精神发育迟滞犯罪患者辨认能力的多因素分析

本文通过对１３１例精神发育迟滞患者犯罪案例资料分析，揭示了影响其作案时辨认能力的有关因素，并通过判别分析选取了作案类型、平素性格、精神发育迟滞诊断分级、作案时是否伴有精神病、是否受骗及作案动机六个因素为判别因子，建立了评定作案时辨认能力的判别方程。组内回代检查总正确率为８３．２％。     

精神发育迟滞患者性防卫能力评定的相关因素分析

目的探讨影响精神发育迟滞患者的性防卫能力评定的相关因素及社会功能水平对性防卫能力的影响。方法对性侵害案中139例符合CCMD-3精神发育迟滞诊断的性受害者采用自编法医精神病学鉴定案例登记表收集-般资料,使用韦氏智力测试量表（WAIS—RC）测定智商,使用成人智残评定量表和功能大体量表（C．AF）进行社会功能的评定。结果单因素分析有统计学意义9因子中只有文化程度、性知识、索要财物、成人智残量表和GAF评分进入回归方程,且它们影响力大小依次为成人智残量表评分（OR=4．3705）,GAF评分（OR=3．4742）,索要财物（OR=2．1607）,性知识（OR=1．5213）,文化（OR=1．3423）。结论性防卫能力受诸多因素的影响,在性自我防卫能力评定时除充分考虑社会学、法学因素外,尤其要考虑其社会功能的水平。     

110例精神发育迟滞调查分析

作者于１９９０年４月对兰州市某城镇和农村１５岁以上人口进行了精神发育迟滞的流行学调查，共查出精神发育迟滞患者１１０例，患病率２．５７‰，其中男性患病率２．８１‰，女性患病率２．２５‰，两者无显著差异（Ｐ＞０．０５）。城市患病率２．１９‰，农村患病率３．８４‰，以农村显著较高（Ｐ＜０．０１）。在各年龄组中以１５～２９岁组患者为最多。先天性因素所致者较多。家庭经济水平及文化程度低的人群中较多     

精神发育迟滞司法鉴定论文分析

精神发育迟滞司法鉴定论文分析靳跃，谢斌精神发育迟滞（以下简称ＭＲ）在刑事犯罪中越来越引起司法精神病学界的重视，司法鉴定案例数日益增多，有关的论文亦逐年增多，探讨的问题日趋广泛深入。作者拟对自１９８６年以来可以查到的、资料比较齐全的国内有关ＭＲ司法精神...     

精神发育迟滞与性侵害

对精神疾病司法鉴定中精神发育迟滞33例进行了分析,其中性侵害者24例(72.73%)占首位,其它危害行为者仅9例(27.27%)。24例中女性14例均为被强奸者,其中半数为未成年者,30岁以下者达100%,对方均知其智能低下不知告发。女性14例中经评定无性防卫能力者13例;男性10例中无责任能力者4例,有限制责任能力者3例。发生性侵害的主要原因,除智能低下、人格发育不成熟、控制能力差外,对弱智儿童缺乏教育、家庭监护能力差及经济状况不良也是重要的原因。     

128例司法鉴定为精神发育迟滞患者的脑电图分析

分析１２８例司法病鉴定为精神发育迟滞（ＭＲ）患者的脑电图（ＥＥＧ）改变，结果正常９８例（７６．６％），异常２８例（２１．９％），边缘２例（１．５％）。９８例轻度ＭＲ者中，ＥＥＧ正常７９例（８０。６％）。先天性组３３例中，ＥＥＧ异常４例（１２．１％）；后天性组７８例中，ＥＥＧ异常２１例（２６．９％）。才者之间存在显著差异（Ｐ〈０．０５）。暴力犯罪５３例中，ＥＥＧ异常９例（１７％）；非暴力犯罪３９例中     

精神发育迟滞的流行学调查

采用国内十二地区精神疾病流调协作组制订的调查程序和方法，对我市精神疾病进行了流行学抽样调查，结果示：精神发育迟滞患病率为４．０２‰，发病率为０．１４７‰，致残率为１００％；精神发育迟滞患病率可能与遗传、母育令较晚，母孕期服药、饮酒，分娩时难产和出生后高热昏迷及营养不良有关。作者试图从优生优育等方面作一探讨。     

Epilepsy and psychiatric disorder in the mentally retarded adult

302 mentally retarded adults, sampled by epidemiological criteria, were examined with regard to epilepsy and psychiatric disorder. Each of the complications was frequent and related to degree and origin of mental retardation. In 55 (18.2%) epilepsy had occurred at some time during their lives, in 25 (8.3%) of these in the past year. In 52% of persons with seizures in the past year a present state psychiatric diagnosis was established, compared to 26% in those without seizures. The nature of the combination of epilepsy and psychiatric disorder is complex, but in the mentally retarded most often reflecting underlying brain pathology in the form of widespread cortical and subcortical cerebral damage causing epilepsy of generalised or mixed type, and predominantly interictal psychiatric disorders unrelated in time to seizures and dominated by behaviour problems.     

