This article will treat those psychic disorders of different etiology and pathogenesis when the patient suffers from an undeveloped intellect.
Oligophrenia is a group of non-progressive psychic disorders of an organic nature. The other terms are mental retardation and mental subnormality.
General signs and symptoms are observed in early childhood (either congenital or acquired) at 3 years.
The diagnostic criteria for oligophrenia are:
- Psychopathological structure peculiar to dementia with processing of abstract thought especially weak and underdeveloped emotional sphere.
- Non-progressive character of the defect of the intellect.
- Slow psychic development of the individual.
Therefore, oligophrenia is not related to disorders of the intellect that occur as a result of progressive psychic illnesses (schizophrenia and epilepsy ) and as a result of a serious organic defect that occurs after 3 years of age (trauma, infection, intoxication, etc.).
Intelligence is determined polygenetically and environmentally. The factors that cause oligophrenia can be divided into prenatal, perinatal and postnatal.
It may be due to genetic factors, congenital infections, teratogenic factors, radiation, etc. Chromosomal anomalies and aberration comprise the largest number of known causes of oligophrenia.
- Edwards Syndrome (trisomy 18).
- Patau syndrome (trisomy 13).
- Down syndrome (trisomy 21).
- Klinefelter syndrome (XXY).
- Turner syndrome (XO).
Trisomy 21 is the most common. It occurs in 1/600 live births. Fragile X syndrome also causes mild familial oligophrenia.
Metabolic genetic disorders that cause oligophrenia (MR) include recessive X-linked (Lesch-Nyhan, Hunter disorders), autosomal recessive ( phenylketonuria , galactosemia, maple syrup disease, tuberous sclerosis , neurofibromatosis, etc.).
And autosomal recessive lysosomal disorders (Tay -Sach, Nienman-Pick, Gaucher diseases, etc.).
Congenital infections are an important cause of oligophrenia. Rubella virus, cytomegalovirus, toxoplasma gondii, treponemal infections during pregnancy cause oligophrenia as a child.
Out of the teratogenic factors, important are the addiction to alcohol and drugs of the parents and the ingestion of medicines during pregnancy by the mother.
The exogenous factors are excessive movements during pregnancy, psychological alterations during pregnancy, intoxication, diabetes mellitus, toxicosis during pregnensia, rhesus conflicts, etc.
Perinatal complications related to prematurity, CNS bleeding, delivery of forceps or high forceps, multiple births, preeclampsia , perinatal asphyxia, etc. should be remembered, premature children <32 weeks and weight <1.5 kg are likely to be delayed by 50%.
The postnatal factors are viral and bacterial encephalitis, meningitis, poisoning, traumatic brain injury or suffocation, etc.
ICD10 classifies MR into 4 different groups according to the severity of the defect of the intellect.
To measure the intellect, the IQ index is used
Mild mental retardation (F70): The level of intelligence of these children is 50-69. At preschool age (0-5 years old) they can develop social and communication skills.
They have a minimal delay in sensorimotor areas, and are often not recognized in normal children until old age.
During school age (6-20 years) they can learn academic skills to a certain extent (US 6th grade standard) at the end of adolescence.
They can usually achieve social and vocational skills for adequate or minimal self-sufficiency, but may need help and guidance when under unusual stress.
Moderate mental retardation (F71): The estimated level of intelligence is from 35 to 49. They can learn to communicate, they have little social conscience.
They have fair motor development, benefit from self-help training, and can be managed with moderate supervision. They have a very poor performance in school.
Generally they can not study more than 2 ° standard. They can obtain self-maintenance in unskilled or semi-skilled jobs in warm conditions. They need help in situations of mild stress. They are uneducable and incapable.
Severe mental retardation (F72): Your level of intellectual quotient is from 20 to 34. Its characteristic features are: poor motor development, speech is minimal.
These are able to benefit from self-help training, few or no expressive skills, begin to speak at school age.
They can be trained in elementary health habits. In the adult stage, they can partially contribute to self-maintenance under full supervision, they can develop self-protection skills in a controlled environment. They are uneducable and incapable.
Deep mental retardation (F73): Their IQ level is 20. They are completely uneducable and unable to learn anything.
Its characteristic characteristics are thick delay, minimum capacity to function in sensorimotor areas, it may need care and care during preschool age.
During school age, they develop some motor skills and can respond to minimal self-help training.
When they reach adulthood, they have some motor and speech development, can achieve minimal self-care and may need nursing care.
We must consider that the defect of the intellect is not only the pathological presentation of the MR. Among his other pathological images we will discuss only psychiatric disorders.
These are the inability to concentrate on a particular object for some times, little memory (although mechanical memory may be good) and, often, behavioral disturbances.
In most cases, a patient suffering from mild oligophrenia recognizes their differences from other people and, therefore, tries to hide their shortcomings.
So most of them are very introverted, they talk less, they always want to be with their parents and they adapt poorly in a new place with new environments.
A portion of patients with MR experience psychosis, which occurs as psychomotor excitement, aggression, rarely with hallucinations and delusions.
Psychosis is usually observed at puberty. Often, with these psychic disorders, neurological, epileptiform and somatic disorders are found.
Motor neurons are mainly affected. In MRI and CT, local and generalized defects of the brain and skull are found.
But sometimes there are no defects found in those exams. Although mental retardation is a unique disease, mental illness can occur in them at all levels and causes abrupt changes in behavior.
These mental disorders are schizophrenia (communication difficulties make diagnosis difficult, it is difficult to identify thought disorders due to delusions, but a flat affection and signs of hallucination suggest a diagnosis), depression, etc.
But the main cause of oligophrenia is going to a psychiatrist is a behavioral disorder.
Explosive explosions, tantrums and physical aggression are often excessive responses to normal stress. The lack of training and the discipline of inconsistency are the main causes of unacceptable behavior.
Brain damage and limited ability to communicate are also key factors.
Treatment of oligophrenia
Deep oligophrenia can not be treated. Therefore, if MR of the baby is suspected during pregnancy, parents should be informed. Genetic counseling helps in this.
We must remember that children with oligophrenia are often severely ill and their immune system is very poor.
Some of them only reach an adult life. If the cause of mental retardation is found (in a child born), an etiological treatment may be performed in some cases (PKU, hypothyroidism, etc.). But in most cases you can not perform an etiological treatment ( Down syndrome ).
As soon as the diagnosis (MR) of a born child is confirmed, parents should be informed.
Counseling should be done for family adjustment. Parents should be informed about the causes, prognosis, impact, education and training of the child.
A comprehensive and individualized program is developed with the help of specialists. A neurologist should investigate all cases of delay, disability, neuromuscular impairment or suspected seizures.
The orthopedist and the therapist should help evaluate and manage the delayed child of cerebral palsy and other important deficits.
Speech pathologists are also necessary in some cases. Family support and counseling are of great importance.
Social rehabilitation is a necessity. There are special schools to train these children for oligophrenia. The medication is also necessary. At first one should try with nonspecific metabolic preparations potentials for the nervous systems.
Vitamins, amino acids are in this category. Antiepileptic drugs are in the second category. They also work as mood stabilizers.
Sometimes antipsychotics become mandatory when there are behavioral problems, restlessness, sleep disturbances, presence of psychotic episodes.
When administering anxiolytics and neuroleptics, we must bear in mind that these patients have alterations or defects in the brain (organic) and, therefore, are considered drugs with minimal adverse effects.
These drugs are periciazine, thioridazines, chlorprothixene; Sometimes, in case of severe psychomotor excitement, chlorpromazine and haloperidol are administered.