Subaverage IQ Research Articles

Quetiapine in children and adolescents with subaverage IQ

A retrospective study was conducted to assess the effectiveness and tolerability of quetiapine in children and adolescents with subaverage replaced with IQ. Through a chart review conducted in a specialized outpatient clinic, five patients were identified (three males, two females; mean age = 16 ± 3.7 years); three were judged to be responders. Patients were included if concomitant medications remained unchanged during the titration and maintenance periods. Treatment duration was 20 ± 4 weeks; dose was 620 ± 205 mg/day. Improvements were observed in the conduct and hyperactivity subscales of the Conners Parent Rating Scale, routinely completed by the same caregiver. No differences were noted in anxiety, inattention, learning, and psychosomatic subscales. None of the patients discontinued the medication due to adverse events, but two experienced sedation. Quetiapine may be beneficial for treating associated symptoms of mental retardation; however, prospective and controlled studies are needed to assess further its efficacy and safety.

The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 2: antipsychotics and traditional mood stabilizers.

Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are among the most common psychiatric diagnoses in childhood. Aggression and conduct problems are a major source of disability and a risk factor for poor long-term outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of antipsychotics, lithium, and anticonvulsants for aggression and conduct problems in youth with ADHD, ODD, and CD. Each medication was given an overall quality of evidence rating based on the Grading of Recommendations Assessment, Development and Evaluation approach. Eleven RCTs of antipsychotics and 7 RCTs of lithium and anticonvulsants were included. There is moderate-quality evidence that risperidone has a moderate-to-large effect on conduct problems and aggression in youth with subaverage IQ and ODD, CD, or disruptive behaviour disorder not otherwise specified, with and without ADHD, and high-quality evidence that risperidone has a moderate effect on disruptive and aggressive behaviour in youth with average IQ and ODD or CD, with and without ADHD. Evidence supporting the use of haloperidol, thioridazine, quetiapine, and lithium in aggressive youth with CD is of low or very-low quality, and evidence supporting the use of divalproex in aggressive youth with ODD or CD is of low quality. There is very-low-quality evidence that carbamazepine is no different from placebo for the management of aggression in youth with CD. With the exception of risperidone, the evidence to support the use of antipsychotics and mood stabilizers is of low quality.

Second-Generation Antipsychotics for the Treatment of Disruptive Behaviour Disorders in Children: A Systematic Review

The use of second-generation antipsychotics (SGAs) in youth has increased considerably. Increases are mainly attributable to treatment of disruptive behaviour disorders (DBDs). Our objective was to review the evidence regarding the efficacy of SGAs for DBDs in youth. We performed a systematic review of all randomized controlled trials (RCTs) of SGAs and placebo for the treatment of DBDs in youth, focusing on efficacy data. Eight RCTs in youth with DBDs were included. Five RCTs evaluated the use of risperidone in youth with the combination of subaverage-borderline IQ and disruptive behaviour-aggression. Single RCTs evaluated the use of risperidone for treatment-resistant aggression in attention-deficit hyperactivity disorder and for the treatment of conduct disorder (CD), and a single RCT evaluated the use of quetiapine for adolescent CD. The efficacy results of each of these studies are described. Four placebo-controlled studies support the short-term efficacy of low-dose risperidone in youth with a subaverage IQ. Placebo-controlled evidence is weak or nonexistent for SGAs other than risperidone, and is weak in youth with an average IQ. Multiple factors likely account for the disconnect between this limited evidence base and the frequent use of SGAs for DBDs in clinical practice. These include extrapolation from studies in youth with autism or a subaverage IQ to normally developing youth; ease of SGA titration and the mistaken perception that little monitoring is required; unavailability of psychosocial treatments; limited familiarity with other pharmacological options; clinical and cultural norms; and the influence of the pharmaceutical industry.

