Psychiatric disorders in the mentally retarded: types, problems, and challenges.

Because of their high incidence of CNS impairment and low overall interpersonal coping abilities, retarded persons have a greater than average risk for developing associated psychiatric disorders. The authors describe the types of disorders and their incidence and review allied treatment challenges. Advances in recognition of developmental issues and medical management support the trend toward decreased institutionalization and the concurrent increased normalization of the retarded individual.

Adrenocortical function and depressive illness in mentally retarded patients.

The authors administered a 1-mg dexamethasone suppression test (DST) to 85 institutionalized adults with mild to profound mental retardation after screening to exclude false-positive nonsuppression. Thirty-one (36%) of these subjects had baseline hypercortisolemia, which was significantly correlated with age, symptoms, and "modified" DSM-III criteria for major depressive disorder. Twenty (24%) of the 85 subjects were nonsuppressors (5 micrograms/dl) after testing; nonsuppression was significantly related to age, female sex, level of retardation, symptoms, and "modified" DSM-III criteria for major depressive disorder (sensitivity 41%, specificity 81%). First-order partial correlations maintained significant relationships between age and severity of retardation but not sex. Mental retardation itself did not appear to invalidate the DST.

Vitamin supplements and purported learning enhancement in mentally retarded children.

Dr. Ruth Harrell and her colleagues conducted a study in 1981 in which the administration of high dosages of vitamins were determined to dramatically improve the intellectual functioning of mentally retarded children. This paper documents the efforts of its authors to replicate the Harrell et al. research and, although no significant differences were found between active treatment groups and control groups at study's end, a thorough comparison is made between the two research efforts.

Model services for treatment/management of the mentally retarded-mentally ill.

Mental illness affects nearly 25-30% of America's mentally retarded population. While a small number of these individuals will require institutional care, it is clearly possible to serve the majority in community-based residential settings. This paper will provide an overview of the various types of mental illness found in the mentally retarded population currently served by the Eastern Nebraska Community Office of Retardation (ENCOR), examine the treatment challenges which the provision of services to this special population have presented, and share recommendations as to how the ENCOR model can assist other communities in serving similar complex subpopulations in a developmental and cost-efficient manner.

Future trends in mental retardation.

In summary, the future of retarded citizen in his or her community will encompass the full impact of today's key ideologies in human service, the fruits of research and prevention efforts, and a continuing guest to bring equal rights to a group of citizens who have for too long been termed ""unequal''. Some current key trends in the care of the mentally retarded strongly suggest that they will envolve into postures towards ideology, prevention, treatment-management, advocacy, and economical approaches which will be oriented along the lines of the nine future trends herein presented. A persisting strong advocacy group of parents, interested professionals, and handicapped citizens themselves will keep pushing back the future horizons of help and hope.

The pilot parent program: helping handicapped children through their parents.

The problems of parents whose child is diagnosed or newly identified as mentally retarded or otherwise developmentally delayed are varied and difficult. As many authors have pointed out, the manner in which parents deal with this initial crisis of acceptance can have long term consequences for the parents, the family, and the handicapped child. In the past, neither psychiatry nor the other helping professions did much to provide parents with the elements they need in this profound emotional crisis: continuing emotional support and role modeling, information about the child's handicap, and information about service programs for handicapped persons. The Omaha Nebraska Pilot Parent Program is a volunteer program of parents of handicapped children whose purpose is to provide these supports to parents in need. After seven years such a program appears to provide satisfaction for its members, help to fellow parents, and an important resource to the human services systems in the community.

Delivery of services in rural settings to the elderly mentally retarded-mentally ill.

A number of controversial arguments exist regarding the ability of sparsely populated areas to adequately provide for their elderly mentally retarded; the elements of distance, education, and capital are said to effectively obstruct access to psychiatric and social support. Yet several facts speak soundly for the necessity to overcome these obstacles: a five-fold increase in the life spans of the mentally retarded in recent decades, and the amply demonstrated reality that individuals with mental retardation are nearly twice as likely as the general population to develop severe behavioral disorders. This article examines both the methods and the reasons for ensuring that rural populations of elderly mentally retarded citizens receive modern psychiatric assistance and community support.

Training psychiatric residents in the diagnosis and treatment of mental illness in mentally retarded persons.

A serious shortage of psychiatrists trained to care for mentally retarded patients exists. Based on a successful program that has been in place for more than a decade, the authors offer guidelines for training psychiatric residents in the diagnosis and treatment of mental illness in mentally retarded persons. They describe a model curriculum and suggest ways to modify existing four-year curricula. Special diagnostic skills for working with this population, such as posing questions in concrete terms and ruling out the effects of disabilities like seizure disorders, are reviewed. Important treatment issues include knowing the side effects of neuroleptics and understanding the stages through which families and other caregivers pass in accepting a person's mental retardation.

Mental illness in the mentally retarded: challenges for social work.

A pressing need exists in social work for information concerning the types of mental illnesses encountered in community-based samples of the mentally retarded. These data are valuable in determining which types of social work treatment are effective with this population. This study examines the types and prevalence of mental disorders seen in a community-based sample of retarded citizens, and delineates the types of psychosocial strategies that were effective in treating these disorders. All of the individuals in this study were treated within a community health facility, thereby supporting ongoing social work contributions toward the normalization and commonly-based care of the retarded.