Implementation of the International Classification of Diseases 11th revision behavioural indicators for disorders of intellectual development with co-occurring autism spectrum disorder

BACKGROUND

The classification of mental, behavioural and neurodevelopmental disorders in the World Health Organization's International Classification of Diseases 11th revision (ICD-11) includes a comprehensive set of behavioural indicators (BIs) within the neurodevelopmental disorders grouping. BIs can be used to assess the severity of disorders of intellectual development in situations in which standardised measures of intellectual functioning and adaptive behaviours are not available or feasible. This international study examines the implementation characteristics of the BIs and compares them to standardised measures for assessing the severity of intellectual impairment and adaptive behaviours in disorders of intellectual development and autism spectrum disorder (ASD). The clinical utility of the ICD-11 and the fidelity of its application in international clinical settings were also assessed.

METHODS

A total of 116 children and adolescents (5-18 years old) with a suspected or established diagnosis of disorders of intellectual development were included across four sites [Italy (n = 18), Sri Lanka (n = 19) and two sites in India (n = 79)]. A principal component analysis was conducted to evaluate the application of the ICD-11 guidance for combining severity levels.

RESULTS

Assessment using the BIs showed a higher proportion of individuals classified with mild severity, whereas the standardised measures indicated a higher proportion of severe ratings. Additionally, individuals with co-occurring ASD tended to have more severe impairments compared with those without ASD, as indicated by both BIs and standardised measures. Overall, the BIs were considered clinically useful, although more time and consideration were required when applying the guidelines for individuals with a co-occurring disorder of intellectual development and ASD. The principal component analysis revealed one principal component representing overall disorders of intellectual development severity levels.

CONCLUSIONS

The ICD-11 BIs can be implemented as intended in international clinical settings for a broad range of presentations of individuals with neurodevelopmental disorders. Use of the BIs results in similar severity diagnoses to those made using standardised measures. The BIs are expected to improve the reliability of severity assessments in settings where appropriate standardised measures for intellectual and adaptive behaviours are not available or feasible.

An international field study of the ICD-11 behavioural indicators for disorders of intellectual development

BACKGROUND

The World Health Organization (WHO) has approved the 11th Revision of the International Classification of Diseases (ICD-11). A version of the ICD-11 for Mental, Behavioural and Neurodevelopmental Disorders for use in clinical settings, called the Clinical Descriptions and Diagnostic Requirements (CDDR), has also been developed. The CDDR includes behavioural indicators (BIs) for assessing the severity of disorders of intellectual development (DID) as part of the section on neurodevelopmental disorders. Reliable and valid diagnostic assessment measures are needed to improve identification and treatment of individuals with DID. Although appropriately normed, standardised intellectual and adaptive behaviour assessments are considered the optimal assessment approach in this area, they are unavailable in many parts of the world. This field study tested the BIs internationally to assess the inter-rater reliability, concurrent validity, and clinical utility of the BIs for the assessment of DID.

METHODS

This international study recruited a total of 206 children and adolescents (5-18 years old) with a suspected or established diagnosis of DID from four sites across three countries [Sri-Lanka (n = 57), Italy (n = 60) and two sites in India (n = 89)]. Two clinicians assessed each participant using the BIs with one conducting the clinical interview and the other observing. Diagnostic formulations using the BIs and clinical utility ratings were collected and entered independently after each assessment. At a follow-up appointment, standardised measures (Leiter-3, Vineland Adaptive Behaviour Scales-II) were used to assess intellectual and adaptive abilities.

RESULTS

The BIs had excellent inter-rater reliability (intra-class correlations ranging from 0.91 to 0.97) and good to excellent concurrent validity (intra-class correlations ranging from 0.66 to 0.82) across sites. Compared to standardised measures, the BIs had more diagnostic overlap between intellectual and adaptive functioning. The BIs were rated as quick and easy to use and applicable across severities; clear and understandable with adequate to too much level of detail and specificity to describe DID; and useful for treatment selection, prognosis assessments, communication with other health care professionals, and education efforts.

