Seasonal Affective Disorder and response to light in two patients with learning disability.

BACKGROUND: Seasonal Affective Disorder is now a well recognised variant of recurrent depressive disorder. No previous description of its occurrence in people with a learning disability has appeared. METHODS: Two patients are described who manifested seasonal cycles in mood related behaviour. RESULTS: Both patients were treated with bright artificial light and showed adequate clinical responses. CONCLUSION: Patients with a learning disability and recurrent behavioural changes indicative of a mood disorder should be assessed for the seasonal pattern of the illness and, if appropriate, given a trial of treatment with bright artificial light. LIMITATION: The data relates to two case reports without structured assessments. Further studies in this population should use standardised diagnostic criteria and systematic severity of depression scores. CLINICAL RELEVANCE: Patients with poor verbal skills may not be able to express their seasonal changes adequately but careful observation of the timing of behavioural abnormalities may aid the diagnosis of SAD leading to new therapeutic possibilities in phototherapy.

Cancer and learning disability.

This study was performed in order to complete a 60-year survey of the rate of deaths from cancer in a group of people with a learning disability. It was carried out on an in-patient population, and information was obtained from hospital records of deaths and patient medical notes. During the 10-year period studied, 13.6% of all deaths were from cancer, compared to a rate of 26% in the general population. The ratios of different types of cancer were also markedly different to those in the general population, with a very high proportion (55%) being cancers of the gastro-intestinal tract. Other types of cancer, such as those affecting the bronchus, breast and prostate gland, which cause death most often in the general population, hardly appeared at all in the in-patient population studied. The present paper explores some of the possible reasons for these findings and the implications for the current research in the wider field of cancer in the general population.

Atlanto-axial instability in adults with Down's syndrome--a survey of a long-stay hospital population.

A survey was performed on the patients with Down's syndrome living in three long-stay hospitals for the mentally handicapped in Bristol. Each patient had a chromosomal analysis, lateral X-rays of the cervical spine in flexion and extension and subsequent measurement of the atlanto-odontoid distance, and a neurological examination. Out of a total of 59 patients, with ages ranging from 23 to 65 years (average age 48.27 years), three (5%) were found to be in the high risk category radiologically, but of these two were in the medium risk group on neurological examination and one low risk. Of five (8.5%) patients in the medium risk group on X-ray, four were in the medium risk group neurologically. Therefore a total of eight patients (13.6%) could be considered to be at risk of atlanto-axial instability.