Risperidone-Induced Adverse Reactions in Children and Adolescents: A Literature Overview

Sinzig, J., Dopfner, M., Lehmkuhl, G., Uebel, H., Schmeck, K., Poustka, F., et al. (2007). Long-acting methylphenidate has an effect on aggressive behavior in children with attentiondeficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 17(4), 421-432. Snyder, R., Turgay, A., et al. (2002). Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. Journal of the American Academy of Child and Adolescent Psychiatry, 41(9), 1026-1036.

IQ Subtypes in Schizophrenia

Intellectual decline, a key component of cognitive impairment in schizophrenia, varies considerably across individuals. To examine such cognitive heterogeneity, we applied cluster analysis of IQ and oral reading scores in 73 patients with schizophrenia. The following 3 empirically-derived subtypes emerged: intellectually compromised (42%) with similarly subaverage IQ (M = 79.90) and oral reading (M = 84.03); intellectually deteriorated (29%) with subaverage IQ (M = 86.81) but average oral reading (M = 107.71); and intellectually preserved (29%) with average IQ (M = 108.38) and oral reading (M = 104.43). Compromised and deteriorated clusters showed impairments in both executive function and memory, whereas the preserved cluster showed only reduced executive functioning. The 3 clusters also differed in symptom patterns; with intellectually compromised and intellectually deteriorated both rated with higher negative than positive symptoms, in contrast to the opposite pattern of intellectually preserved. Cluster symptom and neuropsychological profiles may help to validate empirically-derived IQ subtypes in schizophrenia.

Prescription des psychotropes en pédopsychiatrie : limites des indications officielles et perspectives thérapeutiques

In France, psychotropic drugs may be classified in four categories according to their official data. The first category corresponds to psychotropic drugs with an approved indication available in paediatry. Theyare old agents (e.g. haloperidol, amitriptyline, benzodiazepines...) with the exception of methylphenidate (hyperactivity). The second one corresponds to pharmacological agents approved for some indications obtained with adults but not for a1l (i.e. restricted indication: e.g. sertraline approved in paediatry only for OCD but not for depression, risperidone approved only for the treatment of disruptive behaviors in children with subaverage IQs). For the third category, the psychotropic agent is either contraindicated or unadvised under the age of 15 or 18 years, by lack of data (e.g. most of SSRI or atypical antipsychotic drugs). For the last category, official data available in brief summaries offer no information on paediatric use and consequently their administration does not appear possible. Up to now, no approved use has been delivered to injection route (IM or IV) in France, except for an IM formulation of zuclopenthixol. Prescribing psychotropic drug has to respect good practices including close psychological and somatic monitoring that associates the young patient and his relative (psycho-education program). Particular key-points should be taken into consideration (i.e. pharmacokinetic and physiological specificities, risk of false passage under the age of 6 years with capsules or tablets, presence of alcohol in some oral solution or bitter aroma...). Beside these official data, many studies have been published but must be carefully interpreted according to their level of pertinence. Meta-analysis gather all randomised controlled trials published or not, analyse their specific pertinence and thus provide clinically relevant elements. Randomised controlled trials present clinical interest but key-points in study design must be checked (e.g. number of patients, inclusion and exclusion criteria, length of the study and clinical relevance of clinical scales...). Other studies like open trials or clinical cases do not offersufficient guarantees. Some randomised controlled trials of clinical relevance have been carried out in this population with new pharmacological classes (eg SSRI, atypical antipsychotic drugs) and may lead to extended indications in children and adolescents. According to bibliographic and official data, the main criteria in the prescribing choice may take into consideration the following sis stressing a poor benefit/risk ratio. SSRI may offer better prospects but their use has not been approved in this indication, until now. In OCD, sertraline shows great interest to enhance clinical response and represents the molecule of reference. No drug has been approved for mood disorders in children or adolescent, in France, contrary to USA where lithium can be administered over the age of 12 years. In addition, antiepileptic drugs like carbamazepine or divalproate have conducted to clinical improvement in some studies. Benzodiazepines, hydroxyzine and meprobamate use should be strictly restricted in case of anxiety symptoms but are the only agents approved in this indication despise promising results obtained with SSRI. Transitory insomnia may take advantage of alimemazine prescription (approved use over the age of 36 months). Some typical neuroleptics are indicated in tics or in behaviour disorders associated to autism or related syndromes but present clinical limitations and poor tolerability. Promising clinical trials (randomised or not) have been conducted with new atypical antipsychotic drugs like risperidone. In conclusion, present data available for paediatric use of psychotropic agents emphasizes that safety and effectiveness are not always well established in particular for the treatment of chronic disorders (long term tolerability assessment). Moreover, studies should be carried out to specify factors promoting adherence and quality of life for this young population in order to optimise clinical benefit of drug prescription.

