mental retardation
Introduction
Introduction to mental retardation Mental retardation refers to the mental function of an individual who is mentally retarded, mentally retarded or blocked due to mental retardation, mental retardation, or obstruction before maturity (usually before the age of 18), accompanied by social adjustment difficulties. A major feature of a syndrome. IQ (IQ) is lower than the population mean of 2.0 standard deviation (the IQ of the population is set at 100, the IQ value of a standard deviation is 15), and the general IQ below 70 (or 75) is that the intelligence is significantly lower than the average. The clinical manifestations of cognition, language, emotional will and socialization are significantly behind the same age at maturity and functional level, and may be accompanied by a certain mental or physical illness, or secondary to the latter. basic knowledge The proportion of illness: 0.001% Susceptible people: infants and young children Mode of infection: non-infectious Complications: mental retardation
Cause
Cause of mental retardation
Psychosocial factors (18%):
In addition, due to the early cultural and emotional deprivation, lack of appropriate stimulation, long-term neglect, isolation, living in remote poverty, cultural backwardness, inaccessible areas, general social psychological factors caused by mental retardation is relatively light, once unfavorable factors Elimination, it is possible to improve their intelligence level, the improvement depends on the age of the child, the degree of damage and the conditions provided by the environment.
Genetic factors (34%):
Single-gene genetic diseases are more common, accounting for 1% of life-infested infants, and about 4,000 to 5,000 human diseases are caused by them. Among them, 300 are caused by biochemical metabolic abnormalities, and brain function is impaired. Usually, the clinical symptoms of monogenic diseases are about 25% existed at birth and 90% in early adolescence, such as phenylketonuria and several neurocutaneous syndromes. Neurofibroma is a common type with a prevalence rate of 1/5000 to 1/1. 4000, phenylketonuria is a typical representative of hereditary metabolic deficiency disease. The lack of congenital phenylpyruvate hydroxylase can not oxidize phenylpyruvate to tyrosine, causing a large amount of phenylpyruvate accumulation to affect the central nervous system. Developmental and normal physiological functions, such as galactosemia, are caused by the conversion of 1-galactose to glucose 1-phosphate or the accumulation of lactose in the blood, tissues, damage to various organs such as liver, kidney and brain. In addition to the physical symptoms caused by this, the child also has mental impairment.
Environmental factors (28%):
In some areas, the result of iodine deficiency can cause serious mental retardation. The pollution of lead in gasoline and paints and coatings is also quite serious in some areas and may cause effects on the fetus. The study believes that blood lead levels are 10 to 25 U/dl. There may be cognitive and behavioral disorders. In the mid-1980s, nearly 10% of preschool children in the United States had blood lead levels of 20 U/dl, while in low-income families, about 20% of children had blood lead levels of 30 U/dl, so in urban industries. The developing country is a harmful factor that cannot be ignored.
The health of pregnant women directly affects the normal development of the fetus. Serious chronic diseases such as heart disease, diabetes, high blood pressure, chronic kidney disease and severe anemia can cause fetal ischemia and hypoxia, leading to immature children and intrauterine growth retardation. , low birth weight or nervous system damage, intrauterine asphyxia and intracranial hemorrhage, the impact of maternal disease on the fetus is about 6% of the newborn, and about 1/5 of them are serious, the prognosis is not good in the neonatal period. Signs include Apgar scores below 6 or 7, early seizures, etc.
Prevention
Mental retardation prevention
Primary prevention
(1) Do a good job of pre-marital examination, pregnancy care and family planning: adhere to routine prenatal examination, prevent dystocia, emergency production, in remote areas, especially to prevent damage and infection of the central nervous system of infants and young children, it is recommended in endemic goiter In the epidemic area, pregnant women are given iodine, and the newborns are tested for T3, T4, and TSH levels, and suspicious individuals are monitored to prevent endemic cretinism.
