Clinical Psychiatry

Descriptions of key diagnostic concepts of anxiety require a certain level of IQ and linguistic skills, particularly in relation to more complex subjective cognitive phenomena. Therefore, in people with severe and profound mental retardation the clinician must rely on the observed behaviors and the observations made by primary caregivers. Awareness of the following behavioral correlates of anxiety symptoms may be of help in detecting anxiety symptoms in this population:

Anxiety symptom: behavioral correlate
Dry mouth: increased drinking
Sensations of shortness of breath: hyperventilation
Sensations of anxiety: signs of increased arousal (shortness of breath; increased pulse rate), irritability, anger, sweating, self-injurious behavior, avoidance behavior
Panic: tremulousness with excessive motor activity, agitation and or aggression

Ref: - Starvakaki, C. (2002) The DSM-IV and how it applies to persons with developmental disabilities. In: Griffiths, D., Starvakaki, C. & Summers, J. (Eds), Dual Diagnosis: An Introduction to the Mental Health Needs of persons with Developmental Disabilities. Ontario: Habilitative Mental Health Resource Network.

The following advice may be used in dietary treatment of obesity (Rossner, 2001):

• Plan cooking so that there are no leftovers
• Serve meals on small size plates
• Never eat out of kitchen utensils
• Always eat at the same place
• Concentrate on food, avoid external distractions
• Chew each bite at least 20 times
• Put down knife and fork between each bite
• Let each meal last at least 20 minutes
• Remove leftovers out of sight immediately after meal
• Cover food with invisible plastic cover or aluminium foil to avoid eating cues
• Never shop on empty stomach
• Always make a shopping list
• Shop with others, to control spontaneous purchases of unintended items

Ref: - Rossner, S. (2001) Treatments: Diet. In: Bjorntorp, P. (Ed.), International textbook of obesity. Chichester: John Wiley.

Adult attention-deficit hyperactivity disorder (ADHD) is a common and underdiagnosed condition. In a review article, Wender (1998) summarizes the important past history, family history and presenting symptoms with which adults suffering from ADHD can present.

Past history:

1. A poor academic history, having been placed in special education in childhood, difficulties in learning to read or spell, persistent problems in reading and spelling, grades poorer than expected on the basis of intelligence, flunking out or quitting college


2. Poor job performance, frequent changes, failure to be promoted


3. Difficulty running and administering a household


4. Difficulty in sustaining relationships

Presence of the above features in the history should suggest direct enquiry about ADHD symptoms such as

1. Hot temper


2. Fidgetiness in office


3. Chronic “reactive” depression


4. History of alcohol or drug abuse, heavy use of caffeine, or smoking

Specific family histories include

1. Alcohol and drug use


2. Heavy use of nicotine often associated with cigarette-produced chronic obstructive pulmonary disease


3. Antisocial characteristics


4. ADHD problems such as quick temper and impulsivity
   Familial and occupational maladjustment

Ref: - Wender, P.H. (1998) Attention-deficit hyperactivity disorder in adults. Psychiatric Clinics of North America, 21, 4, 761 - 774.

Naidoo et al. (2003) identified the following potential risk factors for development of osteoporosis in schizophrenia patients:

Factors due to schizophrenia itself

• Poor diet
• Limited weight-bearing exercise
• Smoking
• Polydipsia

Factors due to antipsychotic treatment

• Hyperprolactinemia
• Secondary lowered oestrogen
• Secondary lowered testosterone

Other factors influencing risk of fracture

• Sedation
• Orthostatic hypotension
• Dizziness
• Postmenopausal status
• Anticonvulsants
• Corticosteroids

Ref: - Naidoo, U., Goff, D.C. & Klibanski, A. (2003) Hyperprolactinemia and bone mineral density: the potential impact of antipsychotic agents. Psychoneuroendocrinology, 28 (suppl 2), 97-108.

Patients suffering from epilepsy have a high suicide rate, about nine to ten times higher than that of the general population. Risk factors for suicide in this population include a history of self-injurious behavior, a family history of suicide, events which cause emotional stress, comorbid psychiatric disorders such as depression or psychosis, and alcoholism (Robertson et al., 1987; Labert & Robertson, 1999). Clinicians should assess their epilepsy patients for presence of these risk factors, and initiate necessary preventive interventions in patients who are at high risk for suicide.

Ref: -

Labert, M.V. & Robertson, M.M. (1999) Depression in epilepsy: etiology, phenomenology, and treatment. Epilepsia, 40 (suppl 10), s21 - 47.

Robertson, M.M., Trimble, M.R. & Townsend, H.R. (1987) Phenomenology of depression in epilepsy. Epilepsia, 28, 364 - 372.