Defectives working in the community.
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Adolescent↗
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Results for “EDUCATION OF MENTALLY DEFECTIVE”
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Course, prognosis and complications of childhood-onset myotonic dystrophy.
The outcome for 71 patients with childhood-onset myotonic dystrophy was examined. In addition to 18 patients with later onset, but presenting in childhood, and 46 with the congenital form, seven patients from congenital sibships who did not present in the neonatal period were found to have myotonic dystrophy of intermediate severity. The incidence of the congenital form in South Wales was six per 100,000. In all groups the mortality rate was low after the perinatal period. The prognosis for normal family life and ultimate gainful employment was poor. Testicular atrophy in congenitally affected males was evident at puberty, and there was a high incidence of gastro-intestinal problems. The contributions of deafness as a result of recurrent otitis, and of severe articulation defects, should be considered when assessing the degree of mental handicap.
Adolescent↗
Figure connection test: a universal test for assessment of mental state.
The number connection test (NCT), which assesses the extent of organic brain damage, has been used extensively to evaluate mental state in portasystemic encephalopathy, but has certain inherent limitations. It cannot be performed by illiterates and those unfamiliar with Roman alphanumeric notations. We, therefore, devised a figure connection test (FCT) based on the subject's identification of figures rather than alphabets or numerals. Four variations each of FCT-A (A1-A4) and FCT-B (B1-B4) employing different motifs were developed and compared with four variations each of NCT-A (A1-A4) and NCT-B (B1-B4) in groups of healthy volunteers with differing educational status. These volunteer groups were as follows: postgraduates 64; graduates 66; subgraduates 75; and illiterates 45. Significant differences in mean scores of various tests were observed between these normal groups. Control values of the tests for these groups have been standardized and can serve as nomograms. The effect of educational attainments on performance of FCT and other psychometric tests was analysed and trail-making tests were validated for serial use. The FCT was then prospectively validated on 70 patients (classified for comparison with controls according to educational status as follows: postgraduates 7; graduates 21; subgraduates 32; and illiterates 10) with cirrhosis of liver without over encephalopathy, to detect subclinical hepatic encephalopathy. NCT-A was abnormal in 31.7%, NCT-B in 38.3%, FCT-A in 42.9% and FCT-B in 28.6% of patients. Taken together these tests diagnosed subclinical hepatic encephalopathy in 34 (48.5%) patients. We conclude that FCT is as useful as NCT in detecting psychomotor performance defects in cirrhotic patients without overt encephalopathy.
Adult↗
Verbal memory impairment in COPD: its mechanisms and clinical relevance.
STUDY OBJECTIVES: Identification of mechanisms accounting for verbal memory impairment in patients with severe COPD; assessing the relationship between verbal memory and the overall cognitive performance; verifying if verbal memory impairment affects medication adherence. DESIGN: Case-comparison study. SETTING: Outpatient Departments of Pneumology and Neurology, Day Hospital of General Surgery. PATIENTS: Forty-two COPD ambulatory patients, age 70+/-9.7 years, with hypoxemia and hypercarbia (group A); 27 normal subjects of comparable age and educational level (group B); 31 patients with Alzheimer's disease (group C); and 26 older normal subjects (group D). MEASUREMENTS AND RESULTS: The overall cognitive function and verbal memory were evaluated by the Mental Deterioration Battery and 14 indexes of verbal memory. Defective retrieval and recognition mechanisms distinguished group A from group B. According to discriminant analysis, verbal memory profile of COPD patients was group specific in 38.1% of cases and conformed to that of group B, C, and D in 19%, 16.7%, and 26.2% of cases, respectively. In COPD patients, both immediate and delayed recall, the strongest determinants of the discriminant function, were significantly correlated with the overall cognitive performance (rho=0.64, p=0.001; rho=0.61, p=0.001, respectively). Poor adherence to medication regimen was significantly associated with abnormal delayed recall score (82.3% vs 36% in subjects with normal delayed recall, p<0.008). CONCLUSIONS: Decline of verbal memory parallels that of the overall cognitive function in COPD patients and is due to the impairment of both active recall and passive recognition of learned material. It could be an important determinant of the level of medication adherence.
Aged↗
Training and placement of defectives in a residential school through the division of vocational rehabilitation.
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Education of Persons with Intellectual Disabilitie↗
Representational development of the human figure in familial retardates.
