Classification

Numerous attempts have been made to apply the traditional psychiatric diagnostic categories of ICD-9/10 and DSM-III/IV to the psychopathology of persons with mental retardation. Their applicability to the mentally retarded has, however, been questioned. fy,2,27) Whilst the ICD and DSM criteria may be applied to people functioning in the mild to borderline mental retardation ranges without alteration or with little modification, they become increasingly unreliable as the severity of mental retardation increases. The limited communication skills of these persons make it very difficult to ascertain the presence of certain symptoms such as delusions and hallucinations. As the role of underlying organic brain damage expands, the phenomenology become increasingly more characterized by a range of atypical symptoms. The non-specific nature of behavioural disturbances further confounds diagnostic endeavours. Szymanski,(28) among others, has pointed out that behaviour disturbance is not a psychiatric condition but a symptom, and Reid (29) has drawn attention to the fact that behaviours which would be deemed abnormal in people functioning in the average intellectual range may be developmentally appropriate to the mental age of severely mentally retarded person.

Other authors(1, 30) suggest using the developmental approach when attemping to understand and diagnose the psychiatric and behavioural disorders of the mentally retarded. They point out that there are findings which suggest that there may be a relationship between certain developmental syndromes and specific neuropsychiatric disorders (see below). There are also disorders, such as autistic disorder and self-injurious behaviour, which are more common among persons at low developmental levels.

Not surprisingly there have been calls for the development of a broader taxonomy which takes account of the atypical presentation of mental illness in those who are mentally retarded. A shift in this direction can be evidenced in the latest revisions of the traditional diagnostic classifications systems. Both DSM-IV and ICD-10 allow the substitution of carers' observations in the absence of patients' subjective reports.

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