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INCLUSION OF CHILDREN WITH INTELLECTUAL AND MULTIPLE DISABILITIES: A COMMUNITY-BASED REHABILITATION APPROACH, INDIA
Ram LAKHAN
Journal of Special Education and Rehabilitation , 2013, DOI: 10.2478/v10215-011-0035-1
Abstract: Background: Inclusion of children with intellectual disabilities (ID) and multiple disabilities (MD) in regular schools in India is extremely poor. One of the key objectives of community-based rehabilitation (CBR) is to include ID & MD children in regular schools. This study attempted to find out association with age, ID severity, poverty, gender, parent education, population, and multiple disabilities comprising one or more disorders cerebral palsy, epilepsy and psychiatric disorders with inclusion among 259 children in Barwani Block of Barwani District in the state of Madhya Pradesh, India.Aim: Inclusion of children with intellectual and multiple disabilities in regular schools through CBR approach in India.Method: Chi square test was conducted to investigate association between inclusion and predictor variables ID categories, age, gender, poverty level, parent education, population type and multiple disabilities. Result: Inclusion was possible for borderline 2(66.4%), mild 54(68.3%), moderate 18(18.2%), and age range from 5 to 12 years 63 (43%). Children living in poor families 63 (30.6%), not poor 11(18.9%), parental edu-ca-ti-on none 52 (26%), primary level 11 (65%), midd-le school 10 (48%) high school 0 (0%) and bachelor degree 1(7%), female 34 (27.9%), male 40 (29.2%), tribal 40 (28.7%), non-tribal 34(28.3%) and multiple disabled with cerebral palsy 1(1.2%), epilepsy 3 (4.8%) and psychiatry disorders 12 (22.6%) were able to receive inclusive education. Sig-ni-ficant difference in inclusion among ID ca-te-gories (c2=99.8, p < 0.001), poverty (c2=3.37, p 0.044), parental education (c2=23.7, p < 0.001), MD CP (c2=43.9, p < 0.001) and epilepsy (c2=22.4, p < 0.001) were seen.Conclusion: Inclusion through CBR is feasible and acceptable in poor rural settings in India. CBR can facilitate inclusion of children with borderline, mild and moderate categories by involving their parents, teachers and community members.
The Coexistence of Psychiatric Disorders and Intellectual Disability in Children Aged 3–18 Years in the Barwani District, India
Ram Lakhan
ISRN Psychiatry , 2013, DOI: 10.1155/2013/875873
Abstract: Background. The coexistence of psychiatric disorders in people with intellectual disability (ID) is common. This study determined the prevalence of psychiatric disorders in children with ID in Barwani, India. Method. A total of 262 children with ID were evaluated for psychiatric disorders using the diagnostic criteria outlined in the International Classification of Diseases (ICD-10). Results. Psychiatric disorders appeared in study participants at the following rates: attention deficit hyperactivity disorder (ADHD), 6.5%; autism, 4.2%; anxiety, 2.7%; bipolar disorder, 1.1%; delusional disorder, 0.8%; depression, 2.3%; obsessive-compulsive disorder, 0.8%; schizophrenia, 1.9%; enuresis, 10.3%; epilepsy, 23.7%; and behavioral problems, 80.9%. The prevalence of psychiatric disorders was statistically higher in severely intellectually disabled children ( ) than mildly intellectually disabled children ( ). Conclusions. There is a higher prevalence of psychiatric disorders in children with ID when their compared with ID children whose . 1. Introduction Intellectual disability (ID), previously referred to as mental retardation, is most often associated with other medical and psychiatric conditions such as cerebral palsy, epilepsy, Down syndrome, fragile X syndrome, attention deficit hyperactivity disorder (ADHD), autism, and other emotional and behavioral disorders. The coexistence of psychiatric disorders occurring in people with ID is not uncommon. The study of intellectual disability falls within the field of psychiatry, in which dual diagnoses have historically been common. However, specifically investigating the coexistence of psychiatry disorders among people with ID has only recently begun [1–3]. Compared with the general population, people with ID have a higher prevalence of psychiatry disorders [4, 5], ranging from 10% to 80% [6, 7]. Other epidemiological studies have reported similar prevalence rates [8–13]. For the past few decades, the psychiatric community in developed countries, like England and Australia, has done more to identify the psychiatric needs of people with ID, which has allowed doctors to provide these patients with appropriate mental health services [7, 14–16]. In India dual diagnosis of psychiatric disorders in people with ID has gradually become more common since implementation of the Persons with Disabilities Act in 1995. However, making further efforts to identify people in India with ID who also suffer from psychiatric disorders is necessary to plan for and provide comprehensive intervention for their well-being [17]. Identifying
Schizophrenia proteomics: biomarkers on the path to laboratory medicine?
