Learning disabilities

Question 1

What is mental retardation IC10 definition?

Answer 1

A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities’

Question 2

Intellectual disability criteria - IQ?

what are the 2 scales?

Answer 2

Intellectual impairment (IQ < 70) - Wechsler Adult IntelligenceScale

• (Vineland Adaptive Behaviour Scale)

Question 3

Intellectual disability criteria - SOCIAL or adaptive dysfunction - Deficits/Impairments in 2 or more of following adaptive skills?

Answer 3

communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure & work

Question 4

Intellectual disability criteria - onset?

Answer 4

in the developmental period (before age 18)

Question 5

Mild, moderate , severe, profound LD IQ values?

Answer 5

IQ 50-69 - mild (9-12 yrs)

IQ 35-49 - moderate (6-9)

IQ 20-34 (3-6 yrs) - severe

IQ <20 (<3 yrs) - profound

Question 6

Aetiology of learning difficulties? - single gene (3)

Answer 6

Fragile X, PKU, Retts Syndrome

Question 7

Aetiology of learning difficulties? - Microdeletion/duplication (3)

Answer 7

DiGeorge Syndrome (22Q11), Prader-Willi, Angelman syndrome

Question 8

Aetiology of learning difficulties? - Chromosomal abnormality

Answer 8

Down Syndrome - trisomy 21

Question 9

Aetiology of learning difficulties - acquired? (4 types)

Answer 9

Infective - Rubella, Zika virus

• Traumatic: hypoxic injury during birth, head injury in childhood

Toxic - foetal alcohol syndrome

IDIOPATHIC!!!

Question 10

Microdeletion/duplication - cause of schizophrenia?

Answer 10

DiGeorge Syndrome (22Q11)

Question 11

Most common genetic cause of elating disability in the UK?

Answer 11

Downs syndrome

Question 12

Health inequalities in those with learning disabilities? give some examples why they might not access health care like the rest of the population?

Answer 12

Social exclusion - harder to make friends

Socioeconomic deprivation - rely on the state

Inaccessible services

Discrimination

Challenges to communication

Lack of appropriate knowledge and skills of professionals

Minimal evidence base from research

Question 13

or important physical conditions associated withID (8)

Answer 13

Epilepsy – increased incidence and complexity with severity of learning disability (10-50%)

Sensory impairments – hearing (40 %) and vision (20%), earwax

Obesity – predisposes to other health problems

Gastrointestinal – swallowing problems, reflux oesophagitis, Helicobacter pylorii, constipation

Respiratory problems – chest infections, aspiration pneumonia

Cerebral palsy – especially with severe learning disability

Orthopaedic problems – joint contractures, osteoporosis

Dermatological and Dental problems- 33% unhealthy gums, for Down’s Syndrome, 80%

Question 14

the more severe the LD… the higher?

Answer 14

prevalence of psychiatric disorder

Question 15

people with a moderate- profound LD may..?

Answer 15

present their mental illness differently

- Difficulties in describing internal world” e.g. less complex delusions

Question 16

How may lower IQ patients with communication difficulties present with mental health issues?

Answer 16

challenging behaviour/ change in behaviour

Question 17

Where there is less verbal clues, how may a patient with LD present?

Answer 17

PHYSICAL - weight loss, withdrawal, agitation, tearfulness in depression
behavioural disturbance in psychotic disorder

Question 18

Psychiatry of LD - assessment areas?

Answer 18

Presence and severity of LD

Aetiology of LD - genetic tests?

Associated biomedical conditions - impact on mental health and presentation

Psycho-social assessment

Psychiatric Disorders, their cause and consequences

Question 19

Learning disability and schizophernia and psychosis - what is this associated with?

Answer 19

change in personality and reduction in functional abilities

- self talk

Question 20

Learning disability and mood disorders

Answer 20

Noted by change in behaviour ie biological symptoms - reduction in appetite, weight loss

Question 21

Learning disability and anxiety disorders

Answer 21

• ritualistic behaviour and obsessional themes , work, day to day activities
• compulsions are more easily observed

Question 22

half of those with LD have?

Answer 22

autism

Question 23

Learning disability and Over-activity syndromes

Answer 23

ADHD much higher incidence
- look at developmental age

Many severe LD children are overactive, distractible and impulsive but NOT to extent that would indicate diagnosis of ADHD

Question 24

Learning disability and challenging behaviour and self injury

Answer 24

usually as a result of stress or distress
- aggression towards others 
 wandering
- destruction of property
- PICA
 - sexually inappropriate

Question 25

Learning disability and Forensic

Answer 25

- IQ below 70 over-represented for arson and sexual (usually exhibitionism) in prison population

Question 26

When a person presents with a new behaviour or existing ones escalate, consider? :

Answer 26

Social cause - change in carers, lack of support, lack of social activities Psychological issues - bereavement, abuse Physical problems - pain or discomfort, e.g. from ear infection, toothache, constipation, reflux oesophagitis, deterioration in vision or hearing.  Psychiatric cause - depression, anxiety, psychosis, dementia

Question 27

How to communicate with those who have LD?

Answer 27

Take time and have patience. Value what is being communicated. Recognise non-verbal cues. Alternative communication strategies explain Cleary- pictures etc need to meet lots to build a rapport - use knowledge of the carers

Question 28

lithium is contraindicated with?

Answer 28

diabetes insipidus

Question 29

Side effect of Amisulpiride (atypical antipsychotic)

Answer 29

hyperprolactinaemia.