CONCLUSION

The inclusion of newly developed BIs within the CDDR for ICD-11 Neurodevelopmental Disorders must be supported by information on their reliability, validity, and clinical utility prior to their widespread adoption for international use. BIs were found to have excellent inter-rater reliability, good to excellent concurrent validity, and good clinical utility. This supports use of the BIs within the ICD-11 CDDR to assist with the accurate identification of individuals with DID, particularly in settings where specialised services are unavailable.

Reading skills in children with mild to borderline intellectual disability: a cross-sectional study on second to eighth graders

BACKGROUND

Students with intellectual disabilities (IDs) have various learning difficulties and are at risk for school failure. Large inter-individual differences are described for reading, but it is unclear how these vary as a function of grade. The aim of this study was to examine various reading fluency, accuracy and comprehension parameters in second-to-eighth-grade Italian children with either borderline intellectual functioning (BIF) or mild ID (MID).

METHODS

We examined 106 children with BIF (67 M and 39 F) and 168 children with MID (107 M and 61 F). The children were in the second to eighth grade and were comparable for chronological age (7 to 14 years). They were administered a battery of tests that assessed fluency and accuracy of word, pseudo-word and text reading, as well as text comprehension. Standardised scores allowed us to compare the performance of the two groups with normative values.

RESULTS

Children with ID obtained generally low scores compared with normative values. Those with MID had greater difficulty than those with BIF. Furthermore, difficulty was greater for speed than for accuracy measures and for words than for pseudo-words. Difficulty (particularly in the case of reading speed) tended to be pronounced at later grades. Marked individual differences were present independently of MID-BIF subgrouping, as well as stimulus category and reading parameter.

CONCLUSIONS

As a group, children with ID showed difficulty in reading acquisition; the effect was greater for children with more severe ID, but large individual differences were observed in children with both BIF and MID. Relatively spared pseudo-word reading skills indicate efficient use of the grapheme-to-phoneme conversion routine. This processing mode may prove more ineffective at higher levels of schooling when even in regular orthographies such as Italian typically developing children rely on lexical activation.

Using Z and age-equivalent scores to address WISC-IV floor effects for children with intellectual disability

BACKGROUND

The Wechsler Intelligence Scale for Children - Fourth Edition often produces floor effects in individuals with intellectual disability. Calculating respondents' Z or age-equivalent scores has been claimed to remedy this problem.

METHOD

The present study applied these methods to the Wechsler Intelligence Scale for Children - Fourth Edition scores of 198 individuals diagnosed with intellectual disability. Confirmatory factor analysis and profile analysis were conducted using a Bayesian approach.

RESULTS

The intelligence structure in intellectual disability resembled the one previously reported for typical development, suggesting configural but not metric invariance. When Z or age-equivalent scores (but not traditional scaled scores) were used, the average profile resembled the one previously reported for other neurodevelopmental disorders.

CONCLUSIONS

Both methods avoided any floor effects, generating similar but not identical profiles. Despite some practical and conceptual limitations, age-equivalent scores may be easier to interpret. This was true even for a subgroup of individuals with more severe disabilities (mean IQ < 43).

The diverse toxic effect of SiO₂ and TiO₂ nanoparticles toward the marine microalgae Dunaliella tertiolecta

Nanoparticles (NPs) are widely used in many industrial applications. NP fate and behavior in seawater are a very important issue for the assessment of their environmental impact and potential toxicity. In this study, the toxic effects of two nanomaterials, silicon dioxide (SiO2) and titanium dioxide (TiO2) NPs with similar primary size (~20 nm), on marine microalgae Dunaliella tertiolecta were investigated and compared. The dispersion behavior of SiO2 and TiO2 NPs in seawater matrix was investigated together with the relative trend of the exposed algal population growth. SiO2 aggregates rapidly reached a constant size (600 nm) irrespective of the concentration while TiO2 NP aggregates grew up to 4 ± 5 μm. The dose-response curve and population growth rate alteration of marine alga D. tertiolecta were evaluated showing that the algal population was clearly affected by the presence of TiO2 NPs. These particles showed effects on 50 % of the population at 24.10 [19.38-25.43] mg L(-1) (EC50) and a no observed effect concentration (NOEC) at 7.5 mg L(-1). The 1 % effect concentration (EC1) value was nearly above the actual estimated environmental concentration in the aquatic environment. SiO2 NPs were less toxic than TiO2 for D. tertiolecta, with EC50 and NOEC values one order of magnitude higher. The overall toxic action seemed due to the contact between aggregates and cell surfaces, but while for SiO2 a direct action upon membrane integrity could be observed after the third day of exposure, TiO2 seemed to exert its toxic action in the first hours of exposure, mostly via cell entrapment and agglomeration.

