Flashcards in Learning Disability Psychiatry Deck (20):
According to ICD 10, what is a learning disability?
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
What are the criteria for learning disability?
1. Intellectual impairment (IQ < 70)
2. Social or adaptive dysfunction, deficits/impairments in 2 or more of the following adaptive skills;
- self care
- home living
- social skills
- community use
- self direction
- health and safety
- functional academics
- leisure and work
3. Onset in the developmental period
What is the prevalence of people with learning disability?
Due to - differential mortality and role of functioning
How is IQ used to classify levels of learning disability?
Mild LD - IQ 50-69
Moderate LD - IQ 35-49
Severe LD - IQ 20-34
Profound LD - IQ < 20
Be aware that classification systems have a base of about 40 so IQ below this becomes an objective clinical judgement
What is the aetiology of learning disability?
Genetic e.g. single gene (Fragile X), microdeletion/duplication (DiGeorge syndrome), chromosomal abnormality (Down syndrome)
Infective e.g. antenatal rubella, postnatal meningitis
Toxic e.g. foetal alcohol syndrome
Trauma e.g. birth asphyxia
In most cases, cause is unknown
What classification of learning disability will most people with LD have?
In how many cases is a cause of learning disability identifiable?
What are the common/important physical conditions associated with learning disability?
Epilepsy - increased incidence and complexity with severity of LD, 10-50%
Sensory impairments - hearing 40%, vision 20%
GI - swallowing problems, reflux oesophagi's, helicobacter pylori, constipation
Respiratory - chest infections, aspiration pneumonia
Orthopaedic - joint contractures, osteoporosis in younger patients
Dermatological and dental - 33% unhealthy gums
What are the reasons for having a medical specialty of psychiatry for those with learning disability?
Higher incidence of psychiatric disorders in those with LD
More severe the LD, the higher the prevalence of psychotic disorders is
People with mild learning disability may present in a broadly similar way to the general population
Presentation of mental illness is different, especially in moderate-profound LD
Difficulties in describing internal world i.e. less complex delusions, less ability to explain how they are feeling
Those with lower IQ/communication difficulties often present with challenging behaviour - it is all about a baseline
Where there is less verbal communication, observable signs are relied on more when making the diagnosis e.g. weight loss, withdrawal, agitation, tearfulness in depression, behavioural disturbance in psychotic disorder
Special training for psychiatrists
What are the assessment areas in psychiatry of learning disability?
Aetiology of LD
Associated biomedical conditions
Severity of LD
Psychiatric disorders, their cause and consequences
What is the prevalence of schizophrenia/psychosis in people with learning disability compared to general population?
3% point prevalence compared to 1% in general population
What is schizophrenia/psychosis associated with in learning disability?
Change in personality
Reduction in functional abilities
Self talk common particularly in Down syndrome
What is the presentation of mood disorders in learning disability?
Less likely to complain of mood changes, more likely to be noted by change in behaviour
What is the presentation of OCD in learning disability?
Ritualistic behaviour and obsessional themes are significantly increased in LD
Obsession hard to describe by people with LD but compulsions are more readily observed
How many people with autism have a learning disability?
What is the presentation of over-activity syndromes in learning disability?
ADHD much higher incidence
Many severe LD children are overactive, distractible and impulsive but not to the extent that would indicate a diagnosis of ADHD
What is the presentation of challenging behaviour and self-injury in learning disability?
Mannerisms, head-banging and rocking are common with severe LD
General trend is towards a greater prevalence of problem behaviour with increasing severity of LD, but people with profound LD will exhibit less outwardly
What ist he incidence of forensic offences in people with learning disability?
Mild LD have similar rates of offending to the general population, but different profile of offending
IQ below 70 are over-represented in the prison population for arson and sexual (usually exhibitionism) offences
What should health professionals do when treating a learning disability patient with a psychiatric condition?
Take time and have patience
Value what is being communicated
Recognise non-verbal cues
Find out about the person's alternative communication strategies if communication is difficult e.g. their typical non-verbal cues, use of symbols, sign language
Explain things clearly in an appropriate way (verbally, with pictures etc.)
Simple, short, jargon-free language
Be prepared to meet the person several times to build up rapport and trust
Use the knowledge and support of people's carers