Treatment of psychiatric morbidity in the mentally retarded adult

302 mentally retarded (MR) adults, representative of the total Danish MR population were surveyed for present psychiatric treatment and care. The care was generally satisfactory with the majority living under good conditions and provided with a fairly sufficient level of training and occupational therapy. The psychopharmacological treatment was balanced and performed after modern principles. However, more elaborate psychiatric treatment approaches, such as psychotherapy and behavioural therapy, were only used in very few cases, despite the obvious need. A brief review is given and a guide to the literature on psychiatric treatment in the field of mental retardation.     

The prevalence of psychiatric morbidity in mentally retarded adults

302 mentally retarded adults, sampled by epidemiological criteria, were examined with regard to handicaps, behaviour, skills and psychopathology by use of the MRC HBS-schedule and a list of psychiatric items. Based on research criteria, a computerized psychiatric diagnosis was made on a hierarchial scale. A psychiatric disorder was diagnosed in 85 (27.1%), which is a smaller prevalence rate than found in other studies. Next to behaviour disorder (10.9%), psychosis of uncertain type (5%) was the most common disorder. Dementia and early childhood autism were found equally often (3.6% each). Neurosis was seldom (2%), while schizophrenia (1.3%) and affective disorder (1.7%) occurred at about the same rates as found in similar investigations. No cases of alcohol or drug abuse were found.     

A population-based study on epilepsy in mentally retarded children

PURPOSE: This study presents data on cumulative risk of seizures, cause, comorbidity, and remission of epilepsy among mentally retarded (MR) children followed until the age of 22 years. METHODS: A total of 151 MR children were identified at the age of 8 or 9 years by screening four birth cohorts of 12,882 children born from 1969 to 1972 in the Finnish province of Kuopio. Information about epilepsy was gathered longitudinally when children were 9 to 10, 17, and 22 years old. The guidelines for epidemiological studies on epilepsy proposed by the International League Against Epilepsy were followed. RESULTS: By the age of 10 years, 29 of the 151 MR children (19%) had epilepsy. The cumulative risk for epilepsy at 22 years was 21%. The probability of developing epilepsy was increased fivefold in severely MR children compared with mildly MR children, i.e., in 27 of the 77 severely MR children (35%) versus 5 of the 74 mildly MR children (7%). Postnatal causes of mental retardation or association with cerebral palsy increased the risk for epilepsy, especially in the mildly MR children. When these risk factors were not present, the mildly MR children exhibited only a 3% risk for epilepsy, whereas the respective risk was about 10-fold in severe mental retardation. The cumulative probability of epilepsy being in remission for 5 years by the age of 22 was 32%. CONCLUSIONS: The cumulative risk of epilepsy varies according to the severity and the cause of the retardation as well as the presence of additional disabilities. The cumulative probability of epilepsy remission tended to increase with age.     

Behavioural symptoms and autistic psychosis in the mentally retarded adult

302 mentally retarded (MR) adults, representative of the total Danish MR population, were examined with regard to behavioural symptoms and psychiatric disorder. Deviant behaviour was found in 123 (41%) and was correlated to origin and degree of retardation, epilepsy and place of living. The distribution of the symptoms strongly indicates that organic brain damage is the major etiological cause. By grouping behavioural symptoms on three axes: A: social withdrawal (27%), B: abnormal bodily movements and sensory stimulation (22%) and C: conduct behaviour (17%), different patterns of abnormal behaviour were demonstrated. Behavioural symptoms occurred in 74 (87%) of 85 persons given present state psychiatric diagnoses. Behavioural symptoms are prominent in the group of autistic psychosis (childhood autism), which is classified by the triad of 1) autism, 2) abnormal language, and 3) stereotypic behaviour. This diagnosis was established in 23 (7.6%), and differences in psychopathology are basically determined by degree of intellectual resources, with the subgroup of Kanner's early childhood autism constituting the upper level.     

