Subject(s)
Autistic Disorder/complications , Autistic Disorder/genetics , Intellectual Disability/complications , Intellectual Disability/genetics , Adolescent , Adult , Autistic Disorder/diagnosis , Autistic Disorder/etiology , Electroencephalography , Female , Gene Duplication , Genetic Testing , Hospitals, Psychiatric , Humans , In Situ Hybridization, Fluorescence , Intellectual Disability/diagnosis , Intellectual Disability/etiology , Male , Middle Aged , Netherlands , SyndromeABSTRACT
BACKGROUND: It is hypothesized that self-injurious behavior (SIB) and symptoms of autism may be due to overactivity in some opioid systems in the brain. We examined the efficacy and safety of naltrexone hydrochloride, an opioid antagonist, in the treatment of SIB and autism in mentally retarded adults. METHOD: Thirty-three mentally retarded adults with autism and/or SIB participated in double-blind, placebo-controlled crossover studies. Active treatment was first a single 100-mg dose of naltrexone hydrochloride. Subsequently, 19 subjects were treated with 50 mg/d and 14 with 150 mg/d of naltrexone hydrochloride for 4 weeks. The outcome was assessed by means of direct observations (n = 11) and on the basis of scores on a list of target behaviors, the Aberrant Behavior Checklist, and the Clinical Global Impression Scale. RESULTS: Thirty-two subjects (seven with autism, 16 with autism and SIB, and nine with SIB) completed the trial. Naltrexone treatment failed to have therapeutic effects on SIB and autism. On the contrary, naltrexone increased the incidence of stereotypic behavior on the Aberrant Behavior Checklist, and the care staff evaluated the effect of the 50-mg/d treatment as being significantly worse than that of the placebo treatment as measured by the Clinical Global Impression Scale. CONCLUSION: Our findings suggest that naltrexone has no clinical value for a broad group of mentally retarded subjects with SIB and/or autism.
Subject(s)
Autistic Disorder/drug therapy , Intellectual Disability/psychology , Naltrexone/therapeutic use , Self-Injurious Behavior/drug therapy , Adolescent , Adult , Autistic Disorder/epidemiology , Autistic Disorder/psychology , Comorbidity , Cross-Over Studies , Double-Blind Method , Drug Administration Schedule , Female , Humans , Incidence , Intellectual Disability/epidemiology , Male , Middle Aged , Placebos , Psychiatric Status Rating Scales , Self-Injurious Behavior/epidemiology , Stereotyped Behavior/drug effects , Treatment OutcomeABSTRACT
In The Netherlands, there is a more or less recognized movement in the field of mental health care which is referred to as the psychiatric opposition movement or the patients movement. The nucleus of the Dutch movement consists of patients and ex-patients. As far as mental health professionals are participating in the movement, they do so as more or less passive supporters of a movement dominated by patients and ex-patients. This article is dealing with two questions. The first question is how and to what degree the opposition movement in The Netherlands has succeeded in breaking through or at least questioning the closed nature of Dutch mental health care system. The second question will be whether the dilemma between resistance and dependence in the position of patients and ex-patients is visible in the activities of the opposition movement, and whether this dilemma acted as an obstacle to their efforts to influence the mental health care debate in The Netherlands. An effort is being made to answer this question by describing the position of the opposition movement with respect to the Insanity Law and with respect to the organization of mental health care. In conclusion, three stages were found to be crucial in the development of Dutch opposition movement. In the 1970s, the opposition movement appeared to operate within the borders of a closed system in which the medical profession had a high degree of autonomy.(ABSTRACT TRUNCATED AT 250 WORDS)
KIE: Dutch mental health care is described as a traditionally closed system in which the medical profession has a high degree of autonomy. Since the 1970s the traditional system has been challenged by an opposition movement that is dominated to an unusual extent by mental patients and ex-patients. A sociological analysis of the development and role of this opposition movement is presented, with particular regard to its efforts in pressing for changes in the law on compulsory hospitalization and for a reorganization of the mental health system to give patients more say in their own care and to abolish large psychiatric hospitals.
