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Biomedical subjects

R Sovner

Publications and source records attributed to R Sovner.

At least 19 recordsLinked to original sources
PubMed1996

Irritability and Mental Retardation.

Irritability is a persistent and unpleasant mood state characterized by low frustration tolerance, hostility, impulsivity, and aggression. It may be a normal response to stress or reflect significant central nervous system (CNS) dysfuntion, eg, dementia. There are 15 Diagnostic and Statistical Manual-IV-defined disorders in which irritability is either a diagnostic or associated feature. Evidence from animal and human studies indicates that pathological irritability reflects limbic system dysfunction with a central dysregulation of serotonergic inhibition of dopaminergic activity. In mentally retarded person, irritability may be a mediator of aggression and self-injury associated with psychiatric disorders such as depression and mania. In addition, it has been reported in persons with severe and profound disabilities who have had significant CNS disease such as congenital rubella. There is evidence that an "organic irritability syndrom" exists which is characterized by persistent irritable mood in conjunction with hyperactivity and/or disrupted sleep. Patients with organic irritability lack the typical hyposomnia and pressured verbalizations associated with mania. When irritability is associated with a drug-responsive psychiatric illness, it usually remits with treatment directed at the underlying syndrome. When it is associated with CNS dysfunction in the absence of a classic psychiatric disorder, dopamine receptor antagonism and/or CNS 5-hydroxytryptamine (5-HT) activity are the typical strategies. Carbamazepine, lithium, serotonin reuptake inhibitors, and typical and atypical neuroleptics have been the most commonly used drugs and all been reported to be effective in moderating irritability. Unfortunately, there are few controlled trials to aid in treatment selecton.

Journal Article↗
PubMed1996

Ring chromosome 22 and mood disorders.

The case of a 21-year-old man with severe developmental disabilities, ring chromosome 22 and rapid-cycling bipolar illness is presented. This is the first reported occurrence of mood disorder in a person with ring chromosome 22. Previously published case reports describing behavioural problems associated with this chromosome disorder suggest that severe hyperactivity is typical and that affected individuals may have an excited mood state. These symptoms are consistent with atypical bipolar disorder and raise the possibility that ring chromosome 22 increases the risk for atypical bipolar disorder.

Adult↗
PubMed1995

Six cases of patients with mental retardation who have antisocial personality disorder.

Evidence that antisocial personality disorder occurs in association with mental retardation is presented through case reports of six mildly to moderately retarded men who received a diagnosis of antisocial personality disorder. The men were identified when referred by care providers for more thorough psychological and psychiatric assessments. Their histories were marked by thefts, rapes, multiple assaults, arson, and other predatory acts; a lack of remorse for such actions; criminal charges; and predisposing factors such as an impoverished family. Only one man had received the diagnosis of antisocial personality disorder before the assessments, suggesting that clinicians are reluctant to find sociopathic behavior clinically significant in the presence of mental retardation.

Adult↗
PubMed1995

Thioridazine withdrawal-induced behavioral deterioration treated with clonidine: two case reports.

Neuroleptic withdrawal reactions have significant clinical and medicolegal implications for individuals with developmental disabilities. Behavioral deterioration following neuroleptic taper can represent (a) relapse of a mental illness, (b) and anticholinergic rebound reaction, (c) tardive akathisia, and (d) possibly a supersensitivity psychosis. Such reactions may preclude the discontinuation of neuroleptic drug therapy, even in the absence of a drug-responsive psychiatric illness. In this report, the case histories of two individuals who experienced a thioridazine (Mellaril) withdrawal-induced behavioral deterioration were presented. Both reactions were characterized by anxiety and insomnia, and the patients' symptoms were relieved by uncontrolled treatment with clonidine (Catapres) therapy. Evidence for adrenergic hyperactivity as a mediating event was presented.

Administration, Cutaneous↗
PubMed1993

Fluoxetine treatment of depression and associated self-injury in two adults with mental retardation.

