The savant syndrome and autistic disorder.

Savant syndrome, characterized by remarkable islands of mental ability in otherwise mentally handicapped persons, may occur in autistic as well as nonautistic individuals. Overall, approximately 10% of autistic persons exhibit savant abilities; roughly 50% of those with savant syndrome have autism, and the remaining 50% have other forms of developmental disability. Most commonly, savant syndrome takes the form of extraordinary musical abilities, but may also include calendar-calculation, artistic, mathematical, spatial, mechanical, and memory skills. While savant syndrome was first described more than a century ago, only recently have researchers begun to employ a more uniform nomenclature and more standardized testing in an effort to compare the abilities of savants with those of normal persons. Males show signs of savant syndrome approximately four times more often than females. Along with imaging study findings, this fact suggests the presence of a developmental disorder involving left-brain damage with right-brain compensation.

The idiot savant: a review of the syndrome.

Since it was first described a century ago, the phenomenon of the idiot savant--the juxtaposition of severe mental handicap and prodigious mental ability--has remained unexplained. The author defines the condition, reviews and summarizes the world literature on this topic since the early reports, describes more recent cases, and catalogs and categorizes idiot savant abilities. Theories to explain the condition are reviewed, newer research findings are highlighted, and the far-reaching implications of the idiot savant syndrome for understanding normal brain function, particularly memory, are outlined.

The obviously ill patient in need of treatment: a fourth standard for civil commitment.

The three relatively standard criteria currently contained in most state civil commitment laws (danger to self, danger to others, and gravely disabled) have forced many obviously ill patients to deteriorate to the point of dangerousness before receiving treatment, to become criminalized, or to wander the streets untreated. After discussing the origins of present civil commitment laws and the plight of obviously ill patients, the author details the cooperative effort of several groups in Wisconsin to codify a fourth standard for civil commitment that would ensure that obviously ill patients receive treatment with proper procedural and due process safeguards. Other statutory alternatives to remedy the plight of obviously ill patients are also discussed.

delta 9-Tetrahydrocannabinol and therapeutic research legislation for cancer patients.

The Controlled Substances Board evaluated the implementation of the National Cancer Institute (NCI) program in Wisconsin that distributes delta 9-tetrahydrocannabinol (delta 9-THC) to cancer chemotherapy patients with nausea and vomiting refractory to conventional antiemetic drugs. The board concluded that the distribution mechanism for delta 9-THC is appropriate and adequate in Wisconsin. The drug does relieve nausea and vomiting in some cancer chemotherapy patients, but adverse side effects are prevalent. Important questions about its safety and effectiveness remain and should be resolved through scientific research and within the existing framework for testing investigational drugs that are controlled substances. "Marijuana therapeutic research" legislation, similar to that passed in 32 states, was introduced in Wisconsin after implementation and evaluation of the NCI program, but failed to recognize the existing legal framework for approving new drugs and threatened to disrupt the NCI program. With assistance from the American Cancer Society, the State Medical Society, and volunteers and professionals in cancer research, the legislation was adapted to the existing legal and administrative framework.

Legal "rites": criminalizing the mentally ill.

1. Because of more stringent civil commitment criteria, persons formerly hospitalized on a civil commitment now enter the system on criminal observation orders, having been arrested, booked, and often jailed for minor offenses such as vagrancy, shoplifting, or disorderly conduct. This represents a criminalization of the mentally ill. 2. In a single forensic system (Wisconsin) there was an increase of 73% in such commitments following court decisions and legislative revisions setting forth new commitment criteria. This increase was principally in criminal observations, although this rise was evident as well in "unable to stand trial" commitments. It was not present in "not guilty by reason of insanity" adjudications. 3. Aside from the obvious untoward effects per se of criminalizing mentally ill persons, other untoward effects occur in terms of prolonging hospitalization, depriving those persons of prompt treatment, and putting unnecessary and inhumane pressures on the family and the community, as well as on the mentally ill person himself. 4. The "freedom" to the penniless, helpless, ill, and finally arrested, jailed and criminally committed is not freedom at all--it's abandonment. The "right" to be demented, agonized and terrorized in the face of treatment which cannot, because of legal prohibition, be applied is no right at all--it's a new form of imprisonment. The "liberty" to be naked in a padded cell, hallucinating, delusional, and tormented, is not liberty--it is a folie à deux between pseudo-sophisticated liberals and an unrealizing public. The delusion is that if one changes the name of something to something else, or if one substitutes a jail for a hospital or a preoccupation with legal rites for honest concern over patients' rights, he has done something significant, useful and important, or at least something.

Marijuana use in schizophrenia: a clear hazard.

The use of marijuana as the independent variable produced a serious exacerbation of a psychotic process in four schizophrenic patients whose illness was otherwise well controlled with antipsychotic medication. Each patient served as his own control--the sole substance abused was marijuana and antipsychotic medication intake remained constant. Each time marijuana use at moderate levels began, there was exacerbation and deterioration. The author suggests that marijuana use is a special hazard to schizophrenic patients and that physicians should alert such high-risk patients to the possible untoward interaction between their illness and marijuana.