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Query: UMLS:C0917816 (mental retardation)
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The author reviews the current epidemiological concepts in Latin America, assesses the general mental health levels and sets forth some basic proposals aiming at the allocation and use of scarce resources, incorporating as an important one the community itself. The classic models for Mental Health Programs, defined through their basic infrastructures are analyzed: a) The Institution-Pscychiatric Hospital, aimed mainly at tertiary prevention, custody, and biologic therapy, and having high costs with reduced benefits; b) The Mental Health Unit, aimed mainly at secondary prevention, providing several services, and having high costs with good benefits; and c) The Comprehensive Program, aiming mainly at primary prevention, providing several specialized services together with the use of the resources of the community itself, and having low costs with high benefits. An overview of Mental Health indicators shows the following rates of prevalence: a) neurosis, 15%; b) alcoholism, 5%; c) epilepsy, 2%; d) psychosis, 1%; e) dementia, 1%; f) mental retardation, 1%. The total prevalence rate for the six basic psychopathological entities is 25%, in the population of more than 15 years of age. The minimal requirement of psychiatrists for that degree of prevalence is about 80/one million inhabitants, that is, an increase fourfold to fivefold of the present number. To attain this goal, at least 50 years are required, during which mental health services are likely to maintain their present deficits, unless a new conception of mental health services is used. The author proposes the generalized use of Comprehensive Programs, as the only possibility of providing within periods reasonably short an adequate service. The importance of incorporating the mental health resources of the community is stressed. The experiences made in Chile during three different governments, having different political and ideological basis, are briefed, showing the evidence of a number of advantages to be gained with the proposed system, in a relatively short timespan--less than 10 years.
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PMID:[Policy of mental health in Latin America]. 98 40

The aim of the present work is to investigate the heredity of manic-depressive syndromes, in particular to test the hypothesis of a dominant X-linked transmission in these disorders. The Maximum Likelihood Estimate method was applied to linkage analysis between several X-linked genetic markers and bipolar manic-depressive illness, as well as to a control population of unipolar depressive patients. The genetic markers studied were deuteranopia and protanopia (two X-linked recessive markers) and the Xg blood group (X-linked dominant marker). The sampling methods were identical for both groups of patients and the family studies were performed "blind" (i,e. without knowledge of the proband's diagnosis). The results demonstrate the presence of strong linkage between manic-depressive (bipolar) illness, deuteranopia and protanopia. Linkage (although less strong) was also shown for bipolar illness and the Xg blood group. The genetic data are based on mathematical analysis of 36 informative kindreds ascertained from a sample of 134 manic-depressive patients. The results are concordant and demonstrate that, in this sample, manic-depressive (biopolar) psychosis is genetically transmitted through a X-linked dominant factor. We have also demonstrated the absence of linkage between unipolar depressive illness and the studied genetic markers in 16 informative kndreds ascertained from a sample of 71 unipolar patients. The genetic analyses described in this study demonstrate the existence of a manic-depressive syndrome which phenotype is dominant and determined by a gene located on the short arm of the Xchromosome. Apart from some forms of mental deficiency, manic-depressive psychosis represents the first known instance of a mendelian heredity machanism in psychiatric disorder;
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PMID:[Genetic study of mani-depressive psychoses]. 102 56

There is an important jeopardizing factor for all nosological classificatory systems, in general Psychiatry as well as in child Psychiatry: the lack of a universally valid basis for defining concepts of "normal" and "pathological". Both stem from social patterns, values, culture and organization. Thus, they vary widely in different countries and communities. In order to attain the much needed general nosological criteria, the starting point is to our mind, a scientific comprehensive conception of man in the midst of a social environment. Pathological phenomena are usually located either in biological, psychological or sociological domains, but they are all-pervading and affect man in the whole. Taking into account that the same can be said about children, we discuss in this paper one classificatory system proposed by Telma Reca M. D. and modified by the author. Following the gravitation of the main aethiological factors, four categories are proposed: a. Psychogenetical diseases: regular or reactive developmental disturbances; acute anxiety; neurotic traits; fully developed neurosis, and psychosomatic disturbances of neurotic origin; speech disturbances of a pure psychological nature, etc. b. Psychical disorders derived from physical diseases: acute confusional or delusional states; mental retardation; epilepsy; minimal cerebral disfunction; learning difficulties derived from injuries or/and genetic deficiencies, etc. c. Psychical disorders derived from social problems: bad nourishment, disturbed sleep, faulty or disorderly sexual behaviour; poor or disturbed performance at school or in social groups, etc. d. Disorders caused by several factors: psychotic traits; psychosis; psychopathic behaviour; lack of maturity according to chronological age; congenital personality disorders, etc.
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PMID:[Nosography in child psychiatry]. 116 72