Developmental evolution in a patient with multiple acyl-coenzymeA dehydrogenase deficiency under pharmacological treatment

PURPOSE

evaluate the psychomotor evolution of a child with Multiple acyl-CoA dehydrogenase deficiency after treatment with L-carnitine, ubiquinone and riboflavin.

METHODS

an assessment of psychomotor development was performed before the start of farmacological treatment using the Assessment Scale of Mental Development Griffiths (GMDS-R, 0-2 years). The same assessment was performed after a month and after six months of treatment to evaluate the possible benefits of treatment.

RESULTS

we noticed a quick and dramatic improvement in muscular tone and motor performances after pharmacological treatment. We also observed a substantial improvement in the personal/social and hearing/language areas, suggesting the presence of intellectual/cognitive improvement. The clinical improvement correlated with the biochemical response.

CONCLUSION

In our patient early therapy resulted in a optimal response in psychomotor development, motor function and muscole hypotonia. Evaluation with GMDS-R, a simple, non-invasive and multidimensional tool, represents a useful instrument to monitor the clinical response to treatment.

The impact of living arrangements and deinstitutionalisation in the health status of persons with intellectual disability in Europe

BACKGROUND

Despite progress in the process of deinstitutionalisation, very little is known about the health conditions of people with intellectual disability (PWID) who live in large institutions and PWID living in small residential services, family homes or independent living within the community. Furthermore, there are no international comparison studies at European level of the health status and health risk factors of PWID living in fully staffed residential services with formal support and care compared with those living in unstaffed family homes or independent houses with no formal support.

METHODS

A total of 1269 persons with ID and/or their proxy respondents were recruited and face-to-face interviewed in 14 EU countries with the P15, a multinational assessment battery for collecting data on health indicators relevant to PWID. Participants were grouped according to their living arrangements, availability of formal support and stage of deinstitutionalisation.

RESULTS

Obesity and sedentary lifestyle along with a number of illnesses such as epilepsy, mental disorders, allergies or constipation were highly prevalent among PWID. A significantly higher presence of myocardial infarctions, chronic bronchitis, osteoporosis and gastric or duodenal ulcers was found among participants in countries considered to be at the early stage of deinstitutionalisation. Regardless of deinstitutionalisation stage, important deficits in variables related to such medical health promotion measures as vaccinations, cancer screenings and medical checks were found in family homes and independent living arrangements. Age, number of people living in the same home or number of places in residential services, presence of affective symptoms and obesity require further attention as they seem to be related to an increase in the number of illnesses suffered by PWID.

DISCUSSION

Particular illnesses were found to be highly prevalent in PWID. There were important differences between different living arrangements depending on the level of formal support available and the stage of deinstitutionalisation. PWID are in need of tailored primary health programs that guarantee their access to quality health and health promotion and the preventative health actions of vaccination programs, systematic health checks, specific screenings and nutritional controls. Extensive national health surveys and epidemiological studies of PWID in the EC member states are urgently needed in order to reduce increased morbidity rates among this population.

The P15 - a multinational assessment battery for collecting data on health indicators relevant to adults with intellectual disabilities

BACKGROUND

Health disparities between adults with intellectual disabilities (ID) and the general population have been well documented but, to date, no dedicated assessment battery for measuring health disparity has been available. This paper reports on the development and testing of a multinational assessment battery for collecting data on a range of health indicators relevant to adults with ID.

METHODS

An assessment battery (the P15) was developed following piloting, and administered to samples of adults with ID, in 14 EU countries. Samples were neither random, nor representative of the countries from which they were drawn. However, within the local health administration areas selected in each country, efforts were made to ensure samples were broadly representative of the typical living circumstances, ages and ability levels of the administrative population of adults with ID. The total sample comprised 1269 adults with ID, of whom 49% were female. The mean age was 41 years (range 19 to 90).