Representational development of the human figure of normal and familially retarded children was examined. Five tasks were employed: Drawing a Person, Figure Completion, two Form Puzzles, and Drawing on Dictation. Ss included 34 normal children, ages 3-0 to 5-10, and 34 familially retarded children, ages 4-4 to 13-1. The two groups were matched for mental age, socioeconomic status, public school attendance, and intact family structure. Results indicate that familial retardates performed as well as normals and at times surpassed them. Performance on these representational tasks is, predominantly, a function of mental age which lends support to a "developmental" theory of familial retardation and refutes the "defect" hypothesis.
Adolescent↗
Use of flow-charts by nurses dealing with mental patients: an evaluation in Lesotho.
General nurses without previous training in psychiatry were instructed, over a period of thirteen hours, in the use of eight flow-charts for the identification and management of mental health conditions. They then prepared management plans, with the aid of the flowcharts, for 105 patients with suspected mental health problems who were seen in three outpatient clinics. The same patients were also seen by trained mental health workers who made a diagnosis and wrote up a management plan, which subsequently was compared with the management plans devised by the nurses.Seventy-eight of the 105 patients (74%) were identified and treated correctly by the nurses. A total of 32 mistakes were made, 17 of which were due to the nurses and 15 to defects in the flow-charts. On the basis of these findings, suggestions are made for improvements in the flow-charts and in the way the nurses are instructed in their use.
Algorithms↗
A clinical clerkship in psychiatry.
A clinical clerkship was organized around the goal of teaching information and skills that would be needed by the nonpsychiatrist physician. In most clinical clerkships the students work on an inpatient service. In the clerkship described here the setting is an outpatient clinic, which provides a more relevant experience. Videotaped psychiatric interviews are used extensively and have been found to provide a valuable teaching format. They are effective in holding student interest, in avoiding the practical difficulties of live interviews, and in teaching active listening and interviewing technique, as well as in demonstrating a variety of psychopathology. Field trips to state psychiatric hospitals, institutions for mental defectives, clinics for treating alcoholics or addicts, and other mental health facilities have been used but have not been found to be a very valuable part of the program.
Education, Medical, Undergraduate↗
Visual memory and auditory recall in anatomy students.
The performance of medical students in anatomy assessments of the spot, viva and essay type were compared with their performance in visual memory and auditory recall tests. The results demonstrate that defects in visual memory might be a contributory factor to poor performance in anatomy.
Anatomy↗
Prevention of congenital toxoplasmosis.
In utero infection with Toxoplasma gondii may result in congenital defects such as hydrocephalus, chorioretinitis and mental retardation; these defects may be present at birth or may develop later in life. Prevention of this disease can be achieved in different ways. The most effective measure is to prevent the acquisition of the disease during pregnancy by avoiding risk factors for Toxoplasma gondii infection. Health education may decrease the incidence of toxoplasmosis during pregnancy by 60%. A second preventive measure is based on serologic screening during pregnancy to identify infected women. Treatment during pregnancy results in a significant reduction in the incidence of sequelae including severe handicaps. A third possible intervention is treating infected neonates. Antibiotic treatment of infected children has a beneficial effect on the development of sequelae and the sooner therapy is started after birth, the better the outcome. This overview presents the potential benefits and harms of these different options available for the prevention of congenital toxoplasmosis.
Animals↗
Long-term outcome for children with congenital heart defects. A study from 1 year birth cohort born in 1966 in northern Finland.
The incidence of congenital heart defects (CHD) in a birth cohort of 12,058 live births born in Northern Finland in 1966 was 4.15/1000 with a mortality due to CHD 1.41/1000 up to 14 years of age. The long-term social and educational outcome for CHD children was significantly poorer than for normal children of the same age when evaluated on the basis of school and army service records, and the incidence of cerebral palsy, epilepsy and mental retardation was significantly higher. 15.4% of the Down's syndrome cases in the cohort also had CHD. The CHD boys were significantly lighter in weight than the controls even as adolescents (14 years of age). The only difference between the operated and non-operated group was the higher weight of the boys at the age of 18 years in the former.
Adolescent↗
FAS/FAE: impact on children.
Alcohol is a teratogen and it can cause lasting birth defects called Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE). FAS is one of the leading causes of mental retardation. FAS/FAE can result in a myriad of behavioral, learning and developmental problems. There are estimates of 12,000 new cases of FAS yearly. The school nurse plays an important advocacy and educational role in helping the child with FAS. Family involvement is important for the child with FAS.
Child↗
[Deviant behavior of epileptic children].
