Mental Retardation(MR)

Department of psychology The first affiliated hospital of ZZU Huirong guo

Terminology
 In ICD-10 and DSM- the term mental retardation denotes intellectual impairment starting early in life (as distinct from dementia, which is intellectual impairment developing later in life )  Other terms of this condition include mental deficiency, mental subnormality, mental handicap, and most recently, learning difficulties.
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Terminology
 Although the central feature is intellectual impairment, the definition of mental retardation should include social criteria for the practical purpose of distinguishing between people who can and those who cannot lead a near-normal life.  Thus in DSM- the definition of mental retardation includes not only intellectual impairment but also the phrase with concurrent deficits and impairments in adaptive behavior, taking into account the persons age
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Terminology
 Subgroups of mental retardation are recognized according to the degree of impairment:  mild (IQ 50-70)  moderate (IQ 35-49)  severe (IQ 20-34)  and profound (IQ below 20).

Epidemiology
 Among the population aged 15-19,the prevalence of moderate and severe mental retardation is about 3.0 to 4.0 per thousand  The prevalence of mental disorder among the mentally retarded increase with the severity of the retardation  Among people with mild mental retardation the prevalence of mental disorder is similar to that among people of normal intelligence, but among people with severe retardation it is greater
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Clinical features of MR
 the characteristic feature is low performance of all kinds of intellectual functioning including learning, short-term memory, the use of concepts, and problem solving. Sometimes one specific function is impaired more than the rest, for example the use of language  any of the common behavioral problems of childhood
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Types of retardation
 Mild
     IQ50-70 80 percent of all retarded Specific causes uncommon Many need practical help and education Few need special psychiatric or social services

Types of retardation
 Moderate
    IQ 35-49 12 per cent of all retarded Most can manage some independent activities Require special education, occupation, and supervision

Types of retardation
 Severe
     IQ 20-34 7 per cent of all retarded Specific causes usual Social skills severely limited Require close supervision and much practical help

Types of retardation
 Profound
      IQ below 20 1 per cent of all retarded Specific causes usual Very severely disabled Physical problems usual Very poor self-care
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Physical disorders
 Among the severely and profoundly retarded, most have physical problems such as sensory or motor disabilities, or epilepsy. Disorders of hearing or vision are important additional obstacles. Motor disabilities are frequent including spasticity, ataxia, and athetosis

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Psychiatric disorder
 All kinds of psychiatric disorder can occur in the mentally retarded.  Diagnosis is often difficult because symptoms may be modified by low intelligence

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Psychiatric disorder
       Schizophrenia Affective disorder Adjustment disorder and neurosis Personality disorder Organic psychiatric disorder Overactivity and autistic behavior Sexual problems

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Effects of mental retardation on the family

 When a child is found to be retarded shortly after birth, inevitably the parents are distressed. Some parents reject the child at first, though seldom for long.  More often mental retardation is not diagnosed until after the first year of life; the parents may then have even greater changes in their hopes and expectations for the child

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Effects on the family

   

They often experience prolonged depression, with guilt, shame, or anger A few parents reject the child, while others become overinvolved in caring for the child to the detriment of their other children Most parents eventually achieve a satisfactory adjustment, although they are still tempted to overindulge the child However well they adjust psychologically, parents are faced with the prospect of prolonged hard work and social problems. If the child also has a physical handicap, these problems are increased.
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Aetiology
 Mild mental retardation is usually due to a combination of genetic and adverse environment factors  Severe mental retardation is usually due to pathological conditions, of which most can be diagnosed in life and about two thirds before birth.  Both mild and severe retardation are more common in the lower social classes, possibly because of less effective preventive measures
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Aetiology
 General causes  much mild mental retardation represents the lower end of the normal disturbance of intelligence which is mainly determined by polygenic inheritance. Specific genetic abnormalities are responsible for many of the metabolic and other disorders that causes severe retardation. Some of these causes are discussed further below
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Aetiology
 Social factors: low IQ is associated with lower social class, poverty, poor housing, and an unstable family environment  Antenatal damage may be caused by intrauterine infection or toxic substances.  Perinatal damage: the causes include birth injury, kernicterus, and intraventricular hemorrhage. Clinically recognizable brain injuries at birth account for about 10 per cent of mental retardation.
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Aetiology
 Post-natal damage: may be due to injury, infections, and lead intoxication  Malnutrition is a common cause in developing countries, though much less common in developed countries

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Specific causes
 Genetic causes  dominant conditions: neurofibromatosis and tuberose sclerosis are examples of these rare conditions  recessive conditions: this is the largest group of specific disorders and includes most of the inherited metabolic conditions such as phenylketonuria, homocystinuria, and galactosaemia
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Specific causes
 chromosome abnormalities : the most common chromosome abnormality is Downs syndrome. Abnormalities in the number of sex chromosomes, such as Klinefelters syndrome and Turners syndrome, may also cause retardation  sex-linked conditions  conditional known to be inherited but in a less well understood way: such as microcephaly
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Etiology of behavior problems and psychiatric disorder

 genetic, organic, psychological, and social  The genetic causes of psychiatric disorder amongst the mentally retarded seem to unconnected with the genetic causes of retardation, and to be the same as those causing the corresponding psychiatric disorder in people of normal intelligence.
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Etiology of behavior problems and psychiatric disorder

 Organic brain pathology is a common cause of behavior problems in the most several retarded people. There is a particularly close association between epilepsy and behavior disorder, especially hyperkinetic behavior  Psychological causes account for some of the behavioral problems of mentally retarded people. These causes include frustration associated with communication difficulty, inability to acquire social skills, and educational failure.
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Etiology of behavior problems and psychiatric disorder

 Social factors, such as family tensions or bereavement, are important causes of behavior problems in mentally retarded people, just as in people of normal intelligence. An overstimulating environment may cause behavior problems and an understimulating one may lead to withdrawal and self-stimulation

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Assessment
 Severe mental retardation can usually diagnosed in infancy, as it is often associated with physical abnormalities or delayed motor development.  The diagnosis of less severe mental retardation is more difficult because it is based on delays in psychological development

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Assessment
 History taking  Physical examination  Behavioral assessment

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Assessment
 Developmental testing  Overall assessment  Services for the mentally retarded

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Services for mentally retarded

       Prevention Genetic counseling Early detection Ante-natal screening Ante-natal obstetric care Post-natal screening Assessment and periodic reassessment

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Services for mentally retarded

       Advice and support to families Practical help for families Health care Respite admission to hospital Special education, training, and occupation Residential accommodation General medical services

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Treatment of psychiatric disorder in the mentally retarded


similar to that of the same disorder in a patient of normal intelligence  Particular care is needed

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Thank you See you next time