Psychiatric Disorders and Down Syndrome Abstracts

Mental Health Aspects of Developmental Disabilities 2 (2): 59-63 (1999 Apr/May/Jun)

Bipolar Disorder and Down Syndrome: Six Cases

Robert J. Pary, Robin Friedlander, George T. Capone

This article describes six cases of bipolar disorder in persons with Down syndrome, and only eight cases have previously been reported. A family history was obtainable in only four persons, but three of the four had a positive history of bipolar disorder. Five of the six individuals are males. Potential relevance of these findings are discussed.
Psychiatr Serv 49 (12): 1618-9 (1998 Dec)

Two cases of suicide attempt by patients with Down's syndrome

Hurley, Anne DesNoyers
Tufts University School of Medicine, USA

This report documents cases of suicide attempts by two persons with Down's syndrome. The patients experienced dysphoric affect and feelings of hopelessness about unmet needs associated with their disability. During the course of a major depressive episode, each individual made a suicide attempt that could have been fatal. Although suicidal ideation and attempts are infrequent among patients with mental retardation, completed suicides and potentially fatal attempts have been reported. It is vitally important that mental health practitioners appreciate the seriousness of suicidal ideation among persons who have mental retardation and treat the underlying psychiatric disorder.
J Intellect Disabil Res 42 (4): 293-300 (1998 Aug)

Maladaptive behaviours and symptoms of dementia in adults with Down's syndrome compared with adults with intellectual disability of other aetiologies

Cooper SA, Prasher VP
Rockingham Forest NHS Trust, Kettering, England

Dementia commonly occurs in elderly people with intellectual disability, especially those with Down's syndrome. The non-cognitive symptoms of dementia can be of greater significance to individuals and carers than the cognitive changes caused by this condition. It is not known whether there are differences between people with Down's syndrome and those with intellectual disability of other causes with regard to the prevalence of such symptoms. The present study was undertaken to draw a comparison between a group with Down's syndrome and dementia (n = 19), and a group with intellectual disability of other causes and dementia (n = 26). Maladaptive behaviours and psychiatric symptomatology were assessed in both groups. The group with Down's syndrome had a higher prevalence of low mood, restlessness/excessive overactivity, disturbed sleep, being excessively uncooperative and auditory hallucinations. Aggression occurred with greater frequency in those subjects with intellectual disability of other causes. These findings are of epidemiological importance in terms of service planning and understanding psychiatric presentation.
Tidsskr Nor Laegeforen 118 (14): 2153-4 (1998 May 30)

Depression and Down syndrome

Ramstad K, Loge JH, Sponheim E
Institutt for medisinske atferdsfag Universitetet i Oslo, Blindern

Emotional and behavioural disorders are frequent complications of mental retardation that often go unrecognised or untreated. We describe a 13-year old girl with Down's syndrome and depressive illness who responded well to paroxetin. The importance of organizing comprehensive health provision for children with mental retardation in a way that focuses both psychiatric and physical illness is emphasised.
Int J Eat Disord 23 (1): 107-9 (1998 Jan)

Anorexia nervosa, major depression, and obsessive-compulsive disorder in a Down's syndrome patient

Raitasuo S, Virtanen H, Raitasuo J
Special Welfare District of Southwest, Finland

OBJECTIVE: This paper reports a case of obsessive-compulsive disorder (OCD), major depression, and anorexia nervosa in a Down's syndrome patient. RESULTS: Mental retardation and OCD narrowed the patient's available means to control over life. First he became depressed. Perhaps because of insufficient treatment of the depression or in the context of controlling his body and inner life, anorexia nervosa developed. DISCUSSION: His clinical presentation, diagnostics, and successful treatment of psychiatric disorders and anorexia nervosa are presented.
Semin Clin Neuropsychiatry 2 (1): 148-153 (1996 Apr)

Mood Disorders and Down Syndrome

Pary RJ, Loschen EL, Tomkowiak SB
Department of Psychiatry, SIU School of Medicine, Springfield, USA

Even clinical neuropsychiatrists who do not focus on mental illness and mental retardation may be intrigued by the subject of mood disorders in persons with Down syndrome. This article reviews the following subjects in persons with Down syndrome: epidemiology of major depression and bipolar disorder; clinical symptoms including "psychotoform," differential diagnosis of mood disorders, comorbid diagnoses, and treatment.
J Intellect Disabil Res 40 (1): 32-8 (1996 Feb)

Short-term prognosis of depression in adults with Down's syndrome: association with thyroid status and effects on adaptive behaviour

Prasher VP; Hall W
Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, England

Findings for Down's syndrome adults with depression were compared to those for non-depressed Down's syndrome controls. Mean age of onset of depression was 30.1 years, the majority of subjects were female and biological more so than psychotic symptoms were presenting features. No statistically significant association between depression and thyroid dysfunction was found. For the depressed group, scores for level of adaptive functioning were significantly lower and those for maladaptive behaviour significantly higher. At one-year follow-up, although some improvement was found, the majority of depressed subjects were still symptomatic. The short-term prognosis for depression in adults with Down's syndrome appears to be poor but possibly better the earlier the age of onset.
Res Dev Disabil 16 (4): 285-99 (1995 Jul-Aug)

