Child and adolescent mental and behavioral disorders Assessment of 1572 of children with mental retardation and their psychotropic medication use

摘要

INTRODUCTION: Mental retardation (MR) is a lifelong and chronic impairment which has problematic medical, social, educational and economic aspects. The combination of mental and physical disorders associated with mental retardation is higher than that of the community average. Early diagnosis and appropriate treatment are very important for increasing patients’ functionality and quality of life1. The present study aims to examine the sociodemographic characteristics, admission complaints, the level of MR, accompanying comorbidities, the prevalence of psychotropic medication use, the medications used and the predictors of psychotropic medication in children and adolescents aged 6-18 years and diagnosed with mental retardation. METHODS AND MATERIALS: In this study, hospital records of outpatient cases attending the Child Psychiatry of Ankara Pediatric Hematology Oncology Training and Research Hospital in the six-month period between June and December 2013 were screened retrospectively. Detected cases with mental retardation aged 6-18 years were evaluated in detail. In this evaluation, the sociodemographic characteristics, the level of mental retardation, the first presentation complaints, the psychiatric and medical history of the patients, the presence of comorbidity and drug use variables were examined. Psychiatric diagnoses were classified according to DSM-IV-TR. For measuring the intelligence quotient (IQ), Weschler Intelligence Scale for Children-Revised (WISC-R) and Stanford Binet Intelligence Scale were used. Thus, MR subtypes were defined according to the full-scale IQ score as the following; IQ=50-69 as mild MR; IQ=36-49 as moderate MR; unknown but presumed IQ score 0.05). Similarly, no significant difference was detected between children and adolescents in gender terms. Males represented 60% of all subjects (n=943). Male/female ratio was almost 1.5 (M/F=1.49). Classification of MR subtypes was the following: More than half of the whole sample (57.3%) had mild MR, 15.5% of all had moderate MR, 14.8% of all had severity unspecified MR, 12.2% of all had severe MR, and 0.3% of all had profound MR. Evaluation of the patients’ complaints revealed that the most common cause for presentation was school failure (37.7%). The others were the following: renewal of special education report, aggressive and/or violent behavior, speech delay or retardation, hyperactivity and/or attention deficit, objections to the special education reports arranged before, avoidant and/or anxious behavior, and other reasons. In this sample, 26.1% of all MR (n=410) were newly diagnosed cases of MR. In 3.1% of the sample (n=48), the diagnosis of mental retardation was changed to “borderline intellectual functioning (IQ=70-79) plus specific learning difficulties”. At least one psychiatric comorbidity was detected in 24.6% of all cases; most commonly found were disruptive behavior disorders (DBD; including conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and CD plus ADHD; 14.2%). The others were pervasive developmental disorders (PDD), anxiety disorders, elimination disorders, mood disorders and tic disorders. Non-psychiatric comorbidities accompanying MR were found as 49.7% of the entire sample. Amongst these, the most frequently identified one was epilepsy (21.9%), followed by cerebral palsy (CP) and speech and/or hearing impairment, respectively. Evaluating of the relationship between MR levels and epilepsy showed that epilepsy presence in all five MR subtypes was found significant (χ2=227.845, p<0.001), prominently with profound MR (80%) and severe MR (61.3%). Having epilepsy in profound and/or severe MR cases was significantly higher than that of the other MR patients (χ2=206,937, p<0.001). The relationship between MR level and CP was also evaluated, revealing that CP prominently accompanied 80% of profound MR and 60.2% of severe MR. It was also detected that profound and/or severe MR cases display CP comorbidity significantly more than other MR patients (χ2=278.320, p<0.001). When the relationship between MR levels and speech and/or hearing impairment comorbidity was evaluated, it was found that speech and/or hearing impairment accompanied mostly the 12.5% severity unspecified MR and 10.6% of those with mild MR. It was determined that having speech and/or hearing impairment comorbidity in mild MR, moderate MR and unspecified MR, in favour of unspecified MR (12.5%), was significantly more common than in profound and/or severe MR cases (χ2=14.117, p<0.001). Evaluation of the clinical features of the MR cases in terms of gender revealed that having any of psychiatric disorders and having pervasive developmental disorder were significantly more likely in males than in females (χ2=7456, p=0.006; χ2=15.669, p<0.001, respectively). Psychotropic medication used in children and adolescents with MR showed that 79.6% of the sample (n=1252) had not received any kind of psychotropic medication, whilst 20.4% of all had