Pharmacotherapy of Disruptive Behavior and Item Changes on a Standardized Rating Scale: Pooled Analysis of Risperidone Effects in Children with Subaverage IQ

Disruptive behavior disorders (DBDs), excluding attention deficit/hyperactivity disorder (ADHD), are characterized by a repetitive pattern of antisocial, aggressive, and defiant behavior involving major violations of age-appropriate norms, resulting in significant functional impairment. Risperidone is licensed for the treatment of DBDs in children, adolescents, and adults in several countries. The aim of this study was to determine the effect of risperidone in a clinical setting on the symptom items of the Nisonger Child Behavior Rating Form (N-CBRF), used for the assessment of DBD patients. Data from two 6-week, randomized, double-blind, placebo-controlled trials of risperidone oral solution (0.02-0.06 mg/kg/day) in children with DBDs and subaverage IQ (mild, moderate mental retardation and borderline IQ) were pooled for analysis. Risperidone produced improvement in both the Social Competence and the Problem Behavior N-CBRF subscales. Risperidone reduced symptoms in the Problem Behavior subscales (e.g., Conduct Problem, Insecure/Anxious) but also improved positive behaviors on the Social Competence subscales. Unlike most problem-behavior items, certain items reflecting "Affective insecurity" (e.g., shy, timid; clings to adults; crying, tearful episodes) failed to improve. This was also true of social disinterest and certain rituals. No items showed any worsening of symptoms with active medication. Whereas most categories of problem behavior improved with risperidone, items reflecting "affective insecurity" and some infrequently endorsed items were unaffected in these children with DBDs and subaverage IQ. These data may provide a more refined knowledge of risperidone's therapeutic effects in such children.

Curiosity and Mental Retardation: Beyond IQ

Too much of the behavior shown by people with mental retardation is attributed to their having subaverage intelligence and not enough to their other human qualities. In an effort to correct this imbalance, Zigler (1971) called for the study of the ‘‘whole person’’ and showed that subaverage IQs do not predict personalities. A decade later, Reiss, Levitan, and Szyszko (1982) called for the study of the mental health of persons with mental retardation. They held that negative social experiences and attitudes, not subaverage intelligence, lead to many of the emotional and behavioral problems shown by people with mental retardation. Recently, researchers have disproved the myth that people with significantly subaverage IQs lack the cognitive capacities needed to self-determine their futures (e.g., Turnbull & Turnbull, 2001; Wehmeyer, Kelchner, & Richards, 1995). Despite these and other past efforts to correct for the misuse of IQs, they are still too powerful a determinant of how we respond to people with mental retardation. Here, we consider another misuse of IQs, namely, the assumption that these scores are strongly predictive of curiosity. Our thesis is that intelligence and curiosity are distinguishable traits, less strongly related to each other than generally assumed. Intelligence refers to one’s ability to learn, whereas curiosity refers to one’s motivation to experience intellectual activity. Intelligent people have the potential to solve difficult problems whether or not they enjoy doing so, whereas curious people have the potential to enjoy thinking about difficult problems whether or not they can solve them. Generally, educators pay too much attention to intelligence and not enough attention to curiosity when planning a student’s future. Consider the standardized tests that educators use to assess students. Although educators often use standardized intelligence tests, they rarely use standardized tests of curiosity. Until recently, there were no widely used standardized tests of curiosity for students with mental retardation or for students generally. The recently published Reiss Profile MR/DD (Reiss & Havercamp, 2001) includes a Curiosity subscale that may be the only standardized measure of this construct specifically validated for use with people who have mental retardation. Past educators could not have formally assessed the curiosity of people with mental retardation even if they had wanted to do so because they lacked appropriate assessment tools.

