Clinical features Features affecting presentation

Studies indicate that the types of psychiatric symptoms and syndromes that are observed among persons with borderline and mild mental retardation are similar to those encountered among the population in general. Amongst moderately and severely mentally retarded individuals, however, the presentation of mental illness may be less typical and the diagnosis more difficult to establish.

Sovner and Hurley(!) have categorized four factors which may influence the presentation of mental illness among the mentally retarded.

1. Intellectual distortion: deficient concrete thinking abilities and limited communication skills impair a mentally retarded person's ability to conceptualize his or her feelings and to describe them to others.

2. Psychological masking: the impoverished social skills and life experience of mentally retarded people result in a lack of the usual richness of the symptomatology found in the general population.

3. Cognitive disintegration: an inclination to become more disorganized during mental illness or when under emotional stress with resultant regressive behaviour.

4. Baseline exaggeration: emotional stress or mental illness may cause an increase in pre-existing maladaptive behaviour which may be mistakenly regarded as being a further deterioration in the latter instead of the onset of mental illness.

Hucker et al.(2) pointed to a generally banal symptomatology encountered among mentally retarded individuals often accompanied by regression to a child-like state of dependency and hysterical features. Behavioural disturbances were often more important than symptomatic complaints as indicators of psychiatric disorders.

Apparently the lower the IQ, the more the symptoms of mental illness tend to lose their specificity or take on a different meaning than is the case with the non-retarded population. This, undoubtedly, makes it difficult to establish a confident diagnosis of mental illness in severely mentally retarded people.

The following is a compact survey of the striking clinical features of mental illness and behaviour disorders as they occur among the mentally retarded.

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