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Query: UMLS:C0025362 (mental retardation)
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Participation in paid work in competitive industry through placement in supported employment is compared and analyzed for 278 severely disabled persons. Differential outcomes are described for persons with chronic mental illness, cerebral palsy, traumatic brain injury, and dual diagnosis of chronic mental illness and mental retardation. Results indicated that supported employment appears to be an effective means of assisting these historically unemployable individuals to acquire and retain work. Cross-disability group differences were found in areas such as hourly wages, type of employment, services provided by employment specialists, and job retention. The results represent a baseline from which to evaluate future efforts at competitive work placement for persons with severe disabilities, using the supported-employment model.
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PMID:Supported employment: an alternative model for vocational rehabilitation of persons with severe neurologic, psychiatric, or physical disability. 199 Oct 8

The Aberrant Behavior Checklist (ABC; Aman, Singh, Stewart, & Field, 1985a, 1985b) is a 58-item third-party informant rating scale originally developed for institutionalized, low-functioning adolescents and adults. The present study investigated the appropriateness of the scale for youngsters with dual diagnosis of mental retardation and psychiatric disturbance. Over a period of 2 1/2 years, 204 patients (199 after data reduction) from a child psychiatry unit were rated twice daily by direct care staff. Data analysis addressed internal consistency, interrater reliability, criterion validity, and robustness of the factor structure. Internal consistency was satisfactory with alpha coefficients ranging from .82 to .94. Interrater reliability varied between subscales but was relatively low (Pearson correlations between .39 to .61). In terms of its criterion validity, the ABC was sensitive to psychiatric diagnoses and age and the original 5-factor structure was robust (congruence coefficients ranged between .80 to .89). Yet, only a relatively small proportion of the variance (31.5%) was explained by factor analysis indicating possible limitations of the ABC for this population. Given the paucity of assessment instruments for this particular population and the difficulty involved in developing new population-specific instruments, the ABC can be recommended for children and adolescents with dual diagnosis.
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PMID:The Aberrant Behavior Checklist with children and adolescents with dual diagnosis. 203 47

A two-step methodology was used to estimate the prevalence of dual diagnosis among persons participating in community-based day programs in the Chicago metropolitan area. In Step 1, a dual diagnosis screening test was administered to a random sample of 205 people with mental retardation. In Step 2, 59 subjects were evaluated by clinical psychologists who did not know the results of the screening test. The results consistently suggested very high rates, with the best data suggesting an overall rate of about 39%. The rates were high primarily because personality disorders were very common. The fact that only 11.7% of the subjects had a psychiatric diagnosis in their case files suggests that dual diagnosis was underdiagnosed for this sample.
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PMID:Prevalence of dual diagnosis in community-based day programs in the Chicago metropolitan area. 234 Jan 35

The evaluation of mental health problems among persons with mental retardation is complicated by difficulties in diagnosis as well as by system variables that may also determine who will be assigned a dual diagnosis. In this study a state data base of 78,603 individuals with mental retardation receiving state services was examined. The relations of observed behavior problems, other characteristics of the individual, and residential placement patterns to the likelihood of being given a dual diagnosis were examined. Extrapunitive maladaptive behaviors, cognitive abilities, and social skills were associated with diagnoses of mental health problems among persons with mental retardation. The different perspectives from which these results could be interpreted were discussed.
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PMID:Who are the dually diagnosed? 234 Jan 36

The present report considers organic factors of pathogenesis, in addition to environmental factors, as causal processes in cases of dual disability of mental retardation and behavior disorders. Relevant to organic pathogenesis, in cases of dual diagnosis, basic biological processes are presented, mechanisms concerned with gestational and birth complications that led to fetal-neonatal hypoxic cerebral cortical damage. In such cases, dual diagnosis manifestations of mental retardation and behavior disorders, together with other chronic cerebral disabilities, may be attributed to residues of fetal-neonatal cerebral damage.
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PMID:Behavior disorders in mentally retarded persons, the dually diagnosed: factors of pathogenesis. 269 90

For some time patients with the dual diagnosis of mental retardation and mental illness have been recognized as a distinct patient population, but development of programs meeting their special needs is slow. In October 1986 a Massachusetts state psychiatric facility opened a rehabilitative program for such patients in a separate 40-bed unit on the hospital grounds. All patients admitted to the Specialized Habilitative and Rehabilitative Environment (SHARE) program had long histories of institutionalization, and many had been treated with neuroleptic drugs for several years. Most patients now attend day programming, and a few have been able to move on to less restrictive environments. Patients' average neuroleptic dosage has been substantially reduced. This progress has been made in spite of such program-development problems as the need to change staff's long-held perspectives about dual-diagnosis patients, lack of funding, and high staff turnover.
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PMID:Developing a unit for mentally retarded-mentally ill patients on the grounds of a state hospital. 275 75

The ICF/MR provides services to individuals with a dual diagnosis of mental retardation and mental illness. These services prepare these individuals to the least restrictive environment analogous to the norms and patterns of the mainstream of society. The individuals served are more than 22 years of age and have behavioral problems associated with mental retardation and/or mental illness. In addition, they have multiple medical problems which are related or unrelated to their physical or mental disabilities. These individuals have multiple changing needs which are addressed by an interdisciplinary team. The team develops a unified Individual Program Plan which is the framework for a comprehensive care for these individuals. This is to enable them to live a normal life as possible and to achieve gainful occupational pursuits like any other citizen in the State of South Carolina.
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PMID:A habilitation center for individuals with a dual diagnosis of mental retardation and mental illness. 765 83

An evaluation of the treatment and habilitation services being provided to individuals with dual diagnoses of mental retardation and mental illness was presented. The current status of service delivery is identified as unacceptable. Legal issues relating to the obligation to provide quality services were discussed as were ethical issues relating to where the responsibility for providing such service lies. General ethical principles of nonmaleficence and beneficence were defined, and the codes of ethics for two professional groups were invoked to bolster the position that administrators and supervisors are ultimately responsible for the quality of service provided by their organizations. Recommendations for staff competencies necessary to improve treatment for individuals with dual diagnosis were made.
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PMID:Quality care for individuals with dual diagnosis: the legal and ethical imperative to provide qualified staff. 798 21

A total of 583 children and adolescents with mental retardation were rated on a new psychometric instrument designed to screen for dual diagnosis (psychopathology in individuals with mental retardation). Two psychiatrists and two clinical psychologists judged the items to have face validity as expressions of psychopathology in children and adolescents with mental retardation. Cronbach's alpha coefficient was .91 for the total score and varied between .57 and .86 for 10 psychometric scales. Children and adolescents who had a dual diagnosis obtained total scores approximately 1 standard deviation higher than those who did not have a dual diagnosis. Each of 4 diagnostic groupings had test profiles in accordance with expectation. The results suggest that the instrument is particularly well suited for use in screening and for help in the analysis of the relationships between certain behavior problems and psychopathology.
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PMID:Development of a psychopathology rating scale for children with mental retardation. 803 25

Dual diagnosis, defined in this instance as the co-occurrence of mental health disorders with mental retardation, has become a major area of clinical practice and research in the past 10 years. Whereas areas such as differential diagnosis, assessment, and prevalence have been major focuses of research, etiologies of dual diagnosis have received less attention. Current etiological theories have practical implications for the treatment and prevention of dual diagnoses and suggest important directions for future research. This article provides a historical review of theory development in the field of dual diagnosis. Current status of etiological theories and future directions are discussed with an aim toward encouraging further study.
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PMID:Theories of dual diagnosis in mental retardation. 803 30


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