Psychotropic Medicines and Aggressive Behavior Part II: Antipsychotics and Mood Stabilizers

Free AccessPsychotropic Medicines and Aggressive Behavior Part II: Antipsychotics and Mood StabilizersMichael G. Aman and Ronald L. LindsayMichael G. Aman1. Ohio State University, and he directs OSU's Research Unit on Pediatric Psychopharmacology (RUPP).Search for more papers by this author and Ronald L. LindsaySearch for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.8.2.6.23068PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsAman , M. G., De Smedt, G., Derivan, A., Lyons, B., & Findling, R. L. (2002). The Risperidone Disruptive Behavior Study Group. Risperidone treatment of children with disruptive behavior disorders and subaverage IQ: A Double-Blind, Placebo-Controlled Study. American Journal of Psychiatry, 159, 1337–1346. Crossref, Google ScholarAman , M. G., & Singh, N. N. (1980). The usefulness of thioridazine for treating childhood disorders—Fact or folklore? American Journal of Mental Deficiency, 84, 331–338. Google ScholarBuitelaar , J. K. (2000). Open-label treatment with risperidone of 26 psychiatrically-hospitalized children and adolescents with mixed diagnoses and aggressive behavior. Journal of Child and Adolescent Psychopharmacology, 10, 19–26. Crossref, Google ScholarCampbell , M., Adams, P. B., Small, A. M., Kafantaris, V., Silva, R. R., Shell, J., Perry, R., & Overall, J. E. (1995). Lithium in hospitalized aggressive children with conduct disorder: A double-blind and placebo-controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 445–453. Crossref, Google ScholarCampbell , M., Small, A. M., Green, W. H., Jennings, S. J., Perry, R., Bennett, W. G., & Anderson (1984). Behavioral efficacy of haloperidol and lithium carbonate: A comparison in hospitalized aggressive children with conduct disorder. Archives of General Psychiatry, 41, 650–656. Crossref, Google ScholarCunningham , M. A., Pillai, V., Blachford Rogers, W. J. (1968). Haloperidol in the treatment of children with severe behavior disorders. The British Journal of Psychiatry, 114, 845–854. Crossref, Google ScholarDeLong , G. R., Aldershot, A. L. (1987). Long-term experience with lithium treatment in childhood: Correlation with clinical diagnosis. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 389–394. Crossref, Google ScholarDonovan , S. J., Stewart, J. W., Nunes, E. V., Quitkin, E. M., Parides, M., Daniel, W., Susser, E. S., & Klein, D. F. (2000). Divalproex treatment for youth with explosive temper and mood lability: A double-blind, placebo-controlled crossover design. American Journal of Psychiatry, 157, 818–820. Crossref, Google ScholarFindling , R. L., McNamara, N. K., Branicky, L. A., Schlucter, M. D., Lemon, E., & Blumer, J. L. (2000). A double-blind pilot study of risperidone in the treatment of conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 509–516. Crossref, Google ScholarGreenhill , L., Solomon, M., Pleak, R., & Ambrosini, P. (1985). Molindone hydrochloride treatment of hospitalized children with conduct disorder. Journal of Clinical Psychiatry, 46, 20–25. Google ScholarMalone , R. P., Delaney, M. A., Luebbert, J. F., Cater, J., & Campbell, M. (2000). A Double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Archives of General Psychiatry, 57, 649–654. Crossref, Google ScholarKastner , T. Finesmith, & Walsh, K. (1993). Long-term administration of valproic acid in the treatment of affective symptoms in people with mental retardation. Journal of Clinical Psychopharmacology, 13, 448–451. Crossref, Google ScholarSnyder , R., Turgay, A., Aman, M. G., Binder, C., Fisman, S., & Carroll, A. (2002). The Risperidone Conduct Study Group. Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1026–1036. Crossref, Google ScholarTurgay , A., Binder, C., Snyder, R., & Fisman, S. (2002). Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs. Pediatrics, 110, 1–12 (http//www.pediatrics.org/cgi/content/full/110/3/e34). Crossref, Google ScholarWong , G. H., & Cock, R. J. (1971). Long-term effects of haloperidol in severely emotinoally disturbed children. Australian and New Zealand Journal of Psychiatry, 5, 296–300. Crossref, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Online publication date: Go to citation Crossref 2. Discontinuation of Risperidone and Reversibility of Weight Gain in Children with Disruptive Behavior DisordersOnline publication date: 2 July 2016. Go to citation Crossref Google Scholar3. International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs): Clinical implications and treatment practice suggestionsOnline publication date: Go to citation Crossref Google Scholar4. PharmacotherapyOnline publication date: Go to citation Crossref Google Scholar Volume 8Issue 2Mar 2003 Information© Guilford PressPDF download

