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| Sunday, 30 March 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius When your child is slow to learn... The general description used in designating mental retardation are mild, moderate, severe and profound.
During late adult years they usually achieve social and vocational skills adequate for minimum self-support. Moderate mental retardation: This group consists of approximately 10 per cent of those suffering from the disorder and belongs to the trainable group of people. They can learn to communicate during their pre-school years and later may profit from vocational training and with moderate supervision can take care of themselves. In their adult years they may be able to contribute to their own support by performing unskilled or semi-skilled work, under close supervision, in sheltered, workshops or in the competitive job market, Severe mental retardation: This group constitutes 3 per cent - 4 per cent of people with mental retardation. During the pre-school period they display poor motor development and they acquire little or no communicative speech. These children's handicaps are frequently noticed at birth or shortly after; they show multiple difficulties including in many cases, severe physical difficulties. During the school age period they may learn to talk and can be trained in elementary hygiene skills. They profit to only a limited extent from instruction in pre academic subjects such as familiarity with the alphabet and simple counting. In their adult years they may be able to perform simple tasks under close supervision. Profound mental retardation: This group constitutes approximately 1 per cent - 2 per cent of people with mental retardation. These children have an extremely low IQ and minimal adaptive behaviour and their handicaps are usually noticed at birth. They show multiple difficulties including in many cases, severe physical difficulties. A few children will learn to work, talk and develop some self help skills but this may be minimal. Diagnosis and causes: Mild to moderate mental retardation can be caused by psychosocial disadvantages. This becomes apparent particularly where there is little cultural or social stimulations, either in the home or in the environment. A lack of early stimulation can be significant in creating an inability to develop to full intellectual capacity. The more profound or seriously retarded usually will be noticed earlier especially if a child has definite physical abnormalities, particularly involving face and head. If a child fails to reach motor development milestones by being markedly delayed in sitting, walking or talking, professional consultation is frequently obtained when the child is two to three years of age. A concerned parent might ask when should I seek help? The best advice we can offer is that professional help should be sought at anytime it is felt a child is not reaching the developmental milestones. Hearing loss can cause a child to appear to be retarded. These children usually appear very quiet and inattentive they don't follow sounds and speech may be defective or delayed. The time of acquisition of speech is varied. Most people dealing with mentally retarded children become concerned if a child is not speaking by age two or at least saying short sentences of two or three words. Some children who are not mentally retarded develop speech late and don't develop effective language until three years. Emotional disorders can cause children to appear to be retarded. Chronic anxieties and depression can cause school failure and poor performance on intelligence tests. This type of retardation can usually be alleviated with careful counselling and educational programs. Autism and childhood schizophrenia which are primarily emotional disturbances can be misdiagnosed as mental retardation. These children can be differentiated by careful psychological testing. Teaching retarded children Since retarded children are less intelligent than average they have a harder time learning than most people. Perhaps, the biggest obstacles in the way retarded children learn are the expectations on the part of their parents and teachers. On the one hand there is the expectation that if the child is retarded he will not learn. On the other hand, there are unrealistic expectations of parents unwilling to accept that their child is retarded and that his learning process will be delayed. Children have short attention spans and this is especially true of retarded children. So when teaching, a retarded child it is best to keep the teaching session short. Three ten-minute sessions are better than one thirty minute session. Retarded children have difficulty remembering things for short periods of time. However with repeated drill and practice their long-term memory is adequate. Retarded children learn best and retain what they learn longest when teaching begins early in their lives and continues as a steady repetitious lifelong process. *************************** Spiral CT scanner installed Asha Central Hospital has installed the first Spiral (Helical) CT Scanner which can perform 60 seconds Helical Scans, CT Angiography and 3D reconstruction which means that you can view any organ in 3 dimensions. In angiogrames of the blood vessels of the brain it is possible to see inside the lumen. There are several features like remote diagnosis which means that the picture can be sent through the Internet to a Consultant abroad or even locally for a second opinion or for you to view the images on your computer. This will enable you to view the images and make the diagnosis while you are in your office. Facilities will also be available for telemedicine too, as early as possible, hospital sources said. The hospital has obtained the services of two experienced Radiographers trained in India to provide excellent films, and a full time Radiologist in addition to Consultant Radiologists. *************************** Medical update on smoking Prostate cancer Recent studies have revealed that cumulative or recent smoking is associated with death from prostate cancer suggesting that smoking may influence progression to more advanced disease. Scientists at Johns Hopkins University in Baltimore, Maryland, USA evaluated the association of cigarette smoking with extra prostatic and/or Gleason sum 7 or greater prostate cancer in young men. The study included men who underwent radical prostatectomy before age 55 years for prostate cancer between 1992 and 1999. A survey soliciting cigarette smoking history and other exposures was mailed to 498 eligible men. The response rate was 73 per cent. Ectopic pregnancy A case-control study was carried out in France, associated with a regional register of ectopic pregnancy between 1993 and 2000. