Are the medical needs of mentally handicapped adults being met?

This paper reports on the apparent inadequate level of primary medical care provided to many of the 151 mentally handicapped people who attend an adult training centre. A large number of common medical problems were identified that were not known to the general practitioners and/or were not being managed, including problems known to be associated with Down's syndrome. Many trainees were further handicapped by unmanaged defects of hearing and vision. Contact rates with the general practitioner showed that the mentally handicapped adults did not place a greater burden on the doctor than the rest of the population. Comparing these rates with those for other vulnerable groups such as those aged over 75 years and under four years showed that only 28% of the trainees had an adequate consultation rate with the general practitioner.

A lack of awareness among general practitioners of the special needs of this group is thought to be in part responsible but the major factor is the inherent problem of communication which exists almost universally in people who suffer from mental handicap. Ways of improving the situation are discussed with an emphasis on the need for a change in our attitudes towards mentally handicapped people. Reference is made to the desirability of increasing the cooperation between primary care and community mental handicap teams and the increasing importance of voluntary organizations.

     

A genetic-diagnostic survey in an institutionalized population of 173 severely mentally retarded patients

In this report we summarize the findings in a genetic-diagnostic survey of an institutionalized population of 173 severely mentally retarded patients. The etiological study was based on a clinical genetic approach with special attention for dysmorphology and neurological findings. A constitutional disorder, as the direct cause of the severe mental handicap, was found in 75 patients (43.35%). A detailed survey of the different data and findings are given, and compared with the results of previous studies.     

Differences in the quality of residential provision for mentally handicapped people

This paper examines the quality of care in four types of residence for mentally handicapped adults in Britain. Data were gathered from 175 residents of 150 living units--mental handicap hospital wards, voluntary and private homes, local authority hostels and parental homes. Differences were apparent between the types of residence in terms of both residents' characteristics and care practices and routines. The findings indicate that some of the differences in care practices are not associated with differences in the residents' functioning. Additionally, alternatives to hospital care for mentally handicapped people are not providing demonstrably improved quality of care in several aspects of residential practice. A discussion of those aspects of care calling for more improvement is presented.     

Assessing the psychosocial consequences of epilepsy: a community-based study.

BACKGROUND: Few studies have measured, using validated scales, the psychosocial handicap of epilepsy in a general practice setting. AIM: To assess the prevalence of psychosocial problems associated with epilepsy. METHOD: A survey was undertaken of 309 subjects, with one or more non-febrile epileptic seizures, drawn from two general practices in the United Kingdom (UK). The outcome measures were the Subjective Handicap of Epilepsy Scale (SHE), the SF-36, and the Hospital Anxiety and Depression scale (HAD). RESULTS: One-third of persons with active epilepsy were significantly handicapped by their condition. The severity of subjective handicap was related to seizure frequency and to the duration of remission of seizures. Between one-third and one-half of subjects scored as 'cases' on the HAD scale and on the mental health subscale of the SF-36. Only one-third of the psychiatric morbidity revealed by the questionnaires had been recognized by the general practitioner (GP). Scores on the SF-36 indicated that people with active seizures perceived themselves as significantly less healthy than those in remission, and that, for persons in remission, drug treatment had a detrimental effect on certain aspects of well-being. CONCLUSIONS: The occurrence of seizures, even at low frequencies, is associated with psychosocial handicap, and this may remain covert in general practice.     

Patients with sex chromatin abnormality in two state hospitals

The incidence of sex-chromatin subnormality in two special hospitals for subnormal patients requiring special security on account of violent and aggressive behaviour was found to be significantly higher than the incidence in other institutionalized populations of the mentally subnormal. It is suggested that two factors account for this raised incidence: the higher mean intelligence level in the special hospital population, and the high proportion of sex-chromatin-positive males in these hospitals with an additional Y chromosome. We thank Dr J. N. McDougall, Medical Superintendent of Moss Side Hospital, for permission to study the patients in his care and the Medical and Nursing Staffs of Rampton and Moss Side Hospitals for their full co-operation. This investigation was supported in part by a grant from the National Spastics Society.     

