Primary care of adults with mental retardation living in the community

An increased number of adults with mental retardation are living in the community and seeking health care from family physicians. When mentally retarded patients are enrolled in a medical practice, guardianship status should be determined, but these patients should be involved in their own care to as great an extent possible. Since a verbal history may be difficult to obtain, a systematic, thorough physical examination is important. Certain Illnesses, such as hepatitis B, recurrent aspiration syndrome, leukemia and atlantoaxial instability, are much more common in adults with Down syndrome then in adults with mental retardation from other causes. Seizures and mental illness are equally common in all mentally retarded adults. The behavior management and pharmacologic therapy of patients with mental retardation are best handled in close association with caregivers, as well as psychiatrists and neurologists who are familiar with the special needs of this population.     

Cardiovascular risk factor levels in adults with mental retardation

Cardiovascular risk factors in a population of adults with mental retardation were examined. The subjects resided in three types of settings (16+ bed facility, group home, and natural family) and were measured on the following parameters: blood lipids, obesity, and smoking. The data were compared to a nonretarded population and to the guidelines established by the National Cholesterol Education Program. Results indicated that adults with mental retardation had cardiovascular risk profiles similar to those of individuals without mental retardation in the Framingham Offspring Study and that to the extent that cardiovascular health is a concern to the general population, it must also be a concern for individuals with mental retardation.     

Akathisia in adults with mental retardation: development of the Akathisia Ratings of Movement Scale (ARMS)

We developed an akathisia rating scale for use with persons who have mental retardation and screened for the occurrence of akathisia in three samples: 66 adults receiving maintenance neuroleptic treatment, 20 adults not receiving neuroleptics, and 8 adults undergoing neuroleptic dose reduction. The scale had an acceptable level of interrater reliability and validly measured group differences related to neuroleptic treatment status. Using an empirically derived cut-off-score, we estimated the prevalence rate for akathisia to be 5% in neuroleptic-free subjects, 17% in neuroleptic-maintenance subjects, and 25% in neuroleptic-reduction subjects. Akathisia, dyskinesia, and stereotypy manifested as qualitatively different movement topograhies. The occurrence of dyskinesia stereotyped movement disorder was associated significantly with an increased occurrence of akathisia.     

Evaluation of a sexual abuse prevention program for adults with mental retardation

We have measured the Fourier transform spectrum of natural OCS from 3700 to 4800 cm-1 with a near Doppler resolution and a line-position accuracy between 4 and 8 x 10(-5) cm-1. For the normal isotopic species, 37 vibrational transitions have been analyzed for both frequencies and intensities. We also report 15 bands of OC34S, eight bands of O13CS, nine bands of OC33S, and two bands of 18OCS. Important effective Herman-Wallis terms are explained on the basis of eigenvectors. A comparison of different line-pointing programs is also presented. Copyright 1998 Academic Press.     

Do behavior changes herald physical illness in adults with mental retardation?

Nitric oxide (NO) is a major candidate in vagal-induced LOS relaxation. Vagal adrenergic fibres also innervate the gastrointestinal tract including the LOS. This study investigates the role of these two and other mechanisms in LOS responses to vagal activation in the rat, and provides functional and anatomical evidence for a smooth muscle LOS in this species. LOS, gastric and oesophageal pressures were measured in urethane anaesthetized rats during vagal stimulation. The LOS pressure (LOSP) response to Vagal stimulation (5 mA, 10 Hz, 0.5 msec pulses, 5 sec) comprised three consecutive stages: (1) brief reduction of LOSP, (2) transient increase of LOSP and (3) prolonged reduction of LOSP. The influences of additive treatment with several antagonist drugs on the LOS response to vagal stimulation were investigated. L-NAME (100 mg kg-1) reduced stage 1 and increased stage 2. Subsequent treatment with either phentolamine (1 mg kg-1) or prazosin (200 micrograms kg-1) abolished stage 1. After phentolamine, atropine treatment (400 micrograms kg-1) abolished stage 2. Stage 3 was evident throughout experiments. In five additional studies, treatment with hexamethonium (30 mg kg-1) abolished stages 2 and 3 leaving stage 1, which was later abolished by phentolamine or atropine. In the LOS response to vagal stimulation, the following major mechanisms are therefore evident: nicotinic transmission in both excitation and inhibition, alpha-adrenergic and NO-mediated inhibition, muscarinic excitation, and non-adrenergic, non-NO inhibition (not characterized further). Characteristics of these different neurotransmitter influences may be important in LOS relaxation associated with swallowing and gastro-oesophageal reflux.     