Shaheen Lakhan
Diagnostic Pathology , 2006, DOI: 10.1186/1746-1596-1-11
Abstract: Affecting nearly 1% of the world's population, schizophrenia is marked by chronic psychosis and social, occupational, behavioral, and cognitive impairment. This debilitating psychiatric disorder requires a disproportionate share of medical resources due to its early onset and chronic and severe nature. Schizophrenia is a lifelong disorder that usually manifests after puberty and before 25 years of age, with equal risks across gender. The illness is episodic and places the sufferer at an increased risk of suicide.Proteomics studies have focused extensively on cancer diagnosis and non-invasive monitoring, primarily via serum samples. Many have revealed potential biomarkers or biochemical molecules that identify a specific disease state and are capable of being detected or measured. For example, tumor marker CA125 (MUC16) provides useful information on disease resistance, treatment response, and even early detection in ovarian cancer screening, and efforts are underway for its clinical application [1].Not surprisingly, the standards for viable biomarkers are high. Ideally, a diagnostic marker meets seven conditions: 1) it detects a fundamental feature of the disease with high sensitivity and specificity; 2) is validated in post-mortem confirmed cases; 3) standardized with sound bioinformatics; 4) specific for the disease compared with related disorders; 5) reliable in many testing environments/labs; 6) noninvasive; 7) simple to perform; and 8) inexpensive [adapted from [2]].Despite the significant rates of self-harm behavior associated with schizophrenia, its relatively high prevalence in the general population and the existence of a substantial untreated population, no biomarker has yet been discovered for the disorder.This article describes the ability of proteomic approaches to accurately identify novel biomarkers, which may provide a substantial insight into schizophrenia pathogenesis. In addition, proteomic investigations could lead to the discovery of diagnostic
Diversification of U.S. medical schools via affirmative action implementation
Shaheen Lakhan
BMC Medical Education , 2003, DOI: 10.1186/1472-6920-3-6
Abstract: Selection based solely on academic qualifications such as GPA and MCAT scores does not achieve racial and ethnic diversity in medical school, nor does it adequately predict success as practicing physicians. However, race-conscious preference yields greater practice in underserved and often minority populations, furthers our biomedical research progression, augments health care for minority patients, and fosters an exceptional medical school environment where students are better able to serve an increasingly multicultural society.The implementation of race-conscious affirmative action results in diversity in medicine. Such diversity has shown increased medical practice in underserved areas, thereby providing better health care for the American people."Mend it, but don't end it."President William Jefferson Clinton [1]America's extremely discriminatory past fostered the exclusive practice of medicine by white men. Women and members of minority groups and lower socioeconomic classes were barred or hindered from attaining the dignified and prestigious medical degree (MD). In the nineteenth century, new medical schools were developed to accommodate women and minorities, particularly African Americans, and dubious private schools emerged lacking university affiliation, called "proprietary schools". The Carnegie Foundation in conjunction with the American Medical Association (AMA) Council on Medical Education hired former schoolmaster Abraham Flexner to report the proper and actual basis of American and Canadian medical instruction for immediate action. In 1910, the Carnegie Foundation published Flexner's accounts titled Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Training popularly called the Flexner Report [2]. In it, Flexner summarized in a prominent and sharp approach the 168 medical schools he visited. He called for the closure of all three medical schools that catered entirely to women. He subsequently
Effect of Play and Exposure on Development of Children with Intellectual Disabilities through Community Based Rehabilitation
Lakhan R
Indian Journal of Physical Medicine and Rehabilitation , 2009,