Major depression in a small group of adults with Down syndrome

Myers BA, Pueschel SM
Brown University School of Medicine, USA

The clinical histories and treatment of the nine individuals with Down syndrome (DS) and major depression (MD) previously noted in a report on the psychopathology of a population of 164 adults with DS with and without health disorders from a Down Syndrome Clinic are presented (Myers & Pueschel, 1991). The clinical characteristics including DSM-III-R (1987) criteria of these 9 patients plus 13 individuals with DS and MD described in case reports in the literature are summarized. Depression is rarely verbalized and commonly appears as crying, depressed appearance, or mood lability. Vegetative symptoms of disinterest with severe withdrawal and mutism, psychomotor retardation, decreased appetite, weight loss, and insomnia are prominent. Verbal expression of preoccupations of suicide, death, self-depreciation, and guilt were infrequent and may either be not present or not reported due to mutism or moderate level of mental retardation (MR). Hallucinations were prominent. Family history of depression was infrequent. Psychological stressors were noted mostly in the study sample and not in the 13 from the literature. The pattern of vegetative symptomatology with few verbal complaints and prominent hallucinations may be related to moderate mental retardation in these groups with DS rather than specifically to DS.
Br J Psychiatry 165 (3): 399-403 (1994 Sep)

Clinical features and diagnostic criteria of depression in Down's syndrome

Cooper SA, Collacott RA
Frith Hospital, University of Leicester

BACKGROUND. Depression occurs commonly in people with Down's syndrome, although there is little published about this association. This study explores the limitations of Diagnostic Criteria for Research, based on ICD-10 (DCR) and DSM-III-R depressive criteria. METHOD. Case not examination identified 42 adults with Down's syndrome who have sustained 56 depressive episodes. The clinical features are reported. RESULTS. All episodes were diagnosed as depression. DSM-III-R criteria for major depressive episode were met by 50% of the episodes. DCR for depressive episode of at least mild severity were fulfilled by 68%. CONCLUSIONS. These criteria were unduly restrictive for this group. Commonly occurring symptoms are not included in the criteria, while certain criteria items never occurred. Criteria should be modified to facilitate future research.
British Journal of Psychiatry 161: 671-674 (1992 Nov)

Differential Rates of Psychiatric Disorders in Adults with Down Syndrome Compared with Other Mentally Handicapped Adults

Collacott, R.A; Copper, S.A.; McGrother, C.
Frith Hospital, Leicester

The total number of adults with Down's syndrome living in Leicestershire, ascertained by widespread enquiry, was found to be 378. Of these, 371 were matched with adults with mental handicap due to other pathologies, on the basis of age, sex, and type of residence. Those with Down's syndrome were found to have a different spectrum of mental disorders from those without the syndrome. In particular, Down's syndrome patients were more likely to have been diagnosed as having depression and dementia; the controls were more likely to have been diagnosed as suffering from conduct disorder, personality disorder, or schizophrenia/paranoid state. The same proportion of each group have been given a diagnosis of autism.
J Nerv Ment Dis 179 (10): 609-13 (1991 Oct)

Psychiatric Disorders in Persons with Down Syndrome

Myers BA; Pueschel SM
Child Development Center, Rhode Island Hospital, Providence, RI 02902

This study was designed to provide information on the prevalence and nature of psychiatric disorders in 497 individuals with Down syndrome. There were 261 patients under 20 years of age and 164 patients 20 years and older, with both groups followed as outpatients, and 72 residents from a state school. The overall frequency of psychiatric disorders in our study population was 22.1%. Patients under 20 years of age often displayed disruptive behaviors, anxiety disorders, and repetitive behaviors. Individuals with Down syndrome 20 years and older who were followed as outpatients more often exhibited major depressive disorders and state school residents were found to have an increased prevalence of dementia.
J Clin Psychiatry 51 (10): 422-5 (1990 Oct)

Electroconvulsive therapy and major depression in Down's syndrome

Lazarus A, Jaffe RL, Dubin WR
Philadelphia Psychiatric Center, Temple University School of Medicine, PA 19131

The authors treated two patients who had Down's syndrome and major depression with a combination of inpatient and outpatient electroconvulsive therapy (ECT). They found only 10 other similar published cases, although none involved outpatient ECT. Their experience, in conjunction with that reported in the literature, indicates that ECT is a safe and effective treatment for depressed mentally retarded individuals, including those who respond poorly to antidepressants.
Res Dev Disabil 11 (2): 131-7 (1990)

Differential diagnosis and treatment of depressive features in Down's syndrome: a case illustration

Storm W
Department of Pediatrics, St. Vincenz Hospital, Paderborn, Federal Republic of Germany

A 21-year-old young man with Down's syndrome presented with depressive symptoms and intermittent features of a Parkinsonian like syndrome. After treatment with amitriptyline for 18 months he slowly improved and almost regained his former personality. Neither imaging procedures nor clinical features were able to establish a definitive cause of this patient's depression. There was no evidence of either neurodegenerative or premature aging processes. Discussion focused on increasing clinicians' awareness of frequently undiagnosed but treatable depressive disorders within the Down's syndrome population.
Br J Psychiatry 115: 202-5 (1989 Aug)