Atypical Antipsychotics in Pediatric Psychiatry: Efficacy and Tolerability in Well-Designed Trials

Free AccessAtypical Antipsychotics in Pediatric Psychiatry: Efficacy and Tolerability in Well-Designed TrialsKimberly A. Stigler, David J. Posey and Christopher J. McDougleKimberly A. StiglerSearch for more papers by this author, David J. PoseySearch for more papers by this author and Christopher J. McDougleSearch for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.8.1.8.22949PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsAman , M. G., De Smedt, G., Derivan, A., et al. (2002). Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. American Journal of Psychiatry, 159(8), 1337–1346. Crossref, Google ScholarFindling , R. L., McNamara, N. K., Branicky, L. A., et al. (2000). A double-blind pilot study of risperidone in the treatment of conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39(4), 509–516. Crossref, Google ScholarFrazier , J. A., Biederman, J., Tohen, M., et al. (2001). A prospective open-label treatment trial of olanzapine monotherapy in children and adolescents with bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 11(3), 239–250. Crossref, Google ScholarGaffney , G. R., Perry, P. J., Lund, B. C., et al. (2002). Risperidone versus clonidine in the treatment of children and adolescents with Tourette's syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 41(3), 330–336. Crossref, Google ScholarKumra , S., Frazier, J. A., Jacobson, L. K., et al. (1997). Childhood-onset schizophrenia: a double-blind clozapine-haloperidol comparison. Archives of General Psychiatry, 53, 1090–1097. Crossref, Google ScholarMalone , R. P., Cater J., Sheikh, R. M., et al. (2001). Olanzapine versus haloperidol in children with autistic disorder: an open pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 887–894. Crossref, Google ScholarMartin , A., Koenig, K., Scahill, L., et al. (1999). Open-label quetiapine in the treatment of children and adolescents with autistic disorder. Journal of Child and Adolescent Psychopharmacology, 9(2), 99–107. Crossref, Google ScholarMcConville , B. J., Arvanitis, L. A., Thyrum, P. T., et al. (2000). Pharmacokinetics, tolerability, and clinical effectiveness of quetiapine fumarate: an open-label trial in adolescents with psychotic disorders. Journal of Clinical Psychiatry, 61, 252–260. Crossref, Google ScholarMcDougle , C. J., Kem, D. L., Posey, D. J. (2002). Case series: use of ziprasidone for maladaptive symptoms in youths with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 41(8), 921–927. Crossref, Google ScholarPotenza , M. N., Holmes, J. P., Kanes, S. J., et al. (1999). Olanzapine treatment of children, adolescents, and adults with pervasive developmental disorders: an open-label pilot study. Journal of Clinical Psychopharmacology, 19, 37–44. Crossref, Google ScholarResearch Units on Pediatric Psychopharmacology Autism Network: Risperidone in children with autism and serious behavioral problems (2002). New England Journal of Medicine, 347(5), 314–321. Crossref, Google ScholarSallee , F. R., Kurlan, R., Goetz, C. G., et al. (2000). Ziprasidone treatment of children and adolescents with Tourette's syndrome: a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 39(3), 292–299. Crossref, Google ScholarShaw , J. A., Lewis, J. E., Pascal, S., et al. (2001). A study of quetiapine: efficacy and tolerability in psychotic adolescents. Journal of Child and Adolescent Psychopharmacology, 11(4), 415–424. Crossref, Google ScholarSnyder , R., Turgay, A., Aman, M., et al. (2002). Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. Journal of the American Academy of Child and Adolescent Psychiatry, 41(9), 1026–1036. Crossref, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 8Issue 1Feb 2003 Information© The Guilford PressPDF download