视障大学生心理问题检出情况及其影响因素分析

目的了解视障大学生的心理问题检出情况，反映其心理健康状况。方法本研究以某特教学院在读的58位视障大学生为研究对象．应用SCL-90、社会支持评定量表和应付方式问卷为研究工具。结果视障大学生的SCL-90得分不高于健全大学生；心理问题检出率不高于普通人群；视障大学生客观支持与SCL-90多数因子有非常显著的负相关。视障大学生的主观支持水平与躯体化、焦虑因子有显著负相关。支持利用度与9个因子之间不存在相关。视障大学生应付方式与抑郁、强迫、精神病性、妄想偏执有显著相关，与人际关系、恐怖、焦虑有非常显著的相关。43％的视障大学生能采取较有效的应付方式去处理问题．其人格特征也较稳定。结论学院的心理健康教育工作有助于维持视障大学生的心理健康；友好的人际关系使视障大学生容易获得社会支持；视障大学生的心理特征是影响其心理健康水平的重要因素之一。     

Locally-based residential services for mentally handicapped adults: a comparative study

The patterns of daily living, occupation and leisure activities, skills, behaviour and the structure and organization of living units were assessed for 2 groups of mentally handicapped adults, first in a large hospital and second, a year later in the new local units to which they were transferred. Similar assessments were carried out for individually matched control subjects who remained in the large hospital. For the less severely handicapped, more sociable residents who moved to an NHS hostel in the community, there were significant improvements on several of these measures. For the more severely handicapped, socially aloof people who moved to a ward in a small converted hospital in the district from which they had originally come, some changes on the environmental measures were found, but on the whole the unit was run along similar lines to the wards of the large hospital. There was little change in the pattern of the residents' day to day life. The controls who remained in the large hospital experienced very little change in environmental and life-style measures. The discussion focuses on the interaction between environmental factors and the handicaps of the individuals, and the influence of this interaction upon quality of care and life-style. The study was carried out during the early stages of the rundown to closure of the large mental handicap hospital.     

Television and attitudes toward mental health issues: Cultivation analysis and the third‐person effect

A television content analysis and survey of 419 community respondents supports the hypothesis that media stereotypes affect public attitudes toward mental health issues. A content analysis of network, prime‐time television demonstrates that portrayals are violent, false, and negative. The mentally disordered are portrayed as 10 times more likely to be a violent criminal than nonmentally disordered television characters. A survey demonstrates that as television viewing increases so does the belief among viewers that locating mental health services in residential neighborhoods will endanger the residents. Viewers who watch television news are less likely to support living next to someone who is mentally ill. The survey also tests the third‐person effect, and finds that viewers believe television portrayals of mental illness affect others more than themselves. © 2007 Wiley Periodicals, Inc.     

Healthy living does not reduce life satisfaction among physically handicapped persons

Smoking, drinking, over-eating and sedentary living may be regarded as ways of compensating for losses inflicted by physical handicaps. Therefore, promoting healthy life-styles among physically handicapped persons may amount to reducing their life satisfaction. This article examines the life-style and life satisfaction of all self-reported somatically handicapped respondents 25-50 years of age in a mid-Norwegian county. Persons with physical handicaps had more unhealthy habits than the general population. But life-style was not related to degree of physical handicap. And quality of life among the physically handicapped was not associated with life-style. Efforts to promote healthy living may not threaten the quality of life of physically handicapped persons.     

Physical work capacity and daily physical activities of handicapped and non-handicapped children

Summary In this study physical work capacity, mechanical efficiency on the bicycle ergometer and daily physical activities were compared between 24 physically handicapped and 24 non-handicapped children. As a measure of mechanical efficiency and physical work capacity, the oxygen uptake per kg body weight at 0.5 watt·kg^–1 and oxygen uptake per kg body weight at a heart rate of 150 beats·min^–1 were used. The daily physical activities were recorded during a 24-h period by means of a scoring list. The load imposed by the daily physical activities was investigated by registration of heart rate.The mean value of the physical work capacity of the group of handicapped children was found to be lower compared with the non-handicapped children. The mechanical efficiency of 7 of the 24 handicapped children was lower when compared with the mechanical efficiency of 23 of the 24 non-handicapped children. A significant correlation between mechanical efficiency and nature of the handicap (spastic hemi-, di-, tetraplegic) was found (p<0.05). During light daily physical activities the handicapped children showed the same mean heart rate as the non-handicapped children, but the mean heart rate during heavy daily physical activities was lower for the handicapped group than for the non-handicapped group. The non-handicapped children spent more time in physical activities with relatively high heart rates.From the results obtained of oxygen uptake and heart rate measurements it is to be expected that non-handicapped children are able to maintain a higher state of training by means of their daily physical activities than are handicapped children.     