RESULTS

Overall, feasibility, internal consistency and face validity of the P15 was acceptable.

CONCLUSIONS

With some refinement the P15 could be useful for collecting data on health indicators known to be particularly important for adults with ID. It is useable in a range of countries and has the potential to highlight health inequity for adults with ID at a national or local level. Larger scale epidemiological studies are needed to exploit the potential of the P15 to address health inequity in this group.

Predictability of copper, irgarol, and diuron combined effects on sea urchin Paracentrotus lividus

The aim of this work was to investigate the mixture toxicity of Irgarol (2-methylthio-4-t-butylamino-6-cyclopropylamino-s-triazine), Diuron (3-(3,4-dichlorophenyl)-1,1-dimethylurea), and copper upon the sea urchin Paracentrotus lividus and to compare the observed data with the predictions derived from approaches of Concentration Addition (CA) and Independent Action (IA). Copper spermiotoxicity was more sensitive (EC50 = 0.018 mg/L) than embryotoxicity (EC50 = 0.046 mg/L). The offspring malformations were mainly P1 type (skeletal alterations) in both cases, probably because copper competes to fix Ca2+. Irgarol and Diuron toxicity has been previously investigated. EC50 mixture embryotoxicity showed an EC50 of 1.79 mg/L, whereas spermiotoxicity mixture effects were lower than 11%. Both CA and IA modeling approaches failed to predict accurately mixture toxicity. For embryotoxicity, the IA model overestimated the mixture toxicity at effect levels of <80%. CA does not represent the worst-case approach showing values lower than IA (embryotoxicity) or similar (spermiotoxicity).

PPARalpha mediates the effects of the pesticide methyl thiophanate on liver of the lizard Podarcis sicula

The majority of environmental pollutants are potential peroxisomal proliferators which include a heterogeneous group of compounds known to determine massive peroxisomal proliferation and hepatocarcinogenesis in rodents. Peroxisomal proliferation is accompanied by the induction of the peroxisomal fatty acid beta-oxidation pathway mediated by a class of transcription factors named peroxisome proliferators activated receptors (PPARs). This phenomenon demonstrated also in ectotherm animals after exposition to environmental pollutants may be utilized as biomarker in environmental impact studies. In the present work we have tested the sensitivity to methyl thiophanate (TM) of the lizard Podarcis sicula in order to propose a biological model for monitoring the ecotoxicological effects of this pesticide on terrestrial sentinel species. The data obtained demonstrate that exposition to sub-lethal concentrations of TM leads to hepatocellular morphological changes and glycogen depletion, apoptosis, as well as probable peroxisomal proliferation attested by the increase of acyl-CoA oxidase (AOX). This effect seems to be mediated by the concomitant increase of PPARalpha. On the basis of these results we propose that also in Podarcis sicula, as just proposed for aquatic organisms, peroxisomal proliferation and AOX increase may be considered new biomarkers to evaluate pollution by organic compound in terrestrial environments.

Toxic effects of irgarol and diuron on sea urchin Paracentrotus lividus early development, fertilization, and offspring quality

Irgarol and Diuron are the most representative "organic booster biocides" that replaced organotin compounds in antifouling paints. It cannot be assumed beforehand that their use will have no environmental impact: more ecotoxicological data and a significant environmental monitoring are required. Spermio and embryotoxicities of the biocides Irgarol and Diuron were investigated on Paracentrotus lividus, the dominant echinoid species of the Mediterranean Sea. Spermiotoxicity was studied by assessing the effects of sperm exposure on fertilization rate as well as on the induction of transmissible damages to the offspring. Embryotoxicity was studied by assessing the developmental defects in the exposed larvae. The experimental results show a Diuron EC50 of 2.39 (+/- 0.21) mg/L with a NOEL of 0.25 mg/L for embryos, and of 5.09 (+/- 0.45) mg/L with a NOEL of 0.5 mg/L for sperms, respectively. Data obtained from the embryotoxicity test on Irgarol [EC50 0.99 (+/- 0.69) mg/L] are of the same order of magnitude as the literature data about Japanese urchins. Spermiotoxicity tests show an Irgarol EC50 of 9.04 (+/- 0.45) mg/L with a NOEL of 0.1 mg/L. These data show the different sensitivities of the two tests: embryos are more sensitive than sperms for both the tested chemicals and Diuron seems to be the less toxic one. Moreover, as a major output of the experimental work, tested herbicides exert transmissible damage to spermatozoa evidenced by larval malformations in the offspring, mainly P1 type (skeletal alterations). The comparison of the endpoints results offers an interesting indication of a probable different mode of action (Irgarol seems to interact with calcium homeostasis) of the two biocides.