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was powerful enough to investigate all ectopic pregnancy risk factors. The main risk factors were infectious history and smoking. The other risk factors were age (associated per se with a risk of ectopic pregnancy), prior spontaneous abortinos, history of infertility, and previous use of an intrauterine device. In terms of public health, increasing awareness of the effects of smoking may be useful for ectopic pregnancy prevention. Courtesy: IATH Bulletin *************************** You & Your Doctor by Dr. Sampath R. Nanayakkara Herpes Zoster Q: I am 43-year-old male. A few months back I developed a rash on right side of my chest wall. I had very severe pain. It looked like blisters. I suffered a lot for about 3 weeks and doctors diagnosed it as 'Herpes'. At the onset of the illness doctors could not detect it and first they thought it was gall bladder disease. Now I have been cured but still I get pain from time to time. I am highly worried of the condition because what I have heard about herpes is, it is a Venereal Disease (VD). Please advise me. A: The skin rash you have had is not a venereal or sexually transmitted disease. It is Herpes Zoster (or shingles) caused by the same virus that cause, Chicken pox. This virus is called varicella zoster virus, which causes chicken pox and may subsequently lie in the nerves even for many years and with waning of immunity of the body or at times of stress and in old age the infection becomes reactivated, resulting in the blister-like skin rash in the distribution of the nerve where the virus has been living. The initial symptom is only a pain for upto seven days before the skin rash appears. The pain is usually very severe and depending on the site, may be mistaken for gall bladder pain, heart attack etc. Groups of water filled blisters spread in a linear distribution from one place. Sometimes the rash may spread all over in patients with depressed immunity. The usual course of the disease is spontaneous healing. But pain may continue for a considerable period of time or rarely for the rest of the life, may be extremely disabling particularly in elderly patients. This condition is called Post-Herpetic Neuralgia. The most effective treatment for this condition is, pain management by clinical hypnosis. The simple herpes rash following treatment is advocated: (1) Application of Silver sulphurdiazine or povidone - Iodine cream (2) Pain killers (3) Antiviral Drugs - Ex Acyclovir *************************** Psychological therapy - a new dimension in health care by Nimal Liyanage Until recently, psychologists contributed only on a limited scale to prevention. This situation is therefore changing rapidly as psychological interventions are proving to positively modify health risk behaviour. While psychological factors do contribute to the genesis of such disease as coronary heart disease, cancer, respiratory or neurological disorders, emotional and or behavioural disturbances can also be caused by physical illness, pain and stress due to medical and surgical interventions. Unhealthy behaviour that may cause physical illnesses or disorders is evidently and directly related to specific pattern of lifestyle. Therefore changing of lifestyle is a major endeavour in (health) psychology. Managing of stress and anxiety is also a major issue in health care, which psychologists help in alleviating. All these aspects of psychological therapies can contribute significantly toward quality of life of physically ill patients while they are undergoing treatment for their physical problems apart from helping mentally ill patients exclusively. Results of case studies on the first 650 patients treated by the PTC prove that psychological interventions have the potential to provide a new dimension to the health care service in the Sri Lankan health system. According to the illness from the SL patients, complaints were categorised as follows: (a) Physical symptoms. (b) Cognitive and behavioural symptoms and problems (c) Alcohol and drug abuse related problems. Some patients had only one symptom or complaint. Most of the patients had more than one symptom, complaint or problem. It was found that most of these patients were suffering from anxiety disorders, such as:- Panic disorders without agoraphobia; specific phobia (simple phobia); Social phobia (social anxiety disorders); Obsessive compulsive disorder; Acute stress disorders, generalised anxiety disorders, and Substance-induced anxiety disorder. Somatoform disorders as such: Somatization disorders; Undifferentiated somatoform disorders; Pain disorders (abdominal, chest, knee, somatic, back pain); Hypochondriacs; Somatoform disorders not otherwise specified; Conversion disorders. Sexual dysfunctions, such as: Premature ejaculation; Impotence; Substance induced sexual dysfunctions. Sleep disorders such as: Insomnia. Personality disorders arising from: Alcohol and drug abuses etc. Most of the patients came with Physical Disorders or Physical complaints. They didn't have fair understanding about their Psychological Impairment. Their psychological conflicts aggravated their physical symptoms without having any organic disorders. This was highly dominant among the patients who were categorised under Somatoform Disorders. Family conflicts, marital problems, children's behaviour, spouse's behaviour, neighbours' behaviour, workplace problem, educational conflicts, individual's habits or abuses were also highly influential in developing the stress and generalised anxiety disorders. Improvements When considering total