Adults with Williams-Beuren syndrome: evaluation of the medical, psychological and behavioral aspects

In order to evaluate the medical, psychological and behavioral aspects of Williams-Beuren syndrome in adulthood, data were collected on 11 patients aged 17 to 66 years. The medical data did not confirm previous reports of significant morbidity. All adults were found to have a moderate or severe degree of mental handicap. They showed the same psychological profile as found in children: good verbal abilities, poor motor abilities, problems with sequencing and with performance tasks. The adults we evaluated showed little disturbing behavior in comparison to other mentally retarded subjects. They achieved a good level of autonomy. The majority lived at home with one or both parents and attended a day centre.     

A cytogenetic survey of 449 patients in a Japanese institution for the mentally retarded

A cytogenetic survey was carried out on 449 patients (261 males and 188 females) in an institution for the mentally retarded in Japan. A total of 37 patients (8.1 %) were shown to have chromosome abnormalities. There were 33 individuals (7.3 %) with 21 trisomy. In addition, we found one patient with 46,XY/47,XY, + 12p, one with 46, XY, r(22), and one with 45, XY, -13, -14,+t(13q14q). Only one female was found to have an abnormal sex chromosome constitution, 47, XXX. The significant contribution of chromosome abnormalities in the etiology of mental retardation is also shown in the present survey. The most common chromosome abnormality was 21 trisomy, as seen in other similar surveys.     

MECP2 is highly mutated in X-linked mental retardation

Following the recent discovery that the methyl-CpG binding protein 2 (MECP2) gene located on Xq28 is involved in Rett syndrome (RTT), a wild spectrum of phenotypes, including mental handicap, has been shown to be associated with mutations in MECP2. These findings, with the compelling genetic evidence suggesting the presence in Xq28 of additional genes besides RabGDI1 and FMR2 involved in non-specific X-linked mental retardation (MRX), prompted us to investigate MECP2 in MRX families. Two novel mutations, not found in RTT, were identified. The first mutation, an E137G, was identified in the MRX16 family, and the second, R167W, was identified in a new mental retardation (MR) family shown to be linked to Xq28. In view of these data, we screened MECP2 in a cohort of 185 patients found negative for the expansions across the FRAXA CGG repeat and reported the identification of mutations in four sporadic cases of MR. One of the mutations, A140V, which we found in two patients, has been described previously, whereas the two others, P399L and R453Q, are novel mutations. In addition to the results demonstrating the involvement of MECP2 in MRX, this study shows that the frequency of mutations in MECP2 in the mentally retarded population screened for the fragile X syndrome is comparable to the frequency of the CGG expansions in FMR1. Therefore, implementation of systematic screening of MECP2 in MR patients should result in significant progress in the field of molecular diagnosis and genetic counseling of mental handicap.     

A clinical, cytogenetic and familial study of 307 mentally retarded, institutionalized, adult male patients with special interest for fra(X) negative X-linked mental retardation

In this study we report the results of a systematic etiological, clinical genetic study in 307 institutionalized mentally retarded adult males. Special attention is paid to the nosology of X-linked mental retardation. During the survey 63 males with one or more 'Martin Bell'-like features were identified in whom repetitive fragile Xq27-3 screenings were negative. In 13 of them, belonging to 9 different families, pedigree data were compatible with X-linked inheritance. This finding confirms the existence of one (or more) forms of fra(x) negative mental retardation with 'Martin Bell'-like features.     

Aarskog syndrome: the changing phenotype with age.

We describe the Leuven experience with 52 males with Aarskog syndrome particularly with respect to clinical variability, changing phenotype with age, and previously unreported signs. At least 30% of affected males were mentally retarded, two thirds of them at the level of slight mental handicap. Hyperactive behavior and symptoms of attention deficit disorders were frequently observed (61% of the mentally normal and 84% of the mentally subnormal), but regressed completely after the age of 12 to 14 years. The social integration and functioning as adults is satisfactory. Postpubertal males with Aarskog syndrome have only minor remnant manifestations of the prepubertal phenotype, making clinical diagnosis in adults extremely difficult.     

Hepatitis C antibody testing: problems associated with non-specific binding.

