mentally handicapped
Introduction
Introduction to mental retardation Mental retardation (Mentalretardation), also known as mental dysplasia, is a syndrome caused by brain development disorders caused by a variety of causes. It is characterized by mental retardation and social adjustment difficulties, and may be accompanied by a mental or physical illness. . In the developmental stage, with the increase of age, the intelligence has also improved slightly, but the moderate and severe patients still bring a heavy burden to the family society. Mild patients have no obvious abnormalities in their physical development. They are often neglected and selected in the recruitment experience, which makes the training and management of the troops difficult and should be watched. basic knowledge The proportion of illness: 0.003% Susceptible people: infants and young children Mode of infection: non-infectious Complications: respiratory infections, electric shock, burns
Cause
Mental retardation
Genetic factors (20%):
Mainly refers to the nervous system dysplasia caused by genetic or chromosomal abnormalities, malformation or congenital metabolism Down syndrome, Turner syndrome. Phenylketonuria, galactosemia, familial black scorpion dementia. Neurofibromatosis, tuberous sclerosis and congenital hydrocephalus, brain penetrating malformation, microcephaly and so on.
Prenatal fetal acquired abnormalities (20%):
The first three months of pregnancy is the initial stage of the formation of the fetal nervous system, which is susceptible to damage from pathogenic factors and leads to obvious deformities. In the fetal period of maternal infection (virus, spirochete, toxoplasma), abdominal trauma or radiation, psychoactive substance poisoning, hypothyroidism and other endocrine diseases, pregnancy toxemia, malnutrition, hypoxia and other serious diseases are mental development One of the causes of delay.
Perinatal disease (20%):
Including premature birth, dystocia, brain damage during childbirth, neonatal asphyxia and nuclear jaundice.
Postnatal disease (20%):
In the first 2 years after birth, brain development is the fastest, and the brain damage caused by the pathogenic factors during this period is also serious. Preschool is the most critical period, followed by the primary school age. There are many causes of illness, such as infection (especially infection of the central nervous system), craniocerebral trauma, poisoning, epilepsy, malnutrition, endocrine or metabolic diseases, and encephalitis after vaccination.
Recent studies have shown that stimulation of various sensory organs is an important factor in promoting the development of brain nerve fibers. Social and environmental factors during development, especially in infants and young children, can affect brain development. The study of wolf children and monkeys proves that the deprivation of cultural and educational opportunities in infants and young children can cause damage to the normal development of the brain. Epidemiological surveys have found that low IQ is often associated with low socioeconomic and cultural levels, housing overcrowding, and unstable family environments.
The cause is complicated. According to foreign data, about 20% of mental retardation is caused by environmental factors, 25% is caused by chromosomal abnormalities or genetic abnormalities, and more than half of patients cannot find the cause. It has also been found that 85% of patients with severe disease can find biological causes such as chromosomal abnormalities, congenital diseases, metabolic and endocrine abnormalities, infections, poisoning, trauma and other physical factors.
Prevention
Mental retardation prevention
Mental retardation is difficult to cure once it is developed, so prevention is very important. Preventive measures include: improving the health of young couples, avoiding marriage by close relatives, avoiding fertility in patients with genetic diseases, and having problems after pregnancy. Pregnancy can be terminated, and diseases of infants and young children, especially nervous system diseases, can be detected and prevented in time.
Preschool (before 6 years old), actively prevent the following diseases: infection, craniocerebral trauma, cerebral hypoxia caused by various reasons, poisoning, endocrine or metabolic diseases, encephalitis after vaccination, epilepsy, infants and young children Severe malnutrition or other diseases, because of blindness, paralysis, affect mental development, and a serious lack of access to education.
(1) Carry out genetic metabolism examination and consultation, avoid marriage of close relatives, and discover that carriers should carry out genetic counseling to achieve prenatal and postnatal care.
(2) Suitable for childbirth, to do well-being and perinatal health care, amniocentesis, including chromosomal diseases, neural tube defects, metabolic diseases and other diseases, high-risk pregnancy management, neonatal intensive care, discourage pregnant women from drinking and smoking Measures to avoid or disable drugs that have an adverse effect on fetal development. Scientific methods are delivered.
(3) Popularize health education and nutrition guidance.
(4) Do a good job of immunization of infectious diseases, viruses, bacteria and protozoa.
(5) Prevent the occurrence of various infections and accidents, reduce craniocerebral trauma and accidents, correctly treat brain diseases, and control seizures.
(6) Strengthen pre-school education and early training, and conduct regular health checkups (physical, nutritional, mental and psychological development, vision and hearing) for preschool children. Neglect and abuse of children are prohibited.