Alzheimer neuropathology in non-Down's syndrome mentally retarded adults

Summary We examined the brains of 385 mentally retarded adults aged 23–90 years without Down's syndrome (DS), metabolic disorder, or hydrocephalus to extend our knowledge about the occurrence of Alzheimer-type neuropathology in this population. Relevant measures of neuropathology also were related to selected information available from clinical records. The presence of one or more neurofibrillary tangles (NFT) and/or neuritic plaques (NP) was observed in 63.4% of all cases and varied with age. The prevalence of positive cases was higher when mental retardation was due to head trauma, congenital malformation, or familial factors and when a history of seizures was reported. Comprehensive morphometric analyses of neocortical, hippocampal and parahippocampal areas indicated that recommended agespecific quantitative criteria for the diagnosis of Alzheimer disease [Khachaturian ZS (1985) Arch Neurol 42:1097–1105] were met in 9.5% of cases less than 50 years of age, 54.2% between 50 and 65, 70% between 66 and 75, and 87% of the cases greater than 75 years of age. However, a limited immunohistochemical study revealed that in most cases the NP did not have a neuritic component containing paired helical filaments and in this respect most of the plaques observed in this population may differ from those most strongly associated with Alzheimer disease. In addition, substantial numbers of NFT were seen in frontal cortex, contrasting with results reported in the literature for nonretarded populations. The number of NP per mm² consistently increased with age for all areas examined, while the relationship between NFT density and age varied across areas, and was clearly not monotonic. Our studies show that the neuropathological lesions currently considered hallmarks of Alzheimer disease are prevalent among non-DS mentally retarded adults, and the regional density of these lesions is high. Thus, while people with DS are affected at an earlier age, clear Alzheimer neuropathology develops in many mentally retarded individuals.Supported in part by funds from the New York State Office of Mental Retardation and Developmental Disabilitics, as well as by Grant No. PO1 HD 22634, awarded to H. Wisniewski by the National Institutes of Health. Maria Barcikowska is a Visiting Scientist from the Department of Neurology, Medical Academy of Warsaw, Poland and Christian Bancher is a Visiting Scientist from the Neurological Institute, University of Vienna, Austria     

The risk of paradoxical levetiracetam effect is increased in mentally retarded patients

Purpose: Incidental paradoxical antiepileptic effect of levetiracetam has been described. The aim of the present study was to identify the epilepsy patients at risk.
Methods: We performed a retrospective analysis in 207 patients treated with levetiracetam. This entailed evaluation of patient notes and patient interviews. A paradoxical effect was defined as an increased seizure frequency or the experience of more severe seizures including generalized tonic–clonic seizures (GTCS) within 1 month after starting levetiracetam (LEV).
Results: Thirty patients (14%) experienced a paradoxical effect. Eight of them (4%) developed de novo GTCS. We could not demonstrate any association between the paradoxical effect of levetiracetam and type of epilepsy or the antiepileptic comedication used. However we found that the paradoxical effect developed preferentially (p < 0.001) in mentally retarded patients.
Conclusion: Because there is an increased risk of worsening epilepsy when starting levetiracetam treatment of mentally retarded epileptic patients, there is a need for caution and close observation during the first weeks of therapy.     

Alzheimer neuropathology in mentally retarded adults: statistical independence of regional amyloid plaque and neurofibrillary tangle densities

Summary The densities of neurofibrillary tangles (NFT) and neuritic plaques (NP) were assessed quantitatively in the brains of 303 mentally retarded adults 23 to 90 years of age at the time of their deaths (mean=59.5 years). Cases with Down's syndrome, hydrocephalus and metabolic disorders were excluded from the study. Examinations of frontal, temporal, parietal, and occipital cortex, as well as hippocampus and parahippocampal gyrus were made in every case. NPs and/or NFTs were observed within the brains of 163 cases (53.8%). Detailed analyses indicated that NP density within all brain regions examined was positively related to age, with the largest age associated increases in density seen in frontal and temporal regions. In contrast, NFT density increased with age only within hippocampus and parahippocampal gyrus, but not neocortex. In addition, NP lesions within neocortex were more diffusely distributed across regions for older compared to younger cases, while no similar age-associated change in the topography of NFTs was observed. Finally, factor analyses of the combined NP and NFT data indicated that, while strong correlations existed across the various brain regions for measures of NP and NFT densities, considered separately, there was virtually no indication of regional associations between these two types of lesions. While these data, from cases with mental retardation, cannot be generalized directly to the nonretarded population, they provide strong evidence that models of Alzheimer pathogenesis must take into account the fact that regional densities of NPs and NFTs, and, therefore, the underlying processes associated with formation of these lesions, can be largely independent.Supported by funds provided by New York State through its Office of Mental Retardation and Developmental Disabilities as well as by Grants PO1 HD22634, PO1 AGO4220, and R29 HD24170 from the National Institutes of Health     

An unspecified clinical syndrome in mentally retarded patients with bilateral mesial temporal sclerosis

PURPOSE: The association of febrile convulsions and mesial temporal sclerosis (MTS) is a well-known phenomenon. However, the effects of mental retardation on febrile convulsions and MTS have not been investigated previously. The aim of this study is to investigate the relation of mental retardation to febrile convulsions especially as febrile status epilepticus and MTS. METHODS: We describe three patients who have bilateral mesial temporal sclerosis with mental retardation and a history of febrile status epilepticus (FSE), and have clinically typical mesial temporal lobe epilepsy (MTLE). RESULTS: The FRSB and neuropsychology test revealed executive dysfunction in patients whose bilateral MTS had a benign course, which was unexpected. CONCLUSIONS: Febrile status epilepticus might have a role in the development of their mental retardation. This study also pointed out that MTS might have subtypes as a result of our attempts at distinguishing patients with MTS.