The use of fluoxetine to treat chronic depression and associated self-injurious behaviour (SIB) in a woman with severe mental retardation and a man with profound mental retardation is reported. In the first case, behavioural monitoring of treatment response revealed a dramatic decrease in SIB and a normalization of the woman's sleep disturbance. In the second case, SIB and the use of mechanical restraint decreased substantially. In both cases, anecdotal reports also indicated a diminution of other depressive symptoms. These cases highlight the need to consider an affective disorder as a cause of SIB in persons with severe and profound developmental disabilities. The behaviour monitoring system proved to be a practical aid in the diagnosis of depression and evaluation of antidepressant treatment in individuals who were incapable of self-report.

Adult↗
PubMed1992

Severe behaviour problems associated with rapid cycling bipolar disorder in two adults with profound mental retardation.

The authors report the clinical histories of two adults with profound mental retardation, features of rapid cycling bipolar disorder, and periodic maladaptive behaviour. In each case, primary features of mania and depression were identified, operationally defined and measured with an ongoing data system, which was used to track SIB and aggression. In the first case, data analysis across days showed that 1-week episodes of depressive features alternated with 2-week episodes of manic features and that SIB was only associated with the depressive features. In the second case, episodes of manic and depressive features alternated every few days, and aggression was only associated with the manic features. These cases suggest that severe behaviour problems can be a state-dependent phenomenon of bipolar disorder. The behaviour monitoring system provided an objective methodology for aiding in the diagnosis of bipolar disorder with profoundly handicapped adults.

Activities of Daily Living↗
PubMed1992

The treatment of a chronic organic mental disorder with dextromethorphan in a man with severe mental retardation.

Response to dextromethorphan (15 mg b.i.d.), an antitussive agent not usually considered to have psychotropic properties, was seen in a 25-year-old man with severe developmental disabilities, congenital rubella, and an organic mental disorder. Dextromethorphan affects CNS serotonergic systems, and this was the probable therapeutic mechanism. This and other published cases suggest the existence of a distinct organic mental syndrome in developmentally disabled persons which responds to drugs that increase indoleaminergic activity.

Adult↗
PubMed1991

A factor analytic study of the Diagnostic Assessment for the Severely Handicapped Scale.

Five hundred six severe and profoundly mentally retarded persons (247 women and 259 men) from Wisconsin and Louisiana were assessed on the Diagnostic Assessment for the Severely Handicapped Scale. A factor analysis yielded six factor scales: tantrums, aggression/conduct, language disorder/verbal aggression, social withdrawal/stereotypy, eating disorders, and sleep disorders. These data demonstrate a nosology of symptoms loading more heavily on vegetative symptoms than what is evident with persons in the mild and moderate ranges of mental retardation and persons who are not mentally retarded. The implications of these findings are discussed.

Activities of Daily Living↗
PubMed1991

A scale for evaluating emotional disorders in severely and profoundly mentally retarded persons. Development of the Diagnostic Assessment for the Severely Handicapped (DASH) scale.

The DASH scale was used to assess 506 profoundly and severely mentally retarded persons (247 females and 259 males). The scale, covering 13 major psychiatric disorders, consists of 83 items derived from DSM-III-R as well as previously published studies of this population. Data were collected on symptom frequency, duration and severity in individual interviews with direct-care staff. Elimination and pervasive developmental disorders were most frequent, self-injurious behaviour disorders most severe. Most symptoms had been evident for at least a year. Inter-rater reliability was generally good.

Adult↗
PubMed1991

Buspirone treatment of aggression and anxiety in mentally retarded patients: a multiple-baseline, placebo lead-in study.

Buspirone, a new anxiolytic agent, was used in a multiple-baseline, placebo lead-in study for the treatment of aggression and anxiety in six mentally retarded adult patients. The findings demonstrate buspirone's effectiveness in reducing aggression and anxiety in a mentally retarded group of subjects without causing deleterious cognitive side effects. The authors review a body of literature on animal and human subjects where buspirone was used in the treatment of aggression and other mental disorders. Unlike neuroleptics and benzodiazepines, buspirone does not cause sedation which can compromise adaptive and intellectual capacities and thus reduce the patient's potential to benefit from training programs.

Adult↗