Morphology of the pancreas of some species belonging to the genera Phelsuma and Gecko (family Gekkonidae): evidence of apoptotic process during the seasonal cycle

In this study we investigated comparative morphology of the endocrine pancreas of several species belonging to the family Gekkonidae and apoptotic processes of the pancreas which may be correlated to the seasonal cycle. The following species of the family Gekkonidae were studied: Phelsuma lineata, P. madagascariensis, P. dubia, P. abotti, Gekko gecko, G. vittatus, and Geckonia chazaliae. In all these species the pancreas consisted of large and medium islets as well as endocrine cells which were scattered throughout the acinar cells. Exocrine parenchyma consisted of tubuli-acini. Four mayor cell types were identified in the endocrine pancreas, using immunocytochemistry: glucagon-immunoreactive (A) cells, insulin-immunoreactive (B) cells, somatostatin-immunoreactive (D) cells, and pancreatic polypeptide immunoreactive (PP) cells. In the endocrine pancreas the amount of A cells and B cells was either equal or a prevalence of A cells was observed. In the wet season the pancreatic morphology presented normal features with very rare apoptotic cells. The animals belonging to the genus Phelsuma taken in the dry season (July) showed numerous vacuolated, Caspase 3, 9 and 11-immunoreactive acinar and some endocrine cells containing picnotic nuclei which were positive to tunel reaction. The animals belonging to the genus Gekko taken at the end of the dry season (October) exhibited strongly vacuolated, Caspase 3, 9 and 11-immunoreactive endocrine and some acinar cells containing nuclei which were positive to tunel reaction. These apoptosis events could be a reaction in response to stress mechanisms, such as a starvation period during the dry season.

Cognitive correlates of laterality in mental retardation

Correlations of various laterality score for 202 persons with cognitive test scores in the seventies of mental retardation are presented.

Leptin, Leptin Receptors and ACTH Immunoreactivities are Present in the Gastrointestinal Tract and the Neural Tube of Tadpoles of the Newt Triturus

Leptin, its receptor and ACTH were detected by immunohistochemistry in the gastrointestinal tract and the neural tube of the amphibian urodele, Triturus cristatus carnifex, during development. These molecules were found after hatching of tadpoles, starting from stage 41. In the gastrointestinal tract, cells immunoreactive to leptin and its receptor were first revealed in the stomach, the liver and the gut and then in the pancreas. Both immunoreactives were colocalized in the same cells in some areas. Immunostaining for ACTH appeared at stages 43/45 in the stomach, the gut and the pancreas. In adjacent sections, a few cells immunoreactive to both ACTH and leptin receptor were detected. A few cells were immunoreactive to both insulin and leptin receptor. Immunoreactivities to leptin and its receptor were also found in adjacent sections of the neural tube, often colocalized in the same cell. Moreover, in prosencephalon, mesencephalon, rhomboencephalon and spinal cord, ACTH-immunoreactive cells were detected in the same areas as the leptin receptor immunoreactive cells. These results suggest the existence of a neuroendocrine network in newt tadpoles both at the central level, where it resembles that of mammals, and at the peripheral level, where it may act locally to regulate food intake and metabolism, e.g. yolk digestion.

Topiramate in refractory partial-onset seizures in children, adolescents and young adults: a multicentric open trial

PURPOSE

This study was to evaluate the efficacy and safety of topiramate (TPM) in refractory partial epilepsy in children, adolescents and young adults.