The main clinical forms of deviant behaviour observed in 300 epileptic children are presented. Behavioural deviations in children are considered as a result of brain organic damage or educational defect or a combination of these factors. Ways for medical and pedagogical correction of deviant behaviour in this group of patients are outlined.
Adolescent↗
The problem of the mentally defective child.
Continued effort is necessary not only to prevent mental deficiency but to find methods of treating it. Meanwhile, physicians must have a keener appreciation of the feelings of the parents about their retarded children and must interpret the implications of the problems in a way the parents can understand. Further community effort is necessary to provide institutional and foster home care for those who need it. Educational and training programs should be extended and developed for all those who can benefit from such programs. The problem of mental deficiency is not that of the parents alone, nor of physicians, nor of the psychologists, nor of the social workers, nor of the educators. It is a problem which requires the cooperation of all these groups for solution.
Child↗
Fetal alcohol syndrome: the nurse practitioner perspective.
Fetal alcohol syndrome is the leading cause of mental retardation in the United States. The tragedy is that while FAS is irreversible, it is 100% preventable. FAS is caused by maternal consumption of alcohol during pregnancy. Alcohol is a teratogen and acts in different ways to produce physical and central nervous system malformations and defects in the developing embryo and fetus. FAS is characterized by a history of maternal alcohol ingestion, central nervous system dysfunction, growth deficiencies, and specific physical anomalies. Adolescents and adults with FAS have behavioral problems that differentiate them from other mentally disabled individuals. Nurse practitioners can have an impact on the prevalence of FAS by educating clients about FAS and its relationship to alcohol consumption. NPs need to carefully identify high-risk women and their partners before a pregnancy occurs and assist with interventions to stop active alcoholism or alcohol use during pregnancy. NPs have the capability to decrease the severity of alcohol's effects during pregnancy through education, counseling, and intervention. NPs have the skills to work with case-finding and early identification of infants and children who display signs and symptoms of FAS. With such case-finding, early identification, and prompt referral to the appropriate diagnostic and/or supportive community agencies, individuals with FAS can receive timely intervention to minimize the effects of FAS. Adults with behavioral problems can be assessed for FAS and referred for appropriate assistance as well. Finally, NPs can facilitate public awareness of FAS through educational efforts with individuals, families, and communities.
Adult↗
The place, if any, of the mental hospital in the community mental health care system.
We have touched on the nature of mental disorders in the elderly, the systems of care now in use, described briefly some models of good programs and highlighted some of the defects in the health care delivery system. Patients over 65 comprise 4% of the admissions to community mental health centers, 4% of those admitted to outpatient departments, 5% of admissions to state and county mental hospitals (28% of the resident population), 7% of admissions to general hospitals and 10% of private hospitals admissions (U.S. Department of Health, Education and Welfare, 1980). Private and public mental hospitals have a positive role to play in the care of mental disorders in patients over 65 in the decade of the 1980s. Private mental hospitals provide geriatric programs for the acute disorders as well as the chronic. Mental hospitals provide a needed back-up function for community agencies and other institutions. They also provide care for patients with severe chronic psychoses, who are too disturbed for community placement. These are usually patients who have grown old in the institution. The hospitals care for remitting illness in patients who prefer to return for treatment with staff familiar with their therapy. The mental hospital also can provide 24-hour care for patients for whom day treatment does not suffice and for respite episodes also. The mental hospital is currently needed, and this need will continue throughout the decade of the 1980s, until community alternatives are in place and have proven able to care for all types of illness without a back-up facility, and demonstrations have proven such programs are economically feasible.
Aged↗
Leber's congenital amaurosis. Is mental retardation a frequent associated defect?
Thirty-one patients had Leber's congenital amaurosis. Only one was severely retarded, and three demonstrated hypoplasia of the cerebellar vermis on computed tomographic scanning. These findings are in contrast to those of previous investigators, who have emphasized the high incidence of psychomotor retardation associated with Leber's amaurosis. Much of the psychomotor retardation that has been reported is probably secondary to the sensory deprivation and not necessarily a sign of structural CNS dysfunction. The diagnosis of Leber's congenital amaurosis does not, therefore, portend severe intellectual impairment and poor educability.
Blindness↗
[Care of the mentally defective in Finland].
In Finland the organisation for the rehabilitation of those of retarded development is independent and total, It includes all special welfare needs. Its main objects are the normalisation and integration of those of retarded development into society; this means creating personal and social opportunities for them and helping them in many ways to facilitate thier integration into society.
Education of Persons with Intellectual Disabilitie↗