Ludwik S. Szymanski

Naltrexone in Treatment of Self Injurious Behavior: A Clinical Study.

It has been suggested that the parenteral opiate antagonist, naloxone, might ameliorate self-injurious behavior. However, clinical studies have had conflicting results. We have evaluated whether a potent oral opiate antagonist, naltrexone, is effective in the treatment of this condition. The study was conducted on two young, profoundly mentally retarded adults, who exhibited intractable self-injurious behavior. A double-blind, placebo-controlled, within-subject-withdrawal design was utilized. One subject was studied for 12 weeks and the other one for 18 weeks. No measurable effects on the self-injurious behavior were observed.

Psychological costs of bone marrow transplantation in children.

The emotional strain of bone marrow transplantation procedures on child patients, family members and hospital personnel is described, and an illustrative case history is offered. Reasons for the unusually close relationship between family and staff are considered, and the necessity of appropriate psychological support for patients, siblings, parents, and members of the medical team is delineated.

Psychiatric Diagnostic Evaluation of Mentally Retarded Individuals

Abstract. Techniques useful in psychiatric diagnostic assessment of mentally retarded children and adolescents are described. The diagnostic evaluation is a comprehensive process integrating environmental, biological, cognitive, and psychodynamic findings. Physician bias, patient anxiety, and family defensiveness may hamper the evaluation. A directive and supportive approach is necessary in interviewing the retarded patient. Problems typically presented by retarded individuals in various developmental stages are reviewed and representative cases described. Psychiatric symptoms are interpreted in the context of the patients biological, cognitive, and psychosocial handicap, rather than of a normal childs development. Treatment recommendations include as necessary psychotherapeutic, educational, and rehabilitative intervention. The psychiatrist frequently acts as coordinator of the treatment plan

Review Article : Services for People With Mental Retardation and Psychiatric Disorders: US-UK Comparative Overview

Mental health services for people with mental retardation have been receiving greater attention over recent years following a long period of inactivity. The main policy factors which influenced the developments of services were in the USA, the emphasis on deinstitutionalisation and normalisation, and in the UK the focus on social care. Progress in the assessment of psychiatric disorders and improved diagnostic techniques have stimulated the development of a wide range of mental health services for people with mental retardation, compatible with current ideology of community care on both sides of the Atlantic. Specialist multi disciplinary, community based and easily accessible mental health services should be available for people with mental retardation. Economic cost, quality of care, and training of professionals and direct care staff, remain some of the challenges faced by purchasers and providers of mental retardation and mental health services in both countries.

Coping with Sexuality and Sexual Vulnerability in Developmentally Disabled Individuals

This presentation will focus on the sexuality of retarded persons, including their vulnerability to sexual abuse and exploitation. The material presented here is based on the author’s experience in providing interdisciplinary diagnostic and treatment services to retarded individuals and their families in a large urban developmental disabilities clinic (Developmental Evaluation Clinic at the Children’s Hospital Medical Center, Boston, Massachusetts).

Psychiatric Research in Mental Retardation

“Psychiatric” research in mental retardation may be defined from a number of viewpoints. Psychiatric might be taken to mean that the research has been performed by psychiatrists. Insofar as mental retardation is concerned, it could mean research performed by child psychiatrists, as they are much more likely (perhaps because they deal with development) to be concerned with mental retardation than is the general psychiatrist. Inasmuch as the child psychiatrist is broadly trained in biological issues, in child development, and in clinical assessment and treatment, it could be expected (even demanded of the profession as a whole) that child psychiatrists play a major role in research into the causes and treatment of serious psychopathology in childhood, including mental retardation.1 Project Future,2 an enterprise set in motion by the American Academy of Child Psychiatry, concluded in its final report (1983) that many more child psychiatrists must develop expertise in research, must become active in designing and carrying out research studies, and must provide leadership in child mental-health research. To this end, the report recommended that more training programs in child psychiatry provide research experience, and that postresidency research fellowships be made available to supplement such programs as the NIMH’s Research Scientist Development Awards.

Educational Handicap, Public Policy, and Social History: A Broadened Perspective on Mental Retardation

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