Mental retardation and psychosis comorbidity: where do we stand in diagnostic overshadowing?
Yaluğ, İ. (2005) Mental retardation and psychosis comorbidity: where do we stand in diagnostic overshadowing? Anatolian Journal of Psychiatry (Anadolu Psikiyatri Dergisi), 6 (4). pp. 267-273.
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Objective: Mental retardation in DSM-IV is defined by two features; subnormal cognitive functions characterized by an intelligence quotient (IQ) less than 70 and dysfunction hampering social and personal independence. Psychiatric problems in mild mental retardation are similar but more frequent to general population but, they change both in frequency and presentation more severe mentally retarded. The objective of this study is to summarize the findings of studies done on mentally retarded patients for prevalences of schizophrenia and psychosis and review the guidelines for recognition and interpretation of psychotic findings in this patient population. Methods: PubMed database was searched for studies on psychosis and psychopathology risk in mental retardation and the results reviewed. Results: Prevalences of schizophrenia and psychoses in studies were found to be between 0-19% and 0-24% respectively. Lack of social support, biochemical and neurological abnormalities and genetic etiology increases the risk of psychopathology. Discussion: Differences in methodology, not separating the schizophrenia and psychoses diagnoses and the fact that some studies were done entire-ly with behavioral observation or review of records are limitations of the studies. The importance of questioning of careers, managing interview according to the developmental level of the patient and evaluation of the patient in a biopsychoscoial context are highlighted to prevent misdiagnosis. Especially for patients with severe and profound mental retardation semi-structured interviews may increase reliability and validity of diagnosis but the gold standard is still the experience of the clinician.
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