Abstract: This paper studies the effect of play and exposure on thedevelopment of children with intellectual disabilitiesthrough community Based Rehabilitation in theimpoverished, tribal population of Madhya Pradesh state,India. In study, 23 children (male -13 & Female - 10)ranging from mild to profound disability, were selectedfrom seven villages of Thikari block of Barwani district.Parents and community based rehabilitation workers(CBRWs) worked rigorously with these children for oneyear. Children were exposed to play and participation inhousehold activities under the guidance of a professionaltherapist. The goal was to mainstream these children atplay and in the home. Before starting intervention, bothgroups (CBRWs and parents) were provided training atAshagram Trust Center. A Likert scale was applied preand post intervention to record progress on thedevelopment of children. A standard test VSMS alsoadministered on 10 randomly selected children to verifyLikert scale progress. Obtained pre and post scores ofLikert scale and VSMS test were analyzed in conclusion.
Mass spectrometric analysis of prefrontal cortex proteins in schizophrenia and bipolar disorder
Shaheen E Lakhan
SpringerPlus , 2012, DOI: 10.1186/2193-1801-1-3
Abstract: Postmortem prefrontal cortex tissue from schizophrenia, bipolar disorder, and psychiatric-free controls (n?=?35 in each group) were subject to SELDI-TOF-MS protein profiling. There were 13 protein peaks distinguishing schizophrenia versus control and 15 in bipolar versus control. Using a predictor set of 10 peaks for each comparison, 73% prediction accuracy (p?=?2.3×10?4) was achieved. Three peaks were in common between schizophrenia and bipolar disorder.This pilot study found protein profiles that distinguished schizophrenia and bipolar patients from controls and notably from each other. Identifying and characterizing the proteins in this study may elucidate neuropsychiatric phenotypes and uncover therapeutic targets. Further, applying class prediction bioinformatics may allow the clinician to differentiate the two phenotypes by profiling CSF or even serum.
From a Parkinson's disease expert: Rasagiline and the Future of Therapy
Shaheen E Lakhan
Molecular Neurodegeneration , 2007, DOI: 10.1186/1750-1326-2-13
Abstract: Since joining the Faculty of Medicine at the Technion, Haifa, most of my research has been connected with catecholamines, mainly studies on the mechanism of the action of antidepressants, and on drugs for the treatment of Parkinson's disease. My major interest has been on the pharmacology of MAO inhibitors. These are fascinating compounds, since they can be used to cause irreversible and highly selective inactivation of one of the isoforms, i.e., MAO-A or MAO-B. Because they cause "laser-like" selective enzyme inactivation, one can use them to study not only the pharmacological effects of the drugs, but also the physiological role of these important enzymes. Inhibitors of the A form of the enzyme are effective antidepressants, and I was interested to understand the way in which inhibition of this enzyme affects neuronal noradrenaline release. Remember that, like other neurotransmitters, noradrenaline is released physiologically by exocytosis, and cleared from the extracellular space mainly by reuptake, so the effects of MAO inhibition are not easily predictable. Using in vivo micro dialysis, I was able to show that long-term administration of MAO-A inhibitors does increase CNS extracellular noradrenaline levels [1], by reduction in net neuronal uptake, and a similar effect occurs in the periphery.I was also interested in the pharmacology of MAO-B inhibitors. My colleague Professor Moussa Youdim observed selective MAO-B inhibitory property in a compound now known as rasagiline. The only other selective MAO-B inhibitor available for clinical use before the advent of rasagiline was selegiline, a compound based on the amphetamine structure. The important questions at the start of this project were (a) is the nonpotentiation of tyramine by selegiline due to its amphetamine-like properties, and (b) will rasagiline increase striatal dopamine levels, in spite of its lack of amphetamine-like effect? With graduate students Meir Tenne and Itschak Lamensdorf, we showed that non
An Optional Instrument for European Insurance Contract Law
Mandeep Lakhan,Helmut Heiss
Merkourios : Utrecht Journal of International and European Law , 2010,