METHODS

We performed a prospective open label add-on study in 55 patients (age 2-30 years, mean 15 years) with refractory partial seizures. Topiramate was added to one or two other baseline drugs and the efficacy was rated according to seizure type and frequency.

RESULTS

TPM was initiated at a daily dose of 0.5-1 mg/kg, followed by a 2-week titration at increments of 1-3 mg/kg/24h, up to a maximum daily dose of 12 mg/kg. After 9 months of treatment, 11 patients (20%) had 100% fewer seizures and 25 patients (45%) had a more than 50% seizure reduction. TPM appeared to be effective both in cryptogenic (76.2%) and symptomatic (58.8%) partial epilepsies. Mild to moderate adverse events were present in 25 patients (45.4%), mostly represented by drowsiness, nervousness and hyporexia with or without weight loss.

CONCLUSION

TPM was an overall effective and safe add-on drug both in cryptogenic and symptomatic childhood refractory partial seizures, the adverse reactions being generally mild or moderate.

PP/PYY cells from endocrine pancreas of the scincid lizard Eumeces inexpectatus synthesize ACTH- and alpha-MSH-like molecules

The endocrine pancreas of the scincid lizard Eumeces inexpectatus secretes four major hormones, insulin, glucagon, somatostatin, and pancreatic polypeptide (PP); in addition, other peptides and neuropeptides, often colocalized in one of the principal cell types (A, B, D, and PP), were detected by light and ultrastructural immunocytochemistry. In particular, the pancreas is rich in peptide tyrosine tyrosine (PYY), ACTH, and alpha-MSH immunoreactivity. When single- and double-immunolabeled serial sections were compared for immunostaining for PP, PYY, ACTH, and alpha-MSH, there was broad coincidence with PP, termed PP/PYY, cells in view of the extensive colocalization of these two peptides. Furthermore, ultrastructural morphometric studies revealed similar secretory granules for PP immunoreactive (ir) and ACTH ir cells, while the endocrine cells express pro-opiomelanocortin (POMC) mRNA, indicating an active, extrapituitary synthesis of the POMC-derived peptides in these cells. In conclusion, the presence of POMC-derived peptides in the endocrine pancreatic cells suggests that they may regulate insulin secretion.

The Rorschach Egocentricity Index in subjects with intellectual disability: a study on the incidence of different psychological pathologies

The aims of the present research were to assess the level of self-concern in people with intellectual disability using the Rorschach Egocentricity Index, to correlate the Index with other Rorschach and IQ variables, and to study the effect of associated psychological pathology. The Rorschach Inkblot Test and the Wechsler Intelligence Scale were administered to a group of 75 subjects with intellectual disability, aged between 18 and 38 years, who were divided into subgroups according to their additional diagnosis (i.e. personality disorders, psychosis and depression). A fourth subgroup was composed of people with intellectual disability but without other pathologies. The Egocentricity Index was very low in the subjects with intellectual disability and differences were a result of the effects of additional psychological pathologies. The meaning of the measurement of egocentricity in people with intellectual disability is discussed.

[Evaluation of psychological characteristics in the preoperative phase of patients with mental retardation]

OBJECTIVES

To make easier the psychological evaluation of patients affected by Mental Retardation and scheduled for general anesthesia.

DESIGN

A form prepared by the Psychological Service of the IRCCS "Oasi Maria SS" in collaboration with the Service of Anesthesia was evaluated prospectively. The form is addressed to relatives and psychologists; the interviewed person is firstly asked for a short description of patient's personality and for any suggestion useful to patient's management; secondly it is requested to assign a score from 1 (never present) to 5 (always present) to 44 items concerning adaptive capacities (divided into body scheme, spoken language, receptive language, mimic-gestural language, temporal orientation, memory), emotional and social fields (including sensibility, dependence, and social behaviors), problematic and stereotyped behaviors.

SETTING

A medical and psychological Institute aimed at the study of Mental Retardation.

PATIENTS

Twenty-five patients affected by Mental Retardation and scheduled for general and dental surgery.