The case findings of thirty-three children given a diagnosis of psychosis during hospitalization in the '50s and '60s were reviewed and rediagnosed in 1973. Childhood schizophrenia was the original diagnosis in 58% of the cases but was the rediagnosis in only 18% of those same cases. Chronic brain syndrome with various reactions (psychotic reaction, nonpsychotic behavioral reaction, and mental retardation and autism) was the diagnosis in 27% of the cases, originally, but was given to 67% of the cases on rediagnosis. One-third of the children originally diagnosed as psychotic were rediagnosed as nonpsychotic. Approximately two-thirds of the children were nonpsychotic according to the DeMyer-Churchill guidelines.
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PMID:Changing diagnosis of childhood psychosis. 117 26

At the present time, neuroleptics are indicated for the treatment of acute psychotic states as well as Tourette's syndrome in children and adults. Neuroleptics may have a useful role in the attenuation of problem behaviors, such as stereotypies, hyperactivity, self-injury, and aggressive outbursts in infantile autism, pervasive developmental disorder NOS, and mental retardation, but they do not improve the underlying condition. Neuroleptics are not the agents of first choice for treatment of hyperactivity or aggression in children who do not have major developmental handicaps. Common and troublesome side effects associated with neuroleptic use in children and adolescents include sedation, extrapyramidal symptoms, and withdrawal dyskinesias; therefore, close monitoring is required. Neuroleptics should be used cautiously and only as an adjunct to other nonpharmacologic interventions.
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PMID:Neuroleptics in pediatric psychiatry. 134 40

Published cases of periodic psychosis of puberty and related papers were reviewed. The clinical picture is near-monthly recurrence of episodes of stupor or excitement lasting about 1 or 2 weeks, which are accompanied by delusion and in some cases also by hallucinations or confusion. This condition was found to occur more commonly in girls than in boys, and in half of the girls reported the episodes tended to start a few days before menses. Adolescents with mental retardation were more commonly affected, and this suggests that organic brain damage may play a role in the etiology in some cases. Short-term prognosis is usually favorable, but at long-term follow-up, nearly half of them were found to be suffering from affective or schizophrenic illness. The clinical importance of recognizing this psychosis early in the course of illness is emphasized.
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PMID:Periodic psychosis of puberty: a review on near-monthly episodes. 149 47

The Authors describe the organization and aims of the rehabilitation institute "G. Ferrero" of Alba, Cuneo district, Italy. Afterwards they present, analyse and compare 34 items regarding patients over 14 years of age that were present on the 30 November 1978 and 1988. The most important data are: 1) a large rise in average age and stay at the institute; 2) a similar rise in the mental retardation level; 3) the lack of link between handicap level and possibility for the subject to go back to the original family; 4) a considerable increase in the subjects with psychosis or cerebropathia; 5) the poor prognosis for psychotic subjects, that are affected 10 years after and almost never succeed in going back to their original family or in finding a job; 6) big changes that changing types of patients produced in the institute's aims and in treatment, with partial renunciation to rehabilitation and development of nursing and ergotherapy.
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PMID:[Mental retardation and psychiatric pathology. Statistical investigation and follow-up]. 150 55

Three cases of fragile X (fra X) have been identified in a systematic survey of 30 boys, aged 3 to 14, with infantile autism or psychotic disorders, associated with mental retardation. Only one of these children exhibited a dysmorphy characterizing the Martin-Bell syndrome. Two fra X cases fulfilled the DSM III criteria for autism; none corresponded to the Kanner's description of infantile autism. The prevalence of fra X among children with psychotic disorders (6%) is much higher than in the general population; however it is close to the prevalence observed in non psychotic mentally retarded patients. Given the inconsistency of the somatic phenotype, the screening should benefit from the recent discovery of abnormal methylation of DNA.
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PMID:[Fragile X chromosome in autism and psychotic disorders in children]. 158 Jul 45

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

Altogether 1,179 children aged 7 to 14 years, living in mountain and lowland villages were examined. There were 579 boys and 600 girls. In highlands, mental deficiency was most often diagnosed in boys (56.5 per 1,000), whereas in girls, it was 39 per 1,000. In boys and girls living in lowland villages, mental deficiency was encountered more seldom (36.3 and 21 per 1,000, respectively). The boys living in highlands mostly exhibited neuroses (34 per 1,000) accompanied by neurosis-like enuresis (62%) and speech disturbances (12%). Among the girls living in lowlands, predominant were neuroses (47 against 16 per 1,000) and psychotic disorders (they occurred 6.3 times more frequently than in highlands). In rural highlands and lowlands, mental disorders were most commonly recorded in boys (1:1.52 and 1:1.45, respectively).
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PMID:[Mental health of children living in rural high- and low-altitude areas of the Ivano-Frankovsk district (clinico-epidemiological study)]. 166 27


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