Mental retardation with anxiety disorders

Trichotillomania, listed in the DSM-IV under Impulse Control Disorders Not Elsewhere Classified ( 252), is characterized by impulses to pull out one s hair, often involving multiple sites (scalp, eyebrows, and eyelashes commonly pubic, axillary, chest, and rectal areas less commonly) ( 253). Some clinicians have proposed that this condition is a variant of OCD, based on similarities in phenomenology, family history, and response to treatment. Originally thought to occur more frequently in females, it has become evident that it may affect males just as often. Many victims of this disorder have histories beginning in childhood and refractoriness to all attempted remedies. Co-morbidity of trichotillomania with mood, anxiety, substance abuse, and eating disorders is also common (254). Others have noted that trichotillomania may also coexist with mental retardation and psychotic disorders (see Appendix Q). 

Masi, G., Favilla, L., and Mucci, M. (2000) Generalized anxiety disorder in adolescents and young adults with mild mental retardation. Psychiatry 63 54-64. 

Patients with bipolar disorders may benefit from risperidone. This has been observed in an open trial of ten patients with rapid cycling bipolar disorder who were refractory to lithium carbonate, carbamazepine, and valproate eight improved after 6 months of treatment. One patient dropped out through non-adherence to therapy and one because of adverse effects (agitation, anxiety, insomnia, and headache) (5). There was a similar beneficial effect in eight adults with moderate to profound mental retardation (6). Risperidone was associated with a significant reduction in aggression and self-injurious behavior, whereas adverse effects were primarily those of sedation and restlessness. 

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