Major depression in Down's syndrome

Warren AC, Holroyd S, Folstein MF
Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205

Five patients with trisomy 21 (Down's syndrome (DS], referred to us for evaluation of dementia, were instead found to have major depression. All had shown cognitive and behavioural deterioration and this had led to a mistaken diagnosis of Alzheimer's disease in two. We outline and contrast the features of major depression and Alzheimer's disease in DS, and suggest that electroconvulsive therapy is an effective treatment for major depression in DS.
Therapie 44 (2): 115-21 (1989 Mar-Apr)

Infantile psychosis, pseudo-Alzheimer syndrome, and trisomy 21. A trial of treatment with folinic acid: preliminary report

Lejeune J, Rethore MO, de Blois MC, Peeters M

Trisomy 21 produces excess sensibility to methotrexate (dihydrofolate reductase inhibitor). A trial of medication with folinic acid (5-formyl-tetrahydrofolate) was realized on 39 trisomic 21 patients. 30 of them were affected by severe infantile psychosis and the other 9 were affected by a severe Alzheimer-like regression. On 69 assays, 37 were favorable and 32 were null. A dose/effect correlation was highly significant. It is proposed that a systematic investigation of the effects of folinic acid (associated or not with monocarbon precursors) be studied in cases of trisomy 21 complicated by precocious psychosis or severe secondary regression.
Acta Psychiatr Scand 78 (3): 369-374 (1988 Sep)

Psychiatric aspects of Down's syndrome

Lund, J.
Institute of Psychiatric Demography, Aarhus Psychiatric Hospital, Risskov, Denmark

In a survey study of psychiatric morbidity, based on a representative sample from the Danish mental retardation register, 44 adults with Down's syndrome (DS) were compared with 258 other mentally retarded adults. Assessed by the parameters psychiatric disorder, behaviour problems, neurotic traits, and deviant social interaction, the DS group functioned better on all parameters. However, male and female DS patients were very different, the females constituting a superior well-functioning group while the males had major problems in every area. High prevalence rates of dementia and infantile autism were found in the DS group. General function rapidly decreased with age in DS patients.
British Journal of Psychiatry 149 : 156-161 (1986)

Behavior Problems in Retarded Children with Special Reference to Down Syndrome

Gath, Ann; Gumley, Dianne

Data were collected, using interviews with parents and teachers and rating scales, concerning the behaviour of two groups of mentally retarded children: 193 children with Down's Syndrome (DS) and 154 children with a similar degree of handicap were identified in the same schools. The proportions of children who had high scores on the Rutter or an additional behaviour check list, were similar in the two groups. Deviant behaviour was markedly more common in both sets of retarded children than in their siblings next to age; 31% of the children with DS and 29% of controls were judged to be well adjusted, while 38% of the DS children and 49% 6f the controls had significant behaviour disorder. Conduct disorders were most common in the children with DS. 'Psychosis' was the most common diagnostic label in the control group, but was also found in the children with DS.
Am J Ment Defic 89 (3): 246-51 (1984 Nov)

Depression and anorexia nervosa of persons with Down syndrome

Szymanski LS, Biederman J

The manifestations of major depression in three adults with Down syndrome, one of whom also suffered from anorexia nervosa, were described. The clinical manifestations depended on patient's developmental level, particularly on verbal language skills. Behavioral and vegetative symptoms predominated when the retardation was more severe, whereas in the higher functioning patient affective symptoms were more readily recognizable. The overall findings indicate that major depression in persons with Down syndrome may be more frequent than previously assumed and that it can be diagnosed with standard diagnostic DSM III criteria, modified according to the patient's developmental level.
Postgrad Med J 60 (700): 137-9 (1984 Feb)

Basal ganglia calcification and psychosis in Down's syndrome

Thase ME

A case of basal ganglia calcification (diagnosed in vivo) and schizophreniform psychosis occurring in a young adult with Down's syndrome is reported. A stress-vulnerability model is suggested. Because of the relatively high prevalence of basal ganglia calcification to Down's syndrome, this population appears well suited for systematic study of the neuropsychiatric aspects associated with this neurological condition.
Eur Neurol 17 (5): 300-14 (1978)

Basal ganglia calcification and psychosis in mongolism

Jakab I

An 18-year-old mongoloid girl (trisomy 21) of Asian descent presented two symptoms rarely associated with mongolism (Down's syndrome). (1) Brain stem calcification; the first case diagnosed in vivo in mongolism on computerized axial tomography. (2) Hallucinatory psychotic depression; the first case successfully treated, to full recovery from the psychosis, in a mongoloid child with known brain stem calcification. The psychotic depression was related to moderate environmental stress. While being treated in her parent's home, in their native land, for more than 1 year, the psychosis remained unresponsive to tranquilizers. Following hospital admission in the USA, rapid improvement was obtained within a few weeks through intensive milieu therapy.