Mental retardation with psychiatric disorders

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. 

Definitions of mental illness tend to contain two aspects a normative element and a functional element. Normative definitions delimit abnormal behavior in light of what is typical, usual, or the norm. Some degree of deviance from the norm is necessary for a behavior to be considered abnormal. Deviance alone, however, is never sufficient for a label of abnormality. High IQ is just as deviant as low IQ, but only mental retardation is labeled abnormal. This leads us to the functional element of the definition. Typically, the label of abnormality requires deviance plus maladaptation. Maladaptation suggests some diminished capacity to function relative to an average. For example, the DSM defines mental disorder as a syndrome that is associated with distress or impairment in functioning (American Psychiatric Association, 1994, pp- xxi-xxii). 

Table 17.1. In this context, mental retardation deserves special comment. Although most persons with mental retardation are not violent, there is an increased risk of inappropriate aggression among individuals with psychiatric diagnoses in general, including mental retardation. Most research on associations between violence and mental illness has focused on adults. To assess the relationship between aggressive behaviors and psychiatric disorders, it is useful to look at the prevalence of psychiatric disorders in those who have committed violent acts, and to examine the prevalence of violence in psychiatric patients in different settings.

According to the Expert Consensus Panel for Mental Retardation Rush and Frances, (2000), the mainstays of the pharmacological treatment of acute mania or bipolar disorder in adults are anticonvulsant medications (divalproex, valproic acid, or carbamazepine) or lithium. Both divalproex or valproic acid and lithium were preferred treatments for classic, euphoric manic episodes. Divalproex or valproic acid was preferred over lithium and carbamazepine for mixed or dysphoric manic episodes and rapid-cycling mania. For depressive episodes associated with bipolar disorder, the addition of an antidepressant (SSRI, bupropion, or venlafaxine) was recommended. According to the Expert Consensus Panel, the presence of MR does not affect the choice of medication for these psychiatric disorders in adults. 

Arnold, L.E. (1993) Clinical pharmacological issues in treating psychiatric disorders of patients with mental retardation. Ann Clin Psychiatry 5 189-198. 

Older classifications of psychiatric disorder divided diseases into psychoses and neuroses. The term psychosis is still widely used to describe a severe mental illness with the presence of hallucinations, delusions or extreme abnormalities of behaviour including marked overactivity, retardation and catatonia, usually accompanied by a lack of insight. Psychotic disorders therefore include schizophrenia, severe forms of depression and mania. Psychosis may also be due to illicit substances or organic conditions. Clinical features of schizophrenia may be subdivided into positive symptoms, which include hallucinations, delusions and thought disorder and negative symptoms such as apathy, flattening of affect and poverty of speech. 

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