improvement or recovery, the results based on the first 650 patients displayed a significant improvement in their health. The newest developed and most advanced Psychological Treatment (Psychotherapies) techniques such as psychoassessment, psychodiagnosis and interventions with evaluations were applied for these patients, and a large number of them benefited. The approaches included taking into consideration Sri Lankan culture and also the religious beliefs of the patients. These techniques were new and unique to society. Psychoeducation also helped in different ways to educate the patients on the psychological aspects of their diseases. The self-evaluation methods were very successful. The introduction of the treatment techniques were highly productive because they were done in very informal ways by using very simple explanations according to the patient's educational level, social status and problem. Most of these patients had taken drugs and varying methods of treatments before coming to PTC for treatment. More than 95 per cent of the patients were cured from PTC without resorting to drugs. Hence NHSL was able to save considerable amount of drugs within OPD during the last 11 months. *************************** Violence associated with psychological illness Although violence associated with psychological illness is uncommon compared with levels in general population, some of the psychological illnesses like schizophrenia can cause violence, more than in other illnesses. Apart from schizophrenia, patients with mental retardation, mood disorders, seizures, and learning disabilities can cause violence. The possibility of violence should be considered in every contact with a patient suffering from psychological illness. In most instances, the risk of violence occurring will be negligible, but such judgement can be made only after adopting a rational approach. When violence is threatened, it is important to remain calm and non-threatening and to appear in control. The person who is threatened should speak to the patient slowly, clearly, and in a reassuring manner, and should listen to the patient. The overriding rule is to ensure personal safety and the safety of others. It is unwise to argue with the patient and not to have any discussions, which will lead to any confrontations. The identification of confusion is important, particularly in the elderly and in any one with a first presentation of a psychological illness. A mood disorder like depression or hyperactivity can present with irritability and aggression. Patients with a personality disorder or learning disability who have a depressive illness can present with violent behaviour. Intoxication with alcohol or illicit drugs is a common cause of violence, but the finding of intoxication should not preclude other illnesses. Management includes development of preventive treatment strategies (social and environmental, medicinal and psychological) involving family and relevant significant others, to reduce the frequency of identified risks. Patients who become violent in the community may be manageable in a hostel staffed by trained nurses but in many cases admission to hospital may be necessary. There should not be undue reliance on medication, because it is only one aspect of a range of strategies for dealing with violent incidents. When possible, sedation should be minimal becuase this will make it more difficult to understand what is driving the violent behaviour. But in emergency situations strong sedatives or anti-psychotic drugs have to be used to calm the patient. Sometimes Electro-Convulsive Therapy or ECT has to be used to control the situation. Treatment in non-emergency situations depends on the underlying mental disorder. Restraint should be used only in emergency situations. Minimal force should be applied to ensure control of a situation without injury to the patient. Psychological strategies: 'Time out' is a specific behaviour modification procedure whereby the patient is separated temporarily from the specific environment, as part of a planned therapeutic regimen. This process, which should not be confused with seclusion, can be used as a response to aggression or to prevent such an event. In the long-term, specific cognitive and behavioural programs may provide the patient with alternative behavioural strategies. Psychotherapy also has a role in some patients. There is a place for art therapy and creative therapies in patients who have difficulties with verbalizing anger. - Dr. R. A. R. Perera *************************** Apollo launches weekly Breast Clinic Apollo Hospitals last week launched its Breast Cancer diagnosis initiative with the aid of a Breast Cancer Continuous Medical Education (CME) programme to raise awareness about Breast Cancer. Held every Wednesday, the Breast Clinic will be a comprehensive one-stop Breast Clinic, which will help the patients in getting a variety of diagnoses and treatment. Every Wednesday Dr. M. M. Faiz (Telephone #074 531026) or Dr. Jayaindra Fernando (Telephone #074 531027) will clinically examine patients in their OPD chambers as part of a special package designed specifically for the Breast Clinic which includes: Physical examination by the surgeon, Mammogram, Screening Ultra Sound (without film) and, if required, Fine Needle Aspirations Cytology (FNAC). The clinic will function as per the following timetable: 9.00 a.m. - 11.00 a.m. - Clinical examination by the surgeon, 11.00 a.m. - 1.00 p.m. - Mammogram and screening Ultra sound, 1.00 p.m. - 2.00 p.m. - FNAC. Review reports every Friday morning on an appointment basis. The contact telephone number for appointments is #074 531185/86/87. The Breast Clinic is part of an initiative by Dr. Prathap C. Reddy - the Chairman and Founder of the Apollo Group - to prevent breast cancer before it reaches a stage when treatment is not possible. |
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Mild mental retardation: This group constitutes the largest segment of
those with the disorder - about 85 per cent. Many of the mildly retarded
develop social and communication skills during the pre-school years, and
are not recognised until they begin to fail academically in school.
