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PSYCHIATRY > Learning Disability > Flashcards

Learning Disability Flashcards

1
Q

What diagnostic label will be used for learning disbility in the ICD-11?

A

Intellectual disability

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2
Q

What percentage of the general population have a learning disability?

A

3%

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3
Q

Patients with learning disabilities have increased comorbidity and mortality. TRUE/FALSE?

A

TRUE

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4
Q

Patient with learning difficulty often present with more advanced disease. Why is this?

A

Poor access to screening programmes (as they do not understand the concept/ how to be screened)

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5
Q

Why are patients disabilities often “invisible” whilst receiving healthcare?

A

Lack of effective flagging systems on patients records

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6
Q

What do hospital staff often not understand about patients with disabilities?

A
  • specific requirements of people with learning disabilities
  • adjustments to services that people may need
  • capacity issues
  • communication
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7
Q

What is a learning disability?

A
  • condition of incomplete development of mind,
  • characterised by impairment of skills usually appearing during developmental period
  • contribute to the overall level of intelligence
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8
Q

What are the 3 criteria for a learning disability to be diagnosed?

A 
Deficits in intellectual functioning (IQ < 70)
Deficits in adaptive functioning
Developmental aetiology (occurs < 18 years)
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9
Q

What different psychometric assessments are used to diagnose learning disabilities in adults vs in children?

A

Wechsler Adult Intelligence Scale (WAIS)

Wechsler Intelligence Scale for Children (WISC),

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10
Q

What is the average IQ?

A

100

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11
Q

What is the Flynn effect?

A

IQ average is increasing (American study)

- roughly by 3 points per decade

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12
Q

Why is the Flynn effect thought to now be “slowing” in developed countries?

A

youth culture = less books and conversation, more computer gaming

Schooling = training towards test vs general education

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13
Q

What racial differences come across in average IQ?

A

Average IQ of Asian higher than european

Developed countries higher than developing

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14
Q

How could you potentially tell if someone has a learning disability?

A
  • May be immediately apparent (e.g. dysmorphic features)
  • Information from self / carers
  • History of special schooling
  • Behaviour
  • Communication
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15
Q

How is the severity of a learning disability classified by IQ?

A 
Borderline LD	 		IQ  70+
Mild LD				IQ  50-69 
Moderate LD	 		IQ  35-49
Severe LD		 	IQ  20-34
Profound LD		 	IQ  < 20
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16
Q

People with a borderline learning disability have what mental age?

A

mental age 12 to <15 years.

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17
Q

Patients with a mild learning disability have what mental age?

A

mental age 9 to <12 years.

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18
Q

What tasks do patients with mild learning disabilities struggle with?

A

Delayed speech - but are able to use everyday speech
Difficulties in Reading and Writing
Difficulty in high-skilled work
Problems with Social/Emotional Immaturity

19
Q

What mental age is a patient with a moderate learning disability?

A

mental age 6 to <9 years

20
Q

What tasks do patients with a moderate learning disability struggle with?

A

Slow with Comprehension and Language
Limited Achievements
Delayed Self care and Motor Skills
Simple Practical Tasks often require Supervision

21
Q

What comorbidities are common in a moderate learning disability?

A

Epilepsy and Physical Disability

22
Q

What mental age are patients with severe OR profound learning disabilities?

A 
Severe = mental age 3 to under 6 years
Profound = mental age < 3 years.
23
Q

Explain the restrictions of a patient with a profound learning disability

A

Severe limitation in understanding/complying with requests or instructions.
Little or no self-care.
Often severe mobility restriction.

24
Q

In 1959 the Mental Health Act made it possible to detain patients with learning difficulties in hospital, but what problems did this cause?

A

Meant hospital and community care was very different and MORE patients were admitted in order to be detained and treated

25
Q

What happened in the 1970s to reduce the number of patients with learning disabilities who were admitted?

A
  • Trend developed towards building of smaller facilities

- Idea of normalisation => person with a learning disability should be able to access mainstream facilities

26
Q

What are the potential causes of an intellectual disability during the antenatal period?

A

Maternal infections - e.g. Rubella, CMV
Poor Diet
Substance abuse

27
Q

What are the potential causes of an intellectual disability when the baby is being born?

A

Extreme Prematurity
Birth Injury
Cerebral Anoxia

28
Q

What post-natal problems can cause a baby to develop an intellectual disability?

A

Metabolic causes
Hypoglycaemia
High Bilirubin

29
Q

What causes of intellectual disability usually appear in infancy/childhood?

A

Infections

NAI, Trauma, Toxins

30
Q

What chromosomal abnormalities can cause an intellectual disability?

A

Cri du chat (Chromosome 5)

Angelman (maternal)/ Prader-Willi (paternal) (Chromosome15)

Downs Syndrome (Chromosome 21)

Fragile X (common)

31
Q

What chromosomal abnormalities do not usually cause a learning disability?

A

Turners 45XO

- learning disabilities = rare in this group

32
Q

What other genetic causes can result in a learning disability?

A

Phenylketonuria
Tuberous Sclerosis
Congenital Hypothyroidism

33
Q

What social symptoms may be experienced by a patient with learning difficulties?

A 
Family Dysfunction
Sexual Abuse
Poor employment prospects
Stigma
Poor educational provisions
34
Q

Psychiatric disorders are more common in patients with a learning disability. TRUE/FALSE?

A

TRUE

35
Q

Why are psychiatric disorders often underdiagnosed in patients with learning disorders?

A

Patients want to please you and act as if they understand
=> often try to disguise the symptoms of their learning disability and other psychiatric 6
symptoms

36
Q

What should you be aware of when completing a psychiatric assessment on patients with learning disabilities?

A
  • Use open questions
  • Check accuracy (are they just saying they understand?)
  • Patients may have reduced comprehension and/or verbal skills => answers may be less detailed
  • observe their behaviour
  • Psychotic symptoms reflect developmental level
  • Paranoid” ideas may be due to misinterpretation of a situation
  • unusual behaviour may be developmentally appropriate (e.g. interested in many things at young age)
37
Q

How should patients with learning difficulties be managed?

A
  • General support (eg. school)
  • Specific support (eg. psychiatric problems)
  • Psychoeducation for Patient, Carers
  • Help with communication
    e. g. Hearing aids, glasses, Pictorial, Makaton
38
Q

What psychological treatments can be used for learning disability patients?

A

Behavioural (often easier for them than CBT)

  • Teach/improve basic skills
  • Relaxation techniques
  • Assertiveness training

Modified Cognitive behavioural therapy (CBT)

  • Problem solving skills
  • Anxiety and depression
  • Offending behaviour

Psychodynamic therapy

  • Relationships
  • Adjustment to life events
39
Q

What pharmacological treatments are used for autism and ADHD?

A

Autism - antipsychotics

ADHD - stimulants

40
Q

What is the male:female ratio in autism?

A

3:1

41
Q

What are the main 3 symptoms of autism?

A

Abnormal social interaction
Communication impairment
Rigid/restricted or repetitive behaviour

42
Q

What treatment/support is provided for patients with autism?

A
  • Communication aids / Speech + Language Therapy
  • Educational interventions
  • Behaviour modification, Social skills training
  • Family intervention (education and support)
43
Q

What is the difference between a Learning Difficulty and a Learning Disability?

A

Difficulty = Problem in only one area of cognition
e.g. Dyslexia
=> These DO NOT affect global IQ

Disability = global reduction in cognition resulting in lower IQ

PSYCHIATRY (35 decks)

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