(7) Follow-up of high-risk newborns, early detection of diseases, treatment, especially attention, early nutrition (protein and iron, zinc and other trace elements) supply and appropriate environmental stimulation have a good effect on mental development; pay attention to newborn Screening for metabolic diseases such as hypothyroidism and phenylketonuria.
Complication
Mentally ill complications Complications, respiratory infections, electric shocks
1. Due to the mental retardation of mentally handicapped children, it is impossible to make a correct judgment on the changes of the external environment. In case of emergency, there is often a lack of resilience, so it is prone to loss, car accident, drowning, electric shock, burns, falls and other accidents, so try not to Let the mentally handicapped alone, you should be taken care of at any time.
2. Mentally handicapped children often do not know how to eat or hunger, do not distinguish between good and bad food, and easily eat unclean or corrupt foods and develop gastrointestinal disorders.
3. Mentally handicapped children are often accompanied by immune dysfunction, combined with poor self-care ability, can not increase or decrease clothes with climate change, so it is prone to respiratory infections.
Symptom
Mentally retarded symptoms Common symptoms Very severe mental retardation Mild mental retardation Moderate mental retardation Severe mental retardation
CCMD-2-R divides the disease into mild, moderate, severe, extremely severe, other, specific mental retardation and marginal intelligence.
Mild patients with IQs 55-69, poor academic performance, often fail or repeat grades in ordinary schools, or poor work ability, can only complete simple manual operations, can learn certain life skills and housework. No obvious language barriers, can take care of themselves.
Moderate patient IQ 40-54, can not adapt to ordinary school learning, can only calculate the single digit addition, subtraction, can be engaged in simple labor, but poor quality, low efficiency. You can learn to live a simple life, but often need to be urged and helped. Can master everyday language, but the vocabulary is poor.
Severe patient IQ 25 ~ 39, can not learn and work, will not count. Speech function is severely impaired and effective language communication is not possible.
Very severe patients with IQ below 25, social function is completely lost, will not escape danger, loss of speech function, life can not take care of themselves.
The marginal intelligence IQ is 70-80, the abstract thinking ability is diminished, the breadth, depth and agility of thinking are poor, and high-level and complicated mental work cannot be completed.
Examine
Mentally handicapped
1. Genetic examination: It is helpful to determine genetic abnormalities, dysplasia of the nervous system caused by chromosomal abnormalities, malformations, genetic metabolic defects, etc., especially metabolic defects.
2. Intelligence test: Students in school-aged school, in the same class of students of the same age, intelligence defects can easily be revealed and found for teachers, but parents sometimes do not admit that their children have problems for various reasons, and finally come Ask the doctor to judge that the doctor can not make an intelligence test based on the clinical performance.
Diagnosis
Mentally retarded diagnosis
diagnosis
When determining the cause, doctors must first understand the various causes that may cause mental retardation, and then conduct a targeted medical history and examination. The diagnosis of hereditary diseases and congenital metabolic defects often requires a better laboratory. Equipment and skilled personnel.
Differential diagnosis
1. Identification with phenylketonuria
Phenylketonuria is a group of metabolic diseases. The mental damage is generally serious. After birth, it is usually a few months after birth, and the child is stunted, irritated, unresponsive, yellow, white complexion, blue iris, abnormal muscle tone. Ataxia, hyperreflexia, special odor in the urine, early (neonatal) diagnosis, should be treated early.
2. Identification with endemic cretinism (local dyslexia)
In the epidemic area of endemic goiter, children are short, uneven, and unresponsive, with speech and hearing impairment. The lower part of the body is shorter than the upper part. The weight is lower than that of the same age, and the sexual development is also slow. Early diagnosis should be diagnosed early.
3. Differentiation from various chromosomal disorders
Can check chromosomes, perform karyotype analysis, and some have special signs, such as children with trisomy 21, regardless of race, have common characteristics: wide eye gap, two eyes outside the hanging, inner suede, ear The position is low, the width of the bridge of the nose is low, the tongue is wide and wide, the mouth is half-open, the tongue is extended to the outside of the mouth, and the groove on the tongue surface is deep and many, and the so-called "scrotum" tongue is formed. The palm is thick and short and thick, and the short finger is short and often bends inward.
4. Identification with children with autism
In children with mental retardation, there is a combination of autism (Kanner), autism patients with more prominent social developmental disorders, and a large number of social behavioral deviations, which are more difficult to obtain language and academic skills, and their prognosis is simpler than mental development. The delay is poor. This type of child can be trained.
5. Infant dementia Before the age of 3 years, all aspects of intelligence development are normal. Some children have some obvious causes after some serious infections. They are characterized by mental retrogression in the clinic and finally become dementia with a very poor prognosis.