RESULTS

The form supplied a great deal of information and suggestions for patient management. Subjects that did not cooperative with the anesthetist presented lower scores about the ability to use mimic-gestural language (p < 0.05) and higher scores about the presence of anxiety or fear caused by the sight of syringes or blood (p < 0.05) and about behaviors of flight, isolation, or aggression caused by fear (p < 0.05). By contrast, patients presenting mild or moderate degrees of Mental Retardation differentiated from patients with serious degree of Mental Retardation about body scheme (p < 0.001), spoken language (p < 0.05), receptive language (p < 0.001), temporal orientation (p < 0.001) and memory (p < 0.001).

CONCLUSIONS

The form was very useful to plan patient management. These data suggest that the lack of cooperation by some patients affected by Mental Retardation is related to fear, anxiety, and incapacity to communicate rather than to the degree of Mental Retardation.

Laterality and handedness in mentally retarded subjects

In a study of 69 adults with mental retardation, atypical laterality measured on 12 tasks was only partially noted. Distribution of over-all laterality scores was different from that of handedness with more left-handed than left lateralized and more right manual preference among the 43 women.

Rorschach cognitive developmental indices of mentally retarded persons: a comparison with scores on Wechsler Intelligence Scale for children-revised

In a sample of 55 mentally retarded subjects (M age = 14 yr., 1 mo.) the relations between some perceptual and cognitive Rorschach indices, including the Becker's Genetic Level Score, and Wechsler Scale scores were studied. The mean Developmental Score did not increase across ages and was higher for girls than for boys, while Verbal and Performance IQs were lower for girls. The correlations confirm the hypothesis that for mentally retarded persons WISC-R scaled scores and Rorschach cognitive indices are different measures of intellective functioning. The findings are discussed with reference to the assessment and rehabilitation of retarded subjects.

[Clinical usefulness of quantitative two-dimensional echocardiographic analysis of segmental kinesis of the left ventricle in monitoring of patients with neoplasms treated with anthracyclines]

To determine whether serial quantitative two-dimensional echocardiographic analysis of left ventricular wall motion could be effective in selecting patients in whom anthracycline treatment must be stopped, 26 patients (18 M and 8 F, mean age 10 +/- 3, range 6 to 16 years) with malignancy, receiving doxorubicin or daunomycin were followed up. Left ventricular regional wall motion abnormalities were detected in 11 patients (42%), while left ventricular ejection fraction at rest (although progressively decreased from baseline value [63 +/- 2 vs 55 +/- 2%; p = 0.0001]) was still in normal range. The following distribution of left ventricular contraction abnormalities was noted: septal, anteroseptal and posteroseptal akinesis with posterior wall hypokinesis in one patient; septal, anteroseptal and posteroseptal akinesis with anterolateral free-wall hypokinesis in another; septal, anteroseptal and posteroseptal hypokinesis in four; lateral and posterolateral free-wall hypokinesis in one; septal, anteroseptal, posteroseptal and posterior hypokinesis in four. The drug was discontinued in only two patients with akinesis, since we regarded this contraction abnormality as a predictive index of more serious and extensive myocardial damage. We began to detect hypokinesis when cumulative doses of doxorubicin or daunorubicin were 155-420 mg/m2 and 270-285 mg/m2 respectively, while akinesis was seen at doses of 395 mg/m2 of body-surface area for doxorubicin and 575 mg/m2 for daunorubicin. Follow-up examination was conducted six months after the last dose of anthracycline, and improvement or recovery of left ventricular regional wall motion abnormalities was noted in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

EEG findings in shunted hydrocephalic patients with epileptic seizures

The EEG findings in 40 shunted hydrocephalic patients tested after the onset of epileptic seizures are assessed. The salient point to emerge from the study is the higher frequency of anomalies, both specific (spikes, slow spikes, spike and wave complexes) and nonspecific (monomorphic and polymorphic slow waves) on the shunted hemisphere (19 cases) than on the unshunted side (8 cases). The lateralization of EEG anomalies on the shunted side in patients with no neurological deficits and no focal damage to the substance of the brain suggests that the EEG focus is in some way related to the presence of the shunt. Without denying the importance of the hydrocephalus etiology as a cause of epilepsy in shunted patients, we do think that, in some cases at least, epilepsy is to be regarded as a surgical complication.