(2) Prevention of the occurrence of hereditary diseases: If parents have already had obvious genetic diseases or have genetic diseases in their children, or older primiparas, genetic counseling may be carried out, if necessary, prenatal diagnosis, such as diagnosis of the fetus Inherited diseases, can terminate the pregnancy in time, early detection of certain congenital metabolic defects, Guthite bacteria inhibition test for newborns, the purpose is to detect suspicious cases for further diagnosis, to avoid birth of the second child.
2. Secondary prevention
(1) Regularly inspect infants and young children using the knowledge and techniques of child development psychology, and conduct regular visits and early interventions on suspicious children.
(2) Intensive education and training for children with mental retardation who are mainly caused by social, cultural or psychosocial factors.
(3) Actively prevent and control emotional and behavioral disorders in children with mental retardation, and educate parents and teachers about mental retardation, so that they are familiar with what kind of mental and neurological diseases may occur in children at different times, and General disposal method.
3. Three levels of prevention
Reduce disability and improve compensatory abilities, including patient behavior and life counseling, special education and training, and counseling services to help overcome the patient's difficulties in behavioral and personality problems, and to incorporate physical dysfunction or other deformities It is necessary to treat the disease, to restore the optimal functional level, to provide conditions for participating in social life and employment in the future, to pay attention to structured and individualized teaching in education and training, and to improve the self-care ability and survivability of life as the main goal of training and training. It is also necessary to consciously educate the rights of the disabled and the concept of the legal system so that they can understand the possible ways and means of safeguarding their legitimate rights and interests.
Complication
Mental retardation complications Complications, mental retardation
(1) Intellectual development: intelligent depression, ADHD, autism, and difficulty in IQ measurement.
(2) Personality characteristics: Patients with mental retardation may have the following personality characteristics, stubborn, willful, irritability, solitude, mood swings, and sometimes forced, self-injured, and invasive behavior.
(3) Perception, cognitive impairment: The function of mental retardation in this aspect of the patient seems to be very good, but it has been confirmed that there are two points of recognition, shape identification, spatial perception and other perceptions, cognitive impairment.
Symptom
Symptoms of mental retardation Common symptoms Irritable irritability Responsive sputum Reflexes edifying body dystonia Love frustration syndrome QT interval prolonging lower body than upper tremor beard sparse gait instability
(1) Mild mental retardation: the IQ is between 50 and 69, and the psychological age is about 9 to 12 years old. This type accounts for 75% to 85% of patients with mental retardation. Normal children are delayed in development, preschool is just walking, speech and development may be late, general language ability is well developed, and ability to cope with daily life is ok. Therefore, it is not easy to detect in short-term contact, and it is difficult to learn after entering school. The higher the difficulty, especially the mathematics, can learn the test calculation, but it is more difficult to solve the application problem. It is not difficult to learn through reading, and it is not difficult to read, but the level of thinking activity is not high, in abstract thinking, creative ability Poor, I am struggling with the composition, it is difficult to get promoted with my peers, to reach the level of primary school graduation, often failing or repeating grades in ordinary schools. Generally, I am diagnosed after learning because of difficulties in learning. I can take care of myself in daily life and learn a skill. Most of them can engage in simpler labor when they are skilled in the work of others.
(2) Moderate: IQ is between 35 and 49, and the psychological age is about 6 to 9 years old, accounting for about 15%. Since childhood, mental and motor development are significantly slower than normal children, poor language development, poor vocabulary, and some patients. It is also ambiguous and can grasp the language of daily life, but the vocabulary is so poor that it can not fully express the meaning, and the reading and comprehension ability is limited. For this reason, it can be perceived in the short-term contact, the concept of their logarithm is fuzzy, and the calculation The ability is obviously lower than that of ordinary people. Most patients can only calculate the single digit plus, subtract, or even learn simple calculations and points, so they can't adapt to ordinary primary school. In adulthood, the intelligence level is equivalent to normal children aged 6-9. .