Effects of Risperidone on Conduct and Disruptive Behavior Disorders in Children With Subaverage IQs

To determine whether risperidone is effective in reducing symptoms of disruptive behaviors (such as aggression, impulsivity, defiance of authority figures, and property destruction) associated with conduct disorder, oppositional defiant disorder, and disruptive behavior disorder-not otherwise specified in children with subaverage IQs. The trial consisted of a 1-week, single-blind, placebo run-in period and was followed by a 6-week, double-blind, placebo-controlled period. One hundred ten children (aged 5-12 years inclusive) with an IQ of 36-84 with a disruptive behavior disorder and a score of at least 24 on the Conduct Problem subscale of the Nisonger Child Behavior Rating Form (NCBRF) were enrolled. Eighty percent of subjects had comorbid attention-deficit/hyperactivity disorder (ADHD). Risperidone doses ranged from 0.02 to 0.06 mg/kg per day. Subjects were rated on the NCBRF, Aberrant Behavior Checklist, Behavior Problems Inventory, Clinical Global Impressions (CGI), modified California Verbal Learning Test (CVLT), and a continuous performance task (CPT). The intention-to-treat analysis of risperidone-treated subjects showed a significant (p < .001) reduction in mean scores (from 33.4 at baseline to 17.6 at end point; 47.3% reduction) versus placebo-treated subjects (mean baseline of 32.6 to 25.8 at end point; 20.9% reduction) on the Conduct Problem subscale of the NCBRF. Between-group differences in favor of risperidone were seen as early as week 1 and were significant at all post-baseline visits. Other subscales showed significant improvement with risperidone compared with placebo. CGI scale ratings of improvement showed highly significant gains for risperidone over placebo. A subanalysis demonstrated that the effect of risperidone was unaffected by diagnosis, presence/absence of ADHD, psychostimulant use, IQ status, and somnolence. Risperidone produced no changes on the cognitive variables (CPT/modified CVLT). The most common side effects included somnolence, headache, appetite increase, and dyspepsia. Side effects related to extrapyramidal symptoms were reported in 7 (13.2%) and 3 (5.3%) of the subjects in the risperidone and placebo groups, respectively (p = .245). Risperidone appears to be an adequately tolerated and effective treatment in children with subaverage IQs and severe disruptive behaviors such as aggression and destructive behavior.

Risperidone in children with disruptive behaviors and subaverage IQ

Quality of life (QOL) is markedly affected by multiple sclerosis (MS). Particular personality characteristics (PC) of MS patients can affect their QOL. We designed the present study to determine the role of various PCs on QOL in MS patients accounting for other clinical factors.QOL, PC, physical disability, and mental status were recorded in 83 MS patients referred to two academic hospitals of Tehran University of Medical Sciences in 2011–2012.The mean age of enrolled patients was 31.54 ± 7.38 (range: 14–50) years and 74 (89.2%) were female. Mean disease duration was 4.55 ± 4.70 years. Seventy-seven patients (92.8%) had relapsing–remitting disease, five (6%) had primary progressive, and one showed a secondary progressive course. Correlation between total QOL scores in MS patients and disease duration, cognitive impairment, and physical disability was significant (all p < 0.001). Obsessive-compulsive personality was the most frequent PC (43.4%) in our patients. Only avoidant personality had a significant negative correlation with all components of QOL (Beta: 0.33, p < 0.00). In addition, avoidant personality, physical disability, and mental status were found to be three predictors of QOL with all its components.Avoidant personality appears to be an important predictor of poor QOL in MS patients. In addition, avoidant coping strategies appear to be associated with adverse response to stressful events in these patients. These findings suggest the need for psychological intervention for improving the coping strategies and QOL in MS patients.

