Mental impairment in the West Midlands.

The case records of 55 people from the West Midlands (UK) fulfilling the Mental Health Act 1983 criteria for mental impairment or severe mental impairment, were studied. Most were young men with mild mental retardation. 73 per cent were resident in (or on leave from) mental handicap hospitals, and 27 per cent resident in special hospitals. 29 per cent were subject to a Restriction Order. Most had lived in hospital for more than six years. The commonest problem behaviours were aggression, property offences and inappropriate or offending sexual behaviour. 31 per cent were mentally ill or had a past history of mental illness. A diverse range of services appears necessary to meet the needs of this group of people.

Emotional and behavioural aspects of Rett syndrome.

A survey of 107 families of children with Rett syndrome was conducted to further define the behavioural phenotype. There was a high prevalence of behavioural and emotional problems, including episodes of anxiety (76 per cent), low mood (70 per cent) and self-injurious behaviour (49 per cent). Although there was no significant difference across the age-ranges studied, there was a tendency towards a reduction in these problems with increasing age, suggesting that the behavioural phenotype in Rett syndrome varies with age. Epilepsy occurred in over half the children, but there was no clear association with behavioural and emotional problems. A number of families had established strategies for coping with their child's anxiety and mood changes.

Worsening of pica as a symptom of depressive illness in a person with severe mental handicap.

The case of a person with severe mental handicap whose pica became uncontrollable during episodes of depressive illness is described. Treatment of the depression with lofepramine markedly reduced the pica, and withdrawal of lofepramine led to recurrence. It is suggested that biological symptoms of depression should be monitored in people with severe mental handicap who show significant episodic worsening of long-standing repetitive behaviour.

Podiatric disorders among children with Down syndrome and learning disability.

This study investigated podiatric pathology in seven- to 14-year-old children with Down syndrome (DS) and non-Down syndrome learning-disabled and non-learning-disabled age-matched controls. Several conditions, including pes planus, fissures, split toenails, increased plantar flexed first ray and a wide hallucal cleft were found to be more common in the DS group. Pes cavus and foot rigidity were more common in the non-DS learning-disabled group. In all groups the majority of children wore laced shoes, which were most ill-fitting among children with a learning disability. Approximately one-third in each group had abnormal foot-pressure prints. Greater care and professional awareness of podiatric pathology in children with learning disability is recommended.

Deletion of chromosome 2 (p11-p13): case report and review.

The case of a young man with del(2) (p11.2p13) is reported. Accounts of previous cases of deletion of the short arm of chromosome 2 are reviewed. Common features include mental retardation, proportional short stature and weight, dysmorphic facial features (a prominent nose, abnormal ears), and abnormal hands. Growth and developmental delay are present during the postnatal period.

Partial trisomy 22 (q11.2-q13.1) as a result of duplication and pericentric inversion.

A case of a 27 year old male with a duplication of part of the long arm of chromosome 22 (22q11.2-q13.1) together with a pericentric inversion of the same chromosome is reported. Particular phenotypic features of note include absence of speech, persistent self-injury, lack of daily living skills, colobomata, and very poor vision. Similarities between this case and other case reports of duplications of the long arm of chromosome 22 are discussed.