(3) Severe mental retardation: the IQ is between 20 and 34, and the psychological age is about 3 to 6 years old. The severe patients have poor intelligence, accounting for 3% to 8% of all mental retardation, and obvious development after birth. Behind, I can learn simple sentences after I am older, but I can't communicate effectively. I can find abnormalities in the body and nervous system since I was young. I have poor motor function, can't walk, stand, or walk, but my gait is unstable and my movements are clumsy. They have a low level of language development and can only learn to speak a few words, some can hardly speak, can not conduct effective verbal communication, because they can master a small amount of vocabulary, difficult to understand, and have limited expression, they cannot express their wishes and demands in words. Even simple words of life can't be understood, so they can be detected with short-term contact.
Examine
Mental retardation check
Mental retardation There is currently no specific laboratory test. When other conditions, such as endemic cretinism, phenylketonuria, etc., have mental retardation, laboratory tests show positive results of other conditions. Such as phenylketonuria blood phenylalanine content> 4%, can be regarded as a positive result, then further quantitative examination, generally > 20% diagnostic significance. Another test method is the ferric chloride experiment and the 2-4-dinitrophenylhydrazine test. The positive reaction of the former is green, and the positive reaction of the latter is yellow. Generally, the latter is more sensitive than the former, preferably both. To improve sensitivity. Local cretinism serum protein combined with iodine and butanol extracted iodine was mostly reduced, thyroid uptake 131I rate increased, showing iodine starvation curve, serum cholesterol was normal or low.
Diagnosis
Diagnosis and diagnosis of mental retardation
Diagnostic criteria
1. Diagnostic criteria
(1) Intelligence is significantly lower than the average level of peers. In the individual intelligence test, the IQ (IQ) is lower than the population mean by two standard deviations. Generally speaking, the IQ is below 70.
(2) Insufficient social adaptability, manifested in obvious defects in personal life ability and social responsibility.
(3) Before the age of 18, the diagnosis of mental retardation must have the above three conditions, which are indispensable, that is to say, only those with insufficient mental development or low IQ and low ability cannot be diagnosed. Those with impaired adaptive ability and those with low IQ can not be diagnosed. The mental regression caused by any cause after 18 years old can not be diagnosed as mental retardation and should be called dementia.
2. Diagnostic steps
(1) Detailed collection of medical history: comprehensive collection of children during pregnancy, perinatal conditions, personal growth and development history, maintenance history, past disease history, family cultural economic status, to find out whether there is any physical and psychological development of the child Unfavorable factors.
1 Family history: It is necessary to know whether parents are married to close relatives, whether there are blindness, dumbness, epilepsy, cerebral palsy, congenital malformation, MR and mental illness in the family.
2 maternal pregnancy history: ask the mother early pregnancy with or without viral infection, miscarriage, bleeding, injury, taking chemical drugs, exposure to poison, radiation, whether there is hypothyroidism, diabetes and severe malnutrition, with or without multiple births, polyhydramnios The placenta is incomplete, and the maternal and child blood types are incompatible.
3 Birth history: Whether it is premature or expired, whether there is abnormal production mode, whether the birth weight is low birth weight, whether there is suffocation after birth, birth injury, intracranial hemorrhage, severe jaundice and congenital malformation.
4 growth and development history: including neuropsychiatric onset, such as raising the head, sitting up, walking and other big movements began to appear, using fingers to detect the completion of fine movements such as small toys and daily necessities, shouting father and mother, listening to speech and other language functions The state of development, as well as other intellectual behaviors such as feeding, dressing, controlling bowel movements, etc.
5 past and present disease history: whether there is craniocerebral trauma, hemorrhage, central nervous system infection, systemic serious infection, seizures and so on.
(2) Comprehensive physical examination (including mental and physical) and related laboratory tests including indicators of growth and development of children, such as height, weight, head circumference, skin palm fingerprint, related endocrine, metabolic examination, EEG, brain topography Head X-ray and CT, MRI, chromosome analysis and brittle site examination are indispensable steps for the analysis of the cause of mental retardation.
