Brian R. Ballinger

Behavioural syndromes identified by cluster analysis in a sample of 100 severely and profoundly retarded adults

Very little is known about psychiatric disorders in severely and profoundly retarded adults. We have investigated these disorders by systematically recording and collecting data about the behaviour of 100 severely and profoundly retarded hospitalized adults and subjecting the data thus derived to cluster analysis. Eight clusters were isolated. The clinical psychiatric significance of these clusters is discussed and their relationship to cause retardation, duration of stay in hospital and visiting is considered. A diagnostic framework for psychiatric disorder in severely and profoundly retarded adults is put forward and some possible treatment approaches are suggested.

Epileptic Seizures in Elderly Patients with Dementia

Summary: All inpatients aged <55 years with dementia in the Dundee Psychiatric Service were surveyed for seizure occurrence by interviewing staff and reviewing records. Of 208 patients, 19 (9.1%) were recorded as having seizures. The seizures were major in 92% and occurred at a rate of ∼2.3 seizures per patient per year. Patients with epilepsy were significantly younger than a control group of dementia inpatients and were significantly more cognitively impaired on the survey Clifton Assessment Procedure for the Elderly (CAPE), but not on the Mini Mental State Examination. Of 111 reported accidents, only 5 appeared to be associated with epilepsy. Although epileptic seizures are relatively common in patients with severe dementia, they rarely caused severe problems.

Personality disorder in mental handicap.

100 randomly selected mildly or moderately mentally retarded adults were assessed for personality disorder using the Standardized Assessment of Personality devised by Mann et al. (1981). By the terms of this instrument 56% of patients showed features of abnormal personality, and in 22% this abnormality was marked, suggesting the presence of personality disorder. Personality problems may be a more significant factor in assessing a mentally retarded persons acceptability in a community setting than has hitherto been realized.

Psychiatric disorder in an adult training centre and a hospital for the mentally handicapped

Seventy-five mentally handicapped adult individuals attending a training centre were compared with 75 adult patients in a mental subnormality hospital using a standardized psychiatric interview. Ten of the individuals at the training centre were rated in the pathological range for overall psychiatric disturbance compared with 23 patients in hospital. Details are presented for the various psychiatric symptoms.

Bioavailability of phenytoin. A comparison of two preparations.

SummaryPlasma phenytoin levels were measured in 60 patients under steady-state conditions for a period of six weeks. During the trial, the preparation of phenytoin was changed from Phenytoin BP (Regent) to Epanutin Infatabs. A significant increase in plasma phenytoin levels following the change of tablet was matched by a decrease in the number of seizures.

The effects of hypnotics on imipramine treatment

Plasma imipramine and desmethylimipramine concentrations and depression ratings were measured over a 3 week period in 3 groups of hospitalised depressed patients given standard doses of imipramine. The first group received imipramine alone, the others either amylobarbitone or nitrazepam in addition as a night sedative. The plasma antidepressant levels were consistently higher in the group receiving no hypnotic but only significantly so in the case of ‘total’ IMI in the imipramine alone group compared to the group receiving imipramine plus amylobarbitone. The inter-individual differences in plasma levels were large. There was no difference between the groups with regard to changes in depression, sleep or side-effects. From a clinical point of view, there is therefore no evidence from this study of adverse effects of these drugs given in combination nor any evidence to suggest that the dosage of imipramine given should be adjusted when administered along with either of the hypnotics studied.

A population needs assessment profile for dementia.

The Tayside Profile for Dementia Planning is an instrument designed to obtain data for population needs assessment and planning. It provides a brief tool to collect a minimum dataset by non‐specialists. Third‐party informants—informal carers or involved professionals—are used as data sources. The key concept is the use of a descriptive profile rather than a summative score or categorization. The profile consists of a set of needs indicators, information on current service response and demographic and background data. Key levels of dependency are measured by time interval dependency. Validity, reliability, acceptability and usability are satisfactory, with the crucial exception that informal carers and professionals appear to perceive needs differently. Further research is needed to assess which type of informant provides the more useful data.

A trial of bran and bran biscuits for constipation in mentally handicapped and psychogeriatric patients

Six elderly psychiatric and 17 mentally handicapped individuals suffering from severe constipation received 3 week periods of treatment with 10 g unrefined bran, three bran biscuits, and Senokot syrup daily or three times weekly. There was no significant difference in the number of bowel movements or enemas or in the consistency of the motions. The results suggest that bran may be substituted for laxatives.

Erythrocyte Ouabain Binding in Dementia

Age-matched patients attending a geriatric psychiatry day hospital, one group with Alzheimers dementia and another with functional illness, were studied and compared with similar inpatient groups. Erythrocyte ouabain binding was assayed and Clifton ratings completed. In day hospital patients ouabain binding was significantly lower in the demented group (p less than 0.008) than in the functional group. There was a positive correlation between Clifton ratings and ouabain in the whole group (p less than 0.05). No significant differences were found in inpatient groups. Possible reasons for findings are discussed.

The elderly in a mental subnormality hospital: A comparison with the elderly psychiatric patient

SummaryApproximately 6 % of the patients in a mental subnormality hospital were over the age of 65, in contrast to 61 % of patients in a psychiatric hospital. The mean time spent in institutional care was 46.4 years for the mentally handicapped individuals. The level of self care of the mentally handicapped patients was generally better than that of the psychiatric patients. 39 % of the mentally subnormal showed psychiatric symptoms when assessed by a standard interview and 42 % did not appear to be in need of hospital care.