1/6. akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction.A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/6. Treating selective mutism in a paediatric rehabilitation patient by altering environmental reinforcement contingencies.Selective mutism is a disorder which can cause severe social and academic impairment, and for which a wide variety of treatment approaches have been used, with varying degrees of success. Selective mutism can be conceptualized as the lack of generalization of a class of operant responses (e.g. audible and comprehensible verbalizations) across environmental contexts. The rehabilitation hospital setting, in which the patient is seen daily by multiple people in multiple settings, is particularly well-suited for implementing a systematic behavioural intervention to establish verbal behaviour and simultaneously reinforce its generalization. Data are presented on a 7-year-old female admitted to a rehabilitation hospital following orthopaedic surgery, who met the DSM-IV diagnostic criterion for selective mutism. Additional medical diagnoses included cerebral palsy, microcephaly, and mild mental retardation. A behavioural programme was developed and implemented to reinforce differentially first any communication, then verbal communication across staff and settings. Results were evaluated using a modified multiple baseline across settings design, and demonstrate that verbal, written, and tangible reinforcement effectively increased verbal behaviour where it previously rarely occurred. Results are discussed in terms of the relationship between selective mutism, social phobia and related disorders. The theoretical roles of behavioural phenomena (discriminative stimuli, stimulus generalization) in the development and treatment of these disorders are discussed.- - - - - - - - - - ranking = 5keywords = behaviour (Clic here for more details about this article) |
3/6. Selective mutism and obsessive compulsive disorders associated with zonisamide.We treated 27 children with idiopathic epilepsy with zonisamide monotherapy over a period of 2 years and observed behaviour disturbances in a prospective study. In all cases, seizure control was excellent; however, two cases (7.4%) had behaviour disturbances. The first (Case 1) was a 14-year-old girl with partial epilepsy which began at age 4 years. Zonisamide was administered at age 6 years, which was effective against her seizures, but selective mutism, violent behaviour, and lack of concentration developed at age 10 years. The second (Case 2) was a 15-year-old girl with generalized tonic-clonic seizures which began at age 10 years. Zonisamide was also effective against her seizures, but obsessive compulsive disorders (OCD) developed at age 13 years. The patients have had no other physical or mental problems and decreasing the dosage of zonisamide reduced the problems. There are few reports of behaviour disturbances provoked by zonisamide monotherapy in epileptic children who are neither physically nor mentally disturbed. While problems can develop several years later, in the present study, decreasing the zonisamide dosage maintained adequate prevention of seizures and eliminated the behaviour disturbances. Zonisamide is still a useful anticonvulsant for epileptic seizures, but physicians should be wary of its adverse behavioural side effects, which may arise several years later.- - - - - - - - - - ranking = 6keywords = behaviour (Clic here for more details about this article) |
4/6. Children who do not talk at school.This paper contains two case reports illustrating the use of behaviour modification in the treatment of elective mutism. The programme was carried out by two social workers in the natural environment of the home and school.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/6. Total mutism--a case report of a rare psychiatric disorder and approaches for behaviour therapy.Total mutism, which is an extremely rare psychiatric disorder, was observed in an 11-year-old boy. He refused to speak a few weeks after starting school. Behavioural analysis showed that learning by model as well as positive and negative reinforcements were involved in the pathogenesis and maintenance of the disorder. The treatment followed principles of behaviour therapy by the use of operant techniques in the sense of contingency management methods. White noise, transmitted by earphones, was utilized to interrupt auditory feedback. It has been suggested that by this method anxiety would be diminished in the case of speech phobia. Within a few months of hospital admission the boy developed speaking behaviour progressing from barely audible breaths to sibilants of normal loudness. Short dialogues were possible after 18 months. The additional conduct disorder improved simultaneously with the increase in verbal and social skills. One year after hospitalization some social uncertainty persisted with tendencies to avoid demands.- - - - - - - - - - ranking = 6keywords = behaviour (Clic here for more details about this article) |
6/6. Right parietal infarction with concomitant mutism.Right brain damage results in a variety of cognitive and behavioural dysfunctions. Mutism however, has been described only with left or bihemispheric lesions involving the parietal lobe. We report an elderly man who had left faciobrachial monoparesis and concomitant mutism. His auditory-verbal comprehension was intact. MRI revealed a right parietal infarct involving the cortical and subcortical regions. Recovery from mutism during the course of treatment was abrupt and complete with no residual dysarthria. A possibility of diaschisis or impaired modulation of left hemispheric function due to right cerebral infarct, presenting as conversion reaction, is proposed for this rare association.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |