lithium would be the treatment of choice in bipolar patients with excessive irritability and anger outbursts, and it has been shown to be effective in this population. Anticonvulsant medications are the treatment of choice for patients with outbursts of rage and abnormal EEG findings. The efficacy of these drugs in patients without a seizure disorder, however, remains to be established, with the exception perhaps of valproate and carbamazepine. In fact, dyphenylhydantoin did not appear to be effective in treating aggressive behavior in children with temper tantrums and was found to be effective in only a prison population. There is some evidence for the efficacy of carbamazepine and valproate in treating pathologic aggression in patients with dementia, organic brain syndrome, psychosis, and personality disorders. As Yudofsky et al point out in their review of the literature, although traditional antipsychotic drugs have been used widely to treat aggression, there is little evidence for their effectiveness in treating aggression beyond their sedative effect in agitated patients or their antiaggressive effect among patients whose aggression is related to active psychosis. Antipsychotic agents appear to be effective in treating psychotic aggressive patients, conduct-disordered children, and mentally retarded patients, with only modest effects in the management of pathologic aggression in patients with dementia. Furthermore, at least in one study, these drugs were found to be associated with increased aggressiveness in mentally retarded subjects. On the other hand, atypical antipsychotic agents (i.e., clozapine, risperidone, and olanzapine) may be more effective than traditional antipsychotic drugs in aggressive and violent populations, as they have shown efficacy in patients with dementia, brain injury, mental retardation, and personality disorders. Similarly, benzodiazepines can reduce agitation and irritability in elderly and demented populations, but they also can induce behavioral disinhibition. Therefore, one should be careful in using this class of drugs in patients with pathologic aggression. Beta-blockers appear to be effective in many different neuropsychiatric conditions. These drugs seem effective in reducing violent and assaultive behavior in patients with dementia, brain injury, schizophrenia, mental retardation, and organic brain syndrome. As pointed out by Campbell et al in their review of the literature, however, systematic research is lacking, and little is known about the efficacy and safety of beta-blockers in children and adolescents with pathologic aggression. Although widely used in the management of pathologic aggression, the use of this class of drugs has been limited partially by marked hypotension and bradycardia, which are side effects common at the higher doses. The usefulness of the antihypertensive drug clonidine in the treatment of pathologic aggression has not been assessed adequately, and only marginal benefits were observed with this drug in irritable autistic and conduct disorder children. Psychostimulants seem to be effective in reducing aggressiveness in brain-injured patients as well as in violent adolescents with oppositional or conduct disorders, particu
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PMID:Psychopharmacologic treatment of pathologic aggression. 919 23

The authors report a case of 48 years old woman with mental retardation, followed for 30 years. She has conduct disorder and during this period we note a large number of self-injuries. She swallowed broken glasses, safety pins and once jumped from a bridge. The impulsiveness of these self-injuries is the main factor; they are not planned self-attempts. Lots of different treatments have been prescribed (neuroleptics, antidepressant serotonin uptake blockers and others) and it is only with the lithium that we could observe a period of 2 years without self-injuries. This case questions about the way of action of the lithium and about a possible specificity in the preventive action on conduct disorder with self-injurious behavior, on this type of patient.
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PMID:[Preventive role of lithium in self-injurious behavior: a case report]. 1037 Aug 91

Prader-Willi syndrome is a multi system disorder characterized by neonatal hypotonia, later obesity, hyperphagia and mental retardation. It occurs sporadically, either as a result of microdeletion of chromosome 15p (70%) or as a result of maternal disomy of chromosome 15 (30%). The major problems encountered by parents are those of hyperphagia, food-seeking and obesity, and conduct disorder, particularly tantrums or oppositional behaviour.
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PMID:Prader-Willi syndrome. 1045 84

This is a review of pharmacotherapy in children and adolescents with mental retardation from the perspective of DSM and ICD disorders. The existing research is reviewed in young people with mental retardation but, when data are lacking, we examined the literature from adults with mental retardation and from typically-developing children. The literature is discussed for each of the following disorders: ADHD, anxiety disorders, bipolar disorder, conduct disorder, depression, enuresis, schizophrenia, self injury, and tics and movement disorders. With the possible exception of ADHD, there is a woeful lack of empirical data on most of these disorders in young people with mental retardation. Clinicians will often be forced to extrapolate from data on adults having mental retardation and from typically-developing children. The best policy is probably to treat such patients cautiously, while gathering data on the effects of such therapy in the hopes of beginning a data base.
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PMID:Pharmacotherapy of disorders in mental retardation. 1114 Jul 85

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

In this, the 11th Annual Research Review, I have been pleased to work with an outstanding group of contributors. As in past issues of the Annual Research Review the aim is to provide our readers with reviews that update both current knowledge and research findings. Authors are asked to be selective, rather than comprehensive, in their coverage as they identify the issues that they feel are particularly important for future research. I am grateful not only to the authors but to the numerous referees who provided critiques of each paper. In the first paper in this issue David Skuse provides an update on the relevance of behavioural neuroscience to child psychopathology. This paper provides a thoughtful review of the findings of the past decade and outlines possible directions for future research developments; it appears that we are poised for a major explosion of knowledge in this area. In the second paper Robin Chapman provides a very useful review of recent research on language development. This paper provides an update of Dorothy Bishop's earlier review of the topic and illustrates the considerable progress made since the time of that review. In the third paper Eilish Gilvarry summarises recent research on substance abuse in young people. This review covers recent changes in trends and patterns of substance abuse, aspects of risk and comorbidity, and treatment. Brown and colleagues then review recent work on children and adolescents with HIV and AIDS; this global health problem presents unique issues relative both to research and intervention. Danya Glaser then provides an overview of recent work on child abuse and neglect and the brain; the attempt to bring the various perspectives of neuroscience together on this topic is particularly timely and appropriate. Finally, Sparrow and Davis provide an overview of recent advances in the assessment of intelligence. This paper provides a helpful summary of current perspectives on the assessment of intelligence; the review of instruments will be of particular interest to our readers. For the 12th edition of the Annual Research Review we anticipate coverage of the following topics: intersubjectivity, reading disability, longitudinal approaches to developmental data, mental retardation, conduct disorder, and psychopharmacology.
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PMID:Editorial. 1126 Aug 27