The prevalence of antibodies to hepatitis C virus (anti-HCV) was measured in a number of groups known to be at increased risk of blood-borne viral infections, using an enzyme-linked immunosorbent assay (EIA) based on a nonstructural peptide generated by recombinant DNA technology. The assay was repeatably reactive in 75.6% of men with haemophilia, 61.9% of intravenous drug users, 34.1% of homosexual men who were regular attenders at a gay sauna and 30.8% of prisoners. A lower reactivity was detected in sera collected from female prostitutes (10.4%), patients undergoing maintenance haemodialysis (5.9%), or renal transplantation (6.9%) and patients attending a sexually transmitted diseases clinic (6.2%). We also measured reactivity among inmates of a large institution for the mentally handicapped in which hepatitis B is known to be endemic, and in panels of sera which had been stored for 25-35 years. The test was positive in 41.1% of mentally handicapped patients with Down's syndrome and 7% of subjects with other forms of mental retardation. Similarly some 23% and 20% of sera collected in 1954 and 1964 from patients with a variety of illnesses were found to be reactive. As most diagnostic assays suffer from some degree of non-specificity and confirmatory tests for the anti-HCV assay were not initially available in Australia, we analysed the distribution of optical density (OD) values in the different groups, in an attempt to obtain an insight into the specificity of the results being obtained. Whereas the ODs of sera collected from patients with haemophilia and IVDU had a bimodal pattern, with two well separated sets of results on either side of the cut-off.(ABSTRACT TRUNCATED AT 250 WORDS)     

Threats to kill: a follow-up study

BACKGROUND: Mental health clinicians are frequently asked to assess the risks presented by patients making threats to kill, but there are almost no data to guide such an evaluation. METHOD: This data linkage study examined serious violence following making threats to kill and the potential role of mental disorder. A total of 613 individuals convicted of threats to kill had their prior contact with public mental health services established at the time of the index offence. The group's subsequent criminal convictions were established 10 years later using the police database. Death from suicidal or homicidal violence was also established. RESULTS: Within 10 years, 44% of threateners were convicted of further violent offending, including 19 (3%) homicides. Those with histories of psychiatric contact (40%) had a higher rate (58%) of subsequent violence. The highest risks were in substance misusers, mentally disordered, young, and those without prior criminal convictions. Homicidal violence was most frequent among threateners with a schizophrenic illness. Sixteen threateners (2.6%) killed themselves, and three were murdered. CONCLUSIONS: In contrast to the claims in the literature that threats are not predictive of subsequent violence, this study revealed high rates of assault and even homicide following threats to kill. The mentally disordered were over-represented among threat offenders and among those at high risk of subsequent violence. The mentally disordered threateners at highest risk of violence were young, substance abusing, but not necessarily with prior convictions. Those who threaten others were also found to be at greater risk of killing themselves or being killed.     

Patient factors associated with duration of certified sickness absence and transition to long-term incapacity.

BACKGROUND: Despite a considerable increase in claims for long-term sickness benefits, and the impact of certifying sickness upon general practitioner (GP) workload, little is known about transition to long-term incapacity for work. AIM: To explore the relationship between patient factors and the transition from short-term to long-term work incapacity, in particular focusing on mild mental health and musculoskeletal problems. SETTING: Nine practices comprising the Mersey Primary Care R&D Consortium. DESIGN: Prospective data collection and audit of sickness certificate details. METHOD: GPs issued carbonised sickness certificates for a period of 12 months. The resulting baseline dataset included claimant diagnosis, age, sex, postcode-derived deprivation score, and sickness episode duration. Associations of patient factors with sickness duration outcomes were tested. RESULTS: Mild mental disorder accounted for nearly 40% of certified sickness. Relatively few claimants had their diagnosis changed during a sickness episode. Risk factors for longer-term incapacity included increasing age, social deprivation, mild and severe mental disorder, neoplasm, and congenital illness. For mild mental disorder claimants, age, addiction, and deprivation were risk factors for relatively longer incapacity. For musculoskeletal problems, the development of chronic incapacity was significantly related to the nature of the problem. Back pain claimants were likely to return to work sooner than those with other musculoskeletal problems. CONCLUSIONS: In addition to the presenting diagnosis, a range of factors is associated with the development of chronic incapacity for work, including age and social deprivation. GPs should consider these when negotiating sickness certification with patients.     

Studies in Down''s syndrome

Two series of 88 and 53 patients with Down's syndrome and 91 other mentally retarded patients were investigated for various blood, serum and enzyme groups. No association of trisomy 21 and the following systems and factors was found: ABO, Rh(D), MNSs, K, P, Fy(a, b), Jk(a, b), Gm, (1,2), InV(1), Ag (x), Lp(a), Tf, C3, acP, PGM₁ and GPT. None of these markers was associated with age or the presence or absence of the Au/SH antigen in Down's syndrome or other mentally handicapped patients. Gm(+1) individuals were more frequent among Down and other mentally retarded patients than in normal controls. A decrease of Hp 2 individuals with age was found in the first, but not in the second group of Down patients. A possible association of Au/SH positive and tic 1-1 individuals was found in the first. but not confirmed in the second series of patients with Down's syndrome. The control group of other mentally retarded patients exhibited a helerogeneity according to sex and age in the distribution of Gc phenotypes.