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A more recent article on medical care for adults with developmental disabilities is available. Patient information : See related handout for caregivers of persons with mental retardationwritten by the authors of this article. Persons with mental retardation are living longer and integrating into their communities. Primary medical care of persons with mental retardation should involve continuity of care, maintenance of comprehensive treatment documentation, routine periodic health screening, and an Mental retardation rates in adults of the unique medical Mental retardation rates in adults behavioral disorders common to this population.

Office visits can be successful if physicians familiarize patients with the office and staff, plan for difficult behaviors, and administer mild sedation when appropriate.

Some syndromes that cause mental retardation have specific medical and behavioral features. Health issues in these patients include respiratory problems, gastrointestinal disorders, challenging behaviors, and neurologic conditions. Some commonly overlooked health concerns are sexuality, sexually transmitted diseases, and end-of-life decisions. Approximately 1 percent of the general population has mental retardation.

Avoid the use of psychotropic medications for new challenging behaviors until an attempt has been made to rule out potential medical and environmental causes except when harmful to self or others. Consider a conservatorship, and document end-of-life issues for adults not mentally capable of making medical decisions. Although persons with developmental disabilities are designated in different ways e.

Severe chronic mental or physical disabilities that manifest before a person reaches 22 years of age, are likely to continue indefinitely, and result in substantial functional limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency 3. Identifies a subset of persons who have developmental disabilities with below-average general intellectual functioning below 65 to 75 as measured through standardized general aptitude evaluation tools, such as the Wechsler Intelligence Scales or Stanford-Binet Intelligence Scales mild, 50 to 69; moderate, 35 to 49; severe, 20 to 34; profound, less than Accompanies two or more deficits in adaptive behavior used for everyday living e.

Information from references 3 and 4. For physician office visits, patients with mental retardation should be accompanied by a person who is familiar with them and the purpose of the visit. Providing caregivers in advance with a referral sheet documenting the information expected for each office visit can be helpful Figure 1.

For patients with destructive or challenging Mental retardation rates in adults, physical and emotional trauma can be minimized and the effectiveness of the evaluation enhanced by providing mild sedation e. Additional components of successful primary care office visits are listed in Table 2.

Encounter sheet for caregivers of patients with mental retardation to fill out before each physician visit. Gradually desensitize the patient to the office and staff through short social visits. Consider sedating the patient before medical evaluations e. Patients with mental retardation often have multiple and sometimes complicated medical problems.

Maintaining continuity of care and a complete record of all medical interventions is vital. Furthermore, accurate data collection by caregivers is crucial in identifying disorders, monitoring treatment response, and documenting behavioral problems. Routine periodic health screening should be offered to patients with mental retardation as it is for other adults.

Physical activity, often lacking in this population, 6 can improve quality of life for many. Genetic evaluation may be helpful in defining specific syndromes. Neuromusculoskeletal: chronic pain lumbosacral, hip, legmuscle spasticity, seizures, osteoporosis, scoliosis. Cardiac: adults without apparent congenital heart disease may have valvular disease including mitral valve prolapse and aortic regurgitation.

Dermatologic: seborrheic dermatitis of scalp and face, eczema of hands and feet, tinea infections including onychomycosis. ENT: recurring cerumen impactions, hearing loss, upper airway obstruction, obstructive sleep apnea. Orthopedic: atlantoaxial instability, patellar subluxation, hip disease, osteoporosis. Neurologic: tumors may develop in the brain, on cranial nerves, or on the spinal cord.

Dermatologic: leg edema or Free hardcore bisexual porn, lesions on head and anterior legs from skin picking. Metabolic: insulin resistance, hyperlipidemia, hypertension, growth hormone deficiency, water intoxication, obesity. Neurologic: exaggerated responses to standard dosages of anesthetic and sedative agents. Gastrointestinal: drooling, GERD, swallowing difficulties caused by oropharyngeal and gastroesophageal incoordination, constipation with functional megacolon, gallbladder dysfunction.

Neuromusculoskeletal: seizures, gait apraxia and truncal ataxia, scoliosis, osteoporosis. Orthopedic: cystic defects in the metacarpals, metatarsals, or phalanges; erosions of the tufts of the distal phalanges. Information from reference 9. Absence of speech but with paroxysmal laughter and smiling; fascination with water; sleep disturbance.

Prader-Willi syndrome 11 Obesity, food-seeking and food-hoarding behaviors; antisocial with temper tantrums; obsessive-compulsive features such as skin picking, ordering impulsivity; labile affect; psychosis; sleep disturbance. Williams syndrome Overly friendly and highly sensitive to rejection; impulsivity; incessant chatter; fearful and worrisome; has few friends.

Fetal alcohol syndrome ADHD; inappropriate sexual behavior and sexually offending behaviors e. Psychosocial intervention; stimulants; SSRIs; atypical antipsychotics; mood stabilizers.

Down syndrome Depression; obsessional slowness; obsessive-compulsive disorder; autism; dementia after 50 years of age.