Risperidone in children with subaverage IQ and behavior disorders

Risperidone in children with subaverage IQ and behavior disorders

Risperidone in children with conduct problems and subaverage IQ

Risperidone in children with conduct problems and subaverage IQ

Long-Term Safety and Efficacy of Risperidone in Children with Subaverage Iq and Disruptive Behavior Disorders

Long-Term Safety and Efficacy of Risperidone in Children with Subaverage Iq and Disruptive Behavior Disorders

Risperidone in children with various disruptive behavior disorders, subaverage IQ and comorbid ADHD

Risperidone in children with various disruptive behavior disorders, subaverage IQ and comorbid ADHD

Externalizing behavior problems and academic underachievement in childhood and adolescence: causal relationships and underlying mechanisms.

Conceptual and measurement issues surrounding externalizing behavior problems and academic underachievement, the strength and specificity of the covariation between these domains, and the viability of explanatory models that link these areas are reviewed. In childhood, inattention and hyperactivity are stronger correlates of academic problems than is aggression; by adolescence, however, antisocial behavior and delinquency are clearly associated with underachievement. Whereas investigations with designs that allow accurate causal inference are scarce, unidirectional paths from 1 domain to the other have received little support. Indeed, the overlap of externalizing problems with cognitive and readiness deficits early in development suggests the influence of antecedent variables. Low socioeconomic status, family adversity, subaverage IQ, language deficits, and neurodevelopmental delay are explored as possible underlying factors.

Methylphenidate and thioridazine in the treatment of intellectually subaverage children: Effects on cognitive-motor performance

Twenty-seven children (or smaller subgroups depending upon task difficulty and subject ability) with subaverage IQs took part in a double-blind, placebo-controlled, cross-over study of methylphenidate (0.4 mg/ kg/day) and thioridazine (1.75 mg/kg/day). The children were tested for IQ performance, breadth of attention, and performance on a series of electronically controlled cognitive-motor tests. Methylphenidate improved accuracy on a memory task, reduced omission errors on an attentional task, and reduced seat movements on two tasks. Thioridazine failed to have any deleterious effects on IQ performance when subjects received reinforcers for correct answers. Thioridazine at the given dose did not adversely affect performance on any of the cognitive-motor performance tests. Methylphenidate appears likely to enhance sustained attention and motivation in appropriately selected children with mild developmental delays, whereas thioridazine at this modest dose does not appear to impair performance on most psychomotor tests.

Clinical Effects of Methylphenidate and Thioridazine in Intellectually Subaverage Children

Thirty children with subaverage IQs and psychiatric diagnoses of attention deficit disorder and/or conduct disorder took part in a double-blind study of placebo, methylphenidate, and thioridazine, which were given for 3 weeks each. The results showed a consistent and highly significant effect of methylphenidate in reducing teacher ratings of problem behavior. Parent ratings showed no behavioral effects for the group as a whole. An attentional model of stimulant drug response was used to divide subjects according to a cognitive maturity domain presumed to reflect selective attention. When divided according to breadth of attention, mental age, and IQ level, higher functioning subjects were found to show a generally favorable response to methylphenidate on both teacher and parent rating scales, whereas children of low functional level typically showed an adverse or indifferent response. The present data suggest that mental age and IQ may be important determinants of drug response; below a given level, there was a greatly reduced likelihood of responding positively. Clinical response to thioridazine was substantially less than the response to methylphenidate, with significant improvements confined to conduct and hyperactivity problems on teacher ratings.