Although competence to stand trial is perhaps the most studied area of mental health law, most of the research has been focused on adults. This study describes a population of 471 juveniles committed for treatment/habilitation and restoration of their competence to proceed in the delinquency process. This population differed from their adult counterparts in important ways. For example, 58 percent of the juveniles had a diagnosis of mental retardation, and 57 percent of the juveniles with an Axis I diagnosis also had a diagnosis of conduct disorder. Only 17 percent had a diagnosed psychotic disorder. Diagnoses among cohorts of adults found incompetent differ markedly. However, similar to adult defendants who are adjudicated incompetent to proceed, the majority of these children were returned to court after treatment staff determined that they were competent to proceed. Contrary to expectation, there were no significant age-related differences with respect to the recommendation of clinical staff regarding restoration of competence. The data suggest the need for further research examining that subset of children in the juvenile justice system whose competence to proceed is questionable.
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PMID:Juveniles adjudicated incompetent to proceed: a descriptive study of Florida's Competence Restoration program. 1178 14

Antipsychotic drugs are used to treat a wide variety of child psychiatric disorders characterized by psychotic symptoms, aggression, excitement, tics, stereotypies and hyperactivity nonresponsive to other therapies. Unfortunately, typical antipsychotics have many adverse effects limiting their long-term use. Novel antipsychotics with combined dopaminergic and serotonergic action, such as risperidone, appear to offer better safety and efficacy profiles in controlled studies of adult patients, and therefore appeared as promising pharmacotherapeutic agents in child psychiatry. The purpose of this retrospective chart review was to obtain data on the potential effectiveness and tolerability of risperidone in children and adolescents presenting with a variety of chronic and severe psychiatric disorders who had been unresponsive to previous pharmacological treatments. Charts for 106 children and adolescents (males n = 81 or 76.4%; females n = 25 or 23.6%), presenting with attention deficit and/or hyperactivity disorder (n = 49 or 46.2%), conduct disorder (n = 13 or 12.3%), oppositional-defiant disorder (n = 5 or 4.7%), behavioural problems not otherwise specified (n = 2 or 1.9%), autism (n = 8 or 7.5%), Asperger's syndrome (n = 8 or 7.5%), pervasive developmental disorder (PDD) not otherwise specified (n = 4 or 3.8%), anxiety (n = 6 or 5.7%), depression (n = 2 or 1.9%), dysthymia (n = 2 or 1.9%), schizophrenia (n = 4 or 3.8%), adjustment disorder (n = 1 or 0.9%) and obsessive-compulsive disorder (n = 2 or 1.9%) were reviewed retrospectively to determine the tolerability and potential efficacy of risperidone treatment for a variety of psychiatric disorders. Six subjects also presented with mental retardation. The average length of illness prior to risperidone treatment was 5 years and the average age of risperidone treatment onset was 11 years. The mean daily dose of risperidone was 1.2 mg (range = 0.25 to 8.0 mg). Very few adverse effects were reported. The average length of risperidone treatment was 11 months with the majority (n = 75 or 76%) of patients maintained on risperidone following study termination. Seven cases (6.6%) were missing follow-up data. The majority (n = 78 or 74%) of patients were taking concurrent psychiatric medications, most commonly stimulants for the treatment of ADHD. Clinical global improvements for children and adolescents at the final study visit were marked (n = .37 or 34.9%), moderate (n = .40 or 37.7%), mild (n = 13 or 12.4%), none (n = 12 or 11.3%), or worse (n = 1 or 1%). Three cases (2.9%) were missing clinical improvement data. Results suggest that risperidone may be useful for managing behavioural disturbances and psychotic symptoms associated with a wide variety of childhood psychiatric disorders. For most patients in the study, a combination of risperidone and adjunctive pharmacotherapy was beneficial. Controlled and discontinuation studies of risperidone treatment in children and adolescents with behavioural and psychotic disorders are recommended.
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PMID:A retrospective chart review of risperidone use in treatment-resistant children and adolescents with psychiatric disorders. 1181 3

Animal cruelty in childhood, although generally viewed as abnormal or deviant, for years was not considered symptomatic of any particular psychiatric disorder. Although animal cruelty is currently used as a diagnostic criterion for conduct disorder, research establishing the diagnostic significance of this behavior is essentially nonexistent. In the current study, investigators tested the hypothesis that a history of substantial animal cruelty is associated with a diagnosis of antisocial personality disorder (APD) and looked for associations with other disorders commonly diagnosed in a population of criminal defendants. Forty-eight subjects, criminal defendants who had histories of substantial animal cruelty, were matched with defendants without this history. Data were systematically obtained from the files by using four specifically designed data retrieval outlines. A history of animal cruelty during childhood was significantly associated with APD, antisocial personality traits, and polysubstance abuse. Mental retardation, psychotic disorders, and alcohol abuse showed no such association.
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PMID:Animal cruelty and psychiatric disorders. 1210 63


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