Rett syndrome Repeated movements, hand stereotypy, facial twitches; social interaction autistic-relating problems; mood disturbance, fear, anxiety; insomnia; autistic behaviors. Fragile X 17 syndrome. SSRIs, stimulants, clonidine Catapresatypical antipsychotics, mood stabilizers. Phenylketonuria Information from references 10 through Up to 50 percent of patients coming from institutions may have a history of hepatitis A or B infection.

Oral hygiene often is neglected in adults with mental retardation, 20 and obtaining access to good dental care can be difficult. Hospitalization may be necessary to provide adequate dental care for persons unable to tolerate outpatient settings. Patients with decreased mobility or incontinence are at increased risk of skin breakdown. Caregivers should be counseled on appropriate skin care, and physicians should evaluate Mental retardation rates in adults routinely for skin breakdown.

Persons with tracheotomy and percutaneous endoscopic gastrostomy PEG sites may have chronic colonization with bacteria such as methicillin-resistant Staphylococcus aureus.

Persons with mental retardation, particularly those with Down syndrome, often have obstructive sleep apnea. For persons who require treatment, surgical intervention such as uvulopalatopharyngoplasty Mental retardation rates in adults genioglossal advancement may be helpful.

Many patients with intellectual and physical disabilities develop swallowing difficulties, which can lead to choking, aspiration, malnutrition, and poor hydration. Speech pathology consultation with a fluoroscopic swallowing study can document the presence of aspiration and indicate dietary changes or postural changes during swallowing to minimize aspiration. Because of a limited evidence base, the use of a feeding tube to avoid aspiration with oral feeding is controversial 30 ; however, malnutrition may require nutritional supplementation through a PEG tube.

A person with poor verbal skills may have difficulty communicating discomfort related to gastroesophageal reflux disease GERD. Particularly Mental retardation rates in adults in persons with Down syndrome, GERD may cause unexplained sore throat, choking, cough, or changes in behavior. It also provides Mental retardation rates in adults specific information about the degree of inflammation and pathology and allows for intervention e. Constipation and fecal impaction are common in persons with mental retardation 34 and may lead to unexplained changes in behavior.

These Gravity falls ass porn may be caused by an innate predisposition, but medical causes or medication side effects should be considered. There is limited evidence for an ideal treatment regimen in this population. Nonetheless, proactively regulating bowel movements may be more helpful than waiting Mental retardation rates in adults symptoms of constipation to be reported by caregivers.

Menstrual discomfort can be a source of agitation and aggression, including self-injurious behavior. Surgical or medical interventions affecting reproductive ability require an awareness of relevant ethical issues and should be completed only after appropriate consideration of applicable local, state, Mental retardation rates in adults federal laws. Seizures in persons with mental retardation are likely to be severe, occur often, and be difficult to control 38 ; increase as the degree of psychomotor retardation increases 39 ; and decrease life expectancy by up to 20 years.

Furthermore, physicians should incorporate surveillance for these medication-related movement disorders in patients taking these medications. Many persons with mental retardation, especially those with Down syndrome, do not have predictable responses to pain. Therefore, pain is an unreliable indicator for the presence or severity of many disorders, 41 resulting in delayed diagnosis and intervention and an increased risk of morbidity and mortality.

Neuromuscular scoliosis is common among persons with mental retardation, especially those with cerebral palsy.

Bracing is unlikely to be effective in stabilizing this type of scoliosis. Consultation with an orthopedic subspecialist for significant curvature is important because surgical intervention may be required to limit curve progression, respiratory compromise, and pain. Contractures can develop in persons who do not have use of their lower extremities.

Symptomatic relief can be provided by surgical interventions such as tendon lengthening, tendon release, or osteotomy. Spasticity Mental retardation rates in adults a common source of discomfort.

Osteoporosis is common, particularly among non—weight-bearing patients 48 ; as many as 50 percent of adults with mental retardation have osteoporosis or osteopenia. Furthermore, osteoporosis and use of antiepileptics may predispose patients to degenerative disk disease with spinal cord compromise, Mental retardation rates in adults to functional decline.

For persons unable to communicate adequately, a change in behavior may be the first indication of Mental retardation rates in adults problem. An unrecognized medical disorder or environmental change should be considered before concluding that a new challenging behavior, or an exacerbation of a previous behavior, is caused by an underlying psychiatric disorder Table 5.

Information from reference Although some etiologies of mental retardation may have associated behavioral phenotypes Table 410 — 18 most challenging behaviors are caused by the same neuropsychiatric disorders that affect the general population 54 and respond to the same treatments. One notable exception is benzodiazepine therapy, which can precipitate paradoxical reactions of increased irritability and aggression in 10 to 15 percent of patients with mental retardation.

Once pharmacologic or behavioral intervention is deemed appropriate and informed consent has been obtained, Mental retardation rates in adults goal is to minimize physical and emotional trauma to the patient and caregivers while Mental retardation rates in adults community integration. Counseling and psychotherapy should be considered for persons with mild to moderate mental retardation.

Treatment should be directed at an underlying medical condition, environmental change, or psychiatric disorder. Because many persons with mental retardation have greater access to their community than others, they should be educated about the inappropriate use of illicit drugs and alcohol.


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