Arrested Intellectual Development: Learning Disability and Co-morbidities Flashcards
What are the O-Brien principles?
Learning disabled people will continue to grow and develop given an appropriate environment
Learning disabled people are worthy of all the dignity and rights of any citizen
Concept of learning through risk-taking and the avoidance of over-protection
Availability of everyday, normal conditions of life
Availability of generic environments and services
3 aspects of learning disability?
- Impairment itself, e.g: brain injury as a result of peri-natal trauma
- Resulting disability, e.g: inability to read
- Resulting social handicap, e.g: problems with occupational, leisure and personal relationship opportunities
What issues might a patient with LD experience?
Mental Illness (3x more common in people with LD; those with LD experience the same range of psychiatric disorders as the general population)
Epilepsy
Discrimination and stigma
Substance Misuse
Physical Disability
Sensory and mobility problems
Autistic Spectrum Disorder
Sexual Abuse
Family Dysfunction
Different Appearance
Poor educational provisions and employment prospects
Low expectation of success
Why are psychiatric disorders more common in those with LD?
Organic vulnerability, e.g: brain damage
Social deprivation / disadvantage
Life events
Psychological reasons - learned helplessness
Psychiatric assessment in LD?
Suggestibility
Level of detail obtained can be restricted:
• Reduced comprehension
• Reduced verbal skills
• Observation of behaviour more important
May be easily dissuaded from belief but will return to it
Psychotic symptoms reflect development level (may lack detail)
“Paranoid” ideas may be reality based (misinterpretation of a situation)
Some unusual behaviour may be developmentally appropriate, e.g: soliloquy
Issues in a patient with LD that may be causing their presentation?
Physical, e.g: may be in pain (teeth, ear), epilepsy, constipation
Environmental, e.g: abuse, deaths/loss, changes
Mental, e.g: depression, psychosis
Mx of patients with LD?
Therapeutic environment:
• General support, e.g: school
• Specific support, e.g: psychiatric problems
Education:
• Patient
• Carers
Social:
• Unmet needs
• Support network
Communication:
• Hearing aids, glasses
• Pictorial
• Makaton
Behavioural
Cognitive
Pharmacological
Physical interventions:
• Headgear
• Isolation (low sensory environment for patients who are being over-stimulated)
Admission
Psychological treatments available for LD and specific issues they may help with?
Behavioural: • Teach/improve basic skills • Establish normal patterns • Relaxation techniques • Assertiveness training
CBT:
• Problem solving skills
• Anxiety and depression
• Offending behaviour
Psychodynamic therapy:
• Relationships
• Adjustment to life events
Cautions when considering pharmacological treatment for LD?
Comorbid physical disorders:
• Epilepsy
• Constipation
Atypical responses:
• Decreased or increased sensitivity
• Paradoxical reactions
Evidence base often lacking
Pharmacological treatment for LD?
Anti-psychotics for psychosis, behavioural disturbance, autism, ADHD
Anti-depressants for depression, anxiety disorders, self-injury, autism
Anti-convulsants for BPAD, episodic dyscontrol
Occurrence of schizophrenia in LD?
3x more common and the age of onset is earlier (average of 23)
-ve symptoms are more common
Main presenting symptom may be behaviour change
Signs of schizophrenia in severe LD?
Unexplained aggression, bizarre behaviour, social withdrawal, mood lability, increased mannerisms or stereotypes
Occurrence of depressive disorder in LD?
3x more common; they have more somatisation
Signs of depressive disorder
Reduced verbal expression of unhappiness, guilt, etc
Biological symptoms affecting sleep, appetite, concentration
Anhedonia, etc
Occurrence of Autism Spectrum Disorder as a cause of LD?
Up to 1/3rd of the LD population
70% have an IQ <70
More common in males (4 : 1)
Most are totally dependent on support
Triad of symptoms in ASD?
- Abnormal social interaction
- Communication impairment
- Rigid/restricted or repetitive behaviour, interests and activities
Treatment and support strategies for ASD?
- Structure
- Routine
- Predictability
- Communication:
• Communication aids and language therapy
NOTE - consider mainstream vs specialist education/vocational interventions, behavioural interventions, family intervention
