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 organic nature. The other terms are mental retardation and mental subnormality.
At three years, general signs and symptoms are observed in early childhood (either congenital or acquired).
The diagnostic criteria for oligophrenia are:
- The psychopathological structure is peculiar to dementia with the processing of abstract thought, especially in a weak and underdeveloped emotional sphere.
- The 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 a severe organic defect that occurs after three 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 most significant 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.).
An autosomal recessive lysosomal disorder (Tay -Sach, Nieman-Pick, Gaucher diseases, etc.).
Congenital infections are an important cause of oligophrenia—rubella virus, cytomegalovirus, toxoplasma gondii, and treponemal infections during pregnancy cause oligophrenia as a child.
Out of the teratogenic factors, noteworthy is 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, intoxication, diabetes mellitus, and toxicosis during Presencia, rhesus conflicts.
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 four different groups according to the severity of the defect of the intellect.
To measure 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.
At the end of adolescence, they can learn academic skills during school age (6-20 years) to a certain extent (US 6th grade standard).
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 a little social conscience.
They have fair motor development, benefit from self-help training, and can be managed with moderate supervision. They have an abysmal 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 the intellectual quotient is from 20 to 34. Its characteristic features are poor motor development; speech is minimal.
These can benefit from self-help training, few or no expressive skills, and 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 and develop self-protection skills in a controlled environment. They are uneducable and incapable.
Profound mental retardation (F73): Their IQ level is 20. They are entirely uneducable and unable to learn anything.
Its distinguishing characteristics are thick delay and minimum capacity to function in sensorimotor areas; it may need care and care during preschool age.
They develop some motor skills during school age 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 time, 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 to a new place with new environments.
A portion of patients with MR experience psychosis, which occurs as psychomotor excitement, and aggression, rarely with hallucinations and delusions.
Psychosis is usually observed at puberty. Neurological, epileptiform, and somatic disorders are often found with these psychic disorders.
Motor neurons are mainly affected. In MRI and CT, local and generalized brain and skull defects 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 challenging to identify thought disorders due to delusions, but a flat affection and signs of hallucination suggest a diagnosis), depression, etc.
But the leading cause of oligophrenia is going to a psychiatrist is a behavioral disorder.
Explosive explosions, tantrums, and physical aggression are often excessive responses to everyday stress. The lack of training and the discipline of inconsistency are the leading causes of unacceptable behavior.
Brain damage and limited ability to communicate are also crucial 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 inferior.
Some of them only reach 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 a born child’s diagnosis (MR) is confirmed, parents should be informed.
Counseling should be done for family adjustment. Parents should be informed about the child’s causes, prognosis, impact, education, and training.
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 with cerebral palsy and other vital 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 nonspecific metabolic preparation potentials for the nervous systems.
Vitamins and 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, and presence of psychotic episodes.
When administering anxiolytics and neuroleptics, we must remember that these patients have alterations or defects in the brain (organic) and, therefore, are considered drugs with minimal adverse effects.