Abstract: The Principles of European Insurance Contract Law, also referred tousing the acronym PEICL, were published in September 2009. They are the result of ten years of academic work undertaken by the"Restatement of European Insurance Contract Law" Project Group. In the time since its establishment in 1999, the project has been transformed from being a stand-alone project to a part of the CoPECL (Common Principles of European Insurance Contract Law) network, drafting a specific part of the Common Frame of Reference. Having continually worked under the guiding principle that "the law of insurance [in Europe] must be one," it now represents a serious option for providing Europe with a single legal framework for insurance contracts. Despite the European Council's proclamations that the Common Frame of Reference will remain a non-binding instrument, the implementation of one or more optional instruments in the future does not appear to beimprobable considering recent developments. The possibility of anoptional instrument has been expressed more than once by the European Commission in its Action Plan and Communication on European Contract Law. Other indications in favour of an optional instrument include the European Parliament's repeated references to the Common Frame of Reference as providing, at the very least, a model for a futureoptional instrument, as well as the EESC's earlier proposal of anoptional instrument as an alternative to standardising insurancecontract law. The preparation by the EESC of another (own-initiative) opinion on European contract law is underway, and its presentation is anticipated in 2010. Hence, the optional instrument is evidently the subject of serious political deliberation. Using Article 1:102, the Principles of European Insurance Contract Law represent a prototype for such an instrument.
3T MRI induced post-traumatic stress disorder: a case report
Lakhan Shaheen E
International Archives of Medicine , 2012, DOI: 10.1186/1755-7682-5-27
Abstract: Introduction MRI is considered a safe and well tolerated imaging technique with risks largely limited to heating and/or displacement of implanted ferromagnetic metal in the patient’s body, worsening anxiety, triggering claustrophobia, and gadolinium induced nephrogenic systemic fibrosis. Case presentation We present a case of a 26 year old Asian American man with no significant past medical or psychiatric history and two months of left T4 radicular pain. During 3T-MRI of the whole spine, the patient experienced acute agitation, fear, anxiety, tachypnea, tachycardia with palpitations, and dizziness. He felt intense surface heat over segments of his body and very loud noises. He perceived impending serious bodily harm by the scanner. The scan was aborted at the lumbar spine, and cervical and thoracic spine was unremarkable. The patient’s pain resolved in the weeks following with over the counter analgesics, however, he developed increased arousal, re-experiencing the event, persistent avoidance, and significant psychosocial impairment consistent with DSM-IV-TR criteria for post-traumatic stress disorder (PTSD). Conclusion This is the first reported case of MRI induced PTSD. Theoretically, the high-magnetic field of the 3T scanner may have contributed to the development of symptoms.
Prescribing Privileges for Psychologists: A Public Service or Hazard?
Shaheen E. Lakhan
Online Journal of Health & Allied Sciences , 2007,
Abstract: The privilege to prescribe pharmacotherapeutics has been granted in limited areas to psychologists. The psychologist's role in society may be approaching a great evolution that can dramatically impact the state of mental healthcare and the discipline of psychiatry. Opponents argue drug company funding and cheaper non-PhD psychological professionals fuel the movement for prescription rights for PhD level psychologists. However, proponents claim that this right would equip psychologists with greater psychotherapeutic modalities and the capability of having richer doctor-patient relationships to diagnose and treat underserved populations. Nonetheless, the paucity of prescribing psychologist studies cannot allow the biopsychosocial community to make firm opinions, let alone a decision on this debate. This article reviews the history of clinical psychology and highlights the potential divergence into collaborative clinical and health psychologists and autonomous prescribing psychologists.
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