Mental retardation attention

This chapter is concerned with the neurochemical basis of developmental disability which is considered here in two forms the globally delayed or halted development seen in mental retardation, and the more circumscribed pattern of disordered development of autism. A range of deficits of important key aspects of consciousness are apparent in both conditions. Of particular relevance to consciousness are the cognitive and behavioural impairments in attention, concentration, memory, information processing and social behaviour which are commonly present. Consideration of aberrant neurotransmitter activities in these developmental deficits may provide insights into the role of neurotransmitters in consciousness. 

A third part. Special Clinical Populations, is devoted to those children and adolescents with comorbid conditions who deserve particular clinical attention and expertise. Chapters address the needs of youths with substance abuse, mental retardation, or medical illness. Two last chapters focus on the youngest of the young those infants exposed in utero to psychotropic medications, and those preschoolers for whom recent epidemiological studies suggest medications are being prescribed with increasing (and at times alarming) frequency. 

ADHD, attention-deficit hyperactivity disorder EKG, electrocardiogram GI, gastrointestinal MD, major depression MR, mental retardation OCD, obsessive-compulsive disorder PTSD, post-traumatic stress disorder. Trade names are in parentheses. Doses are general guidelines. All doses must be individualized with appropriate monitoring. Weight-corrected doses are less appropriate for obese children. 

ADHD, attention-deficit hyperactivity disorder BPD, bipolar disorder CD, conduct disorder DB, double-blind DD, developmental disability IM, intramuscular MR, mental retardation PDD, pervasive developmental disorder... 

A trial published by Gillberg et al. (1997) comprised 62 children (52 males, 10 females), aged 6 11 years and meeting DSM-HI-R criteria for ADHD. The children suffered from severe attention deficits and 42% had comorbid diagnoses including mild mental retardation, autistic features, oppositional defiant disorder and tic disorder. They were included in a parallel-group, randomized, double-blind, place bo-cont ro 1 led study of amphetamine treatment. 

Correct answer = B. Phenyllactate, phenyl-acetate, and phenylpyruvate, which are not normally produced in significant amounts in the presence of functional phenylalanine hydroxylase, are elevated in PKU, and appear in the urine. In patients with PKU, tyrosine cannot be synthesized from phenylalanine and, hence, becomes essential and must be supplied in the diet Treatment must begin during the first seven to ten days of life to prevent mental retardation. Discontinuance of the phenylalanine-restricted diet before eight years of age is associated with poor performance on IQ tests. Adult PKU patients show deterioration of attention and speed of mental processing after discontinuation of the diet. Life-long restriction of dietary phenylalanine is, therefore, recommended. 

Neuroleptic drugs have been prescribed for children in the treatment of psychotic disorders, Tourette s syndrome, attention deficit disorder, hyperactivity, behavioral and psychiatric complications of mental retardation, and pervasive developmental disorders, for example infantile autism (580,581). 

Also falling within the scope of modern psychiatric diagnostic systems are organic mental disorders (e.g. dementia in Alzheimer s disease), disorders due to substance misuse (e.g. alcohol and opiate dependence—see Chapter 10), personality disorders, disorders of childhood and adolescence (e.g. attention deficit/hyperactivity disorder, Tourette s syndrome) and mental retardation (learning disabilities). 

Exposures to developmental neurotoxins are believed to be responsible for the staggering numbers of affected children. In the United States, 5-10% of public school children have learning disabilities, up to 17% of children suffer from attention deficit hyperactivity disorder (ADHD), approximately 1% of all children are mentally retarded and as many as 1 in 150 children born have autismJ5-6 Though some of these effects are genetically influenced, the available evidence suggests that environmental exposures and not genetics are the primary causes for these disorders. 5 ... 

The developing human brain is much more susceptible to injury caused by toxic agents than the brain of an adult. Probably all potential neurotoxic compounds would also cause damage to the developing brain and at much lower doses [1], Indeed, neuro-developmental disorders in children such as attention deficit, mental retardation or autism are often associated with the exposure to chemicals in the environment during early fetal and postnatal development [1-3]. 

Other Explosive speech, abusive language, insomnia, nightmares, mental retardation, loss of libido, fatigue, personality change Poor attention, academic decline (adolescents)... 

At the present time, ASD is defined by significant impairments in social interaction and communication and the presence of apparently unusual behaviors and interests. Many people with ASD also have unusual ways of learning, of giving attention, or of reacting to various sensations. Their thinking and learning abilities may vary from mentally retarded to extremely intelligent. 

In addition, it exerts beneficial effects in many disorders as an adjuvant to other treatment modalities. Such effects are apparent only if it is administered to an already pharmacologically treated patient. For example, in unresponsive major depressive disorder, the co-administration of lithium to an ongoing antidepressant treatment increases the response rate by up to 50%. In most cases, the response to lithium augmentation is either considerable or not at all ( all-or-none phenomenon). Some (currently not convincing) results have also been reported in unipolar depression, bulimia nervosa, and attention deficit hyperactivity disorder (ADHD). Lithium also exerts antiaggressive effects in conduct disorder, independent of any mood disorder, and can reduce behavioral dyscontrol and self-mutilation in mentally retarded patients. One of the most striking effects of lithium is its antisuicidal effect in patients who suffer from bipolar and unipolar depressive disorder irrespective of comorbid axis I disorder. ... 

I believe that the study of the functioning of the brain in its relation to the concentrations and intake of the vitamins, essential amino acids, and other substances normally present in the brain constitutes a field of research in which much more work needs to be done. Biochemical and genetic arguments support the idea that orthomolecular therapy, the provision for the individual human being of the optimal concentrations of important normal constituents of the human body, may be the preferred treatment for many patients, especially those with mild mental retardation or mild psychosis. I suggest that this therapy, to be successful, should involve the thorough study of the individual, and. continued attention to him, such as is customary in psychoanalysis but not in conventional chemotherapy. There is the possibility that analysis of body fluids and tests of the ability of the individual to utilize essential substances may indicate the types of orthomolecular therapy that would be most likely to be effective for the patient. 

In contrast, in other subjects, the simulated disease is due to psychiatric problems such as psychoses, mental retardation and personality disorders. In these cases, the intrinsic reason for the lesions is different, as the subject generally hopes to attract the attention of the people he is surrounded by and of the doctor, or else he is reacting to difficult or unfavourable environmental conditions with involuntary somatisation at the skin level. These unconscious simulators are prevalently female. 

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