Architectural acoustics in residences for adults with mental retardation and its relation to perceived homelikeness

Previous investigators examined how architectural features of residences for adults with mental retardation contributed to the visual appearance of homelikeness. Acoustical characteristics of 18 residences for people with mental retardation were examined here. As part of a concurrent study, college undergraduates rated photographs of rooms in each house for their apparent homelikeness. Reverberation times in living and dining rooms were negatively correlated with mean homelikeness ratings. The less homelike rooms had reverberation times that may interfere with speech perception for some people and that were comparable with those found in larger public rooms (e.g., lecture halls). The larger reverberation times in these rooms were the result of insufficient sound absorption by these rooms' furnishings.     

Growth differences associated with compulsive and stereotyped behavior disorders in adults with mental retardation

Oxidized-low density lipoprotein (ox-LDL) exhibits various atherogenic properties, such as the formation of foam cells, the recruitment of macrophages into arteries, the promotion of cell growth, the formation of thrombi, and the development of vasoconstriction. Antioxidants inhibit atherosclerosis in cholesterol-fed animals by preventing the recruitment of macrophages into the arteries suggesting that oxidation is important for such recruitment of macrophages, and that it is responsible for early development of atherosclerosis. Calcification and an increase in extracellular matrix (ECM) are frequently observed in advanced atherosclerosis. These processes are active and regulated, not passive and degenerative, and do not appear to be controlled by ox-LDL. The control of calcifications and ECM increase will provide new directions in the treatment of atherosclerosis especially in the advanced stages. Future treatment should include strategies to inhibit the calcification and the increase in ECM.     

A closer look at interpersonal decision-making in adults with and without mental retardation

Two experiments were conducted to examine the interpersonal decision-making performance of women and men with and without mental retardation. In Experiment 1, adults with mental retardation listened to either short or long vignettes depicting situations in which a female or male protagonist was faced with a decision involving either a peer or authority figure. In Experiment 2, adults without mental retardation were presented with long versions of the vignettes. As expected, the task was considerably more difficult for the participants with mental retardation, possibly because of differences in their ability to fully comprehend the social situations. Women in both studies outperformed men. Results suggest that emotional and motivational factors may have contributed to these differences.     

Supported employment for adults with psychiatric disability: Results of an innovative demonstration project.

Describes an innovative 3-yr research and demonstration project evaluating a supported employment program on a university campus designed specifically for persons with psychiatric disability. The vocational status, job satisfaction, work integration, symptomatology, and social supports of 20 Ss were assessed during the project, and a 2-yr follow-up of employment status was conducted. While a university setting was ideal for providing supported employment services for persons with psychiatric disabilities, the university itself was not a particularly receptive or compatible employer. The 2-yr follow-up showed that 10 Ss were employed an average of 17.5 hrs per week with mean earnings of $156 per week, representing a modest increase in percentage of Ss employed, and a substantial increase in average hours worked and average wages earned. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual diagnosis: prevalence of psychiatric disorders in a large state residential facility for individuals with mental retardation

The prevalence of psychiatric disorders in a large residential population (N = 1,273) of individuals with mental retardation was examined. We found that the point prevalence rate for dual diagnoses based on DSM-III-R criteria was 15.55% (n = 198). Rates for specific psychiatric disorders were also provided by level of retardation and sex. Results were compared to similar epidemiological studies and discussed in light of factors hypothesized to affect diagnosis of psychiatric disorders among individuals with mental retardation.     

A comparison of coping strategies of aging mothers of adults with mental illness or mental retardation.

Differences in coping by 105 aging mothers of adults with mental illness and 389 similar mothers of adults with mental retardation were investigated. Although no differences in problem-focused coping were found, mothers of adults with mental illness used more emotion-focused coping, which predicted greater maternal depression. For mothers of adults with retardation, depressive symptoms were a function of their child's behavior problems, although this source of stress was buffered by coping. For mothers of adults with mental illness, depression was a function of caregiving demands, but coping did not buffer the effects of stress. Explanations for findings include maternal perceptions of the context of care, of her control over the disability, and her caregiving efficacy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Validity of informants' ratings of the behavior and symptoms of psychiatric patients.

Rated 138 psychiatric patients with respect to symptoms and behavior by their nearest relative and also by a nurse after admission to a psychiatric hospital. Data on admissions were analyzed by computing r's between 12 family rating scale clusters and 4 ward behavior factors and by canonical correlations between the 2 sets of data. The canonical analysis indicated there were 2 underlying factors accounting for the intercorrelations among the 2 sets of ratings. Results of both analyses provided support for the validity of relatives' ratings of psychiatric symptoms and behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caregiving outcomes for older mothers of adults with mental retardation: A test of the two-factor model of psychological well-being.

A two-factor model of caregiving appraisal and psychological well-being, based on previous findings with caregiving spouses (M. P. Lawton et al; see record 1991-34214-001) was tested with 225 older mothers who provided care at home to an offspring with mental retardation The effects of objective caregiving stressors, caregiver resources, and subjective appraisals (caregiving satisfaction and burden) on the positive and negative dimensions of psychological well-being were examined. LISREL 8 analyses revealed that the model differed in two key ways for caregiving mothers: (a) Positive psychological well-being appeared to diminish subjective burden, and (b) both objective stressors and resources were unrelated to subjective burden. These findings suggest the need for future research into how caregiving dynamics are influenced by the specific nature of the relationship between the caregiver and the recipient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of mental retardation in patients with hereditary retinoblastoma

Transvaginal amniotic puncture (TAP) was performed on 20 consecutive missed abortions immediately prior to dilatation and evacuation and the cytogenetic results compared. The information received from products of conception (POC) and TAP was in concordance in only 5 of 20 (25%) cases. Tissue obtained from POC yielded cells in all instances. However, only 3 of 20 POC samples yielded findings other than normal female. In contrast, 92.8% of the conclusive diagnoses would have been achieved by TAP alone. These data strongly suggest that TAP is superior to POC for accurate cytogenetic assessment of missed abortion and should lead to a reevaluation of our current understanding and management of pregnancy loss.     

Use of advance directives: facilitating health care decisions by adults with mental retardation and their families

As increasing numbers of adults with mental retardation survive into adulthood and old age, they may face decisions about their health care and end-of-life treatment. Advance directives may serve as a tool for communicating one's preferences about future medical treatment. Information about the types, extent of use, and ethical context of advanced directives is provided and four critical issues regarding use of advanced directives by adults with mental retardation and their families are examined: assessment of decision-making capacity, standards for surrogate decision-making, family involvement in advanced directives planning, and constraints on the use of advanced directives. Implications for professionals are discussed, including ways to facilitate advance care planning.     

Effects of disability and bereavement on the mental health and recovery of older adults.

We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60–80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role for animal research in the investigation of human mental retardation

Themes central to sex-role socialization are traced, along with the processes by which dominance and female deference are developed. Gender differences in parent-child interactions, peer-group relations, classroom settings, children's observations of the marital dyad, and messages from television are examined. The link between sex-role socialization and the etiology and maintenance of wife abuse is discussed.     

Validity of the Psychological Screening Inventory for psychiatric screening.

Administered the Psychological Screening Inventory to 126 adult psychiatric outpatients. Responses were scored using R. I. Lanyon's clinical scales and J. E. Overall's recently derived factor scoring keys. Responses of 800 normal adults were similarly scored by the 2 methods. Discriminant function analysis revealed 18% misclassification for clinical scale scoring and 22% misclassification for factor scoring. The hit rates are considered appropriately high in view of criterion uncertainty. As in similar studies with other instruments, factor analysis did not provide a superior basis for discriminant validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)