Learning Disability Psychiatry Flashcards
How do you meet the criteria of having a mental disorder?
Mental illness
Personality disorder
Learning disability
How do you define a learning disability?
A condition of arrested or incomplete development of the mind which is especially characterised by impairment of skills manifested during the development period (childhood) which contributes ti the overall level of intelligence e.g. cognitive, language, motor and social abilities
What are the tests for learning criteria?
Intellectual impairment (IQ<70, Wechsler)
Social or adpataivd dysfunction (Vineland scale)
Deficits/impairments in 2 or more of the following, adaptive skills, communication, self care, home loving, social skills, health and safety
Once the in the developmental period (<18)
What are the grades of learning disability?
Mild learning disability 50-69
Moderate learning disability34-49
Severe learning disability20-34
Profound learning disability<20
What causes learning disabilities?
Genetics-PKU, Down’s syndrome, fragile x
Infective- rubella (antenatal) meningitis (post natal)
Toxic- fetal alcohol syndrome
Trauma- birth asphyxia, head injury
Most common aetiology is unknown
What are some common physical co-morbidities
Epilepsy
Sensory impairments- hearing
Obesity
GI- swallowing, reflux
Resp- chest infections, aspirations pneumonia
Cerebral palsy
Orthopaedic problems- joint contracture, osteoporosis
Dermatological and dental problems- gum disease
Why do people with learning disabilities need psychiatry?
Higher incidence of psychiatric disorders
Presentation of mental illness is different in profound LD
Difficulties describing internal works
Communication disorders
Where there is less verbal communication, observable signals are relied on
E.g. weight loss, withdrawal, agitation, tearfulness
What is the job of a learning disability psychiatrists
What’s caused it- reversible?
The associated conditions
The severity of the learning disability
The psychiatric disorders, their causes and their consequences
Giving expert evidence to the criminal court
What symptoms of schizophrenia would you notice in those with a learning disability?
Change in personality
Reduction in functional abilities
Self talk common, particularly in downs syndrome
What symptoms of mood disorders would you notice in those with a learning disability?
Less likely to complain of mood changes
Change in behaviour e.g. biological symptoms
What symptoms of OCD would you notice in those with a learning disability?
Ritualistic and obsessional themes
Obsessions hard to describe by people with learning difficulties
Compulsions and readily observed
What symptoms of over-active syndromes would you notice in those with a learning disability?
ADHD much higher incidence
Many severe LD children are overactive, distractingly and Impulsive but not to the extent that would indicate diagnosis of ADHD
What challenging behaviours and self injuries would you notice in those with a learning disability?
Head banging and rocking
Greater prevalence of problem behaviour with increasing severity of learning disability
What forensic issues would you notice in those with a learning disability?
IQ below 70 more likely to commit arson and sexual crimes
How do you manage someone with a learning disability and another co-morbidity
Take time and have patience (use link nurse, special needs nurse)
Value what is being communicated
Recognise non-verbal cues
Find out about the persons alternative communication
Explain things clearly in an appropriate way, simple,short and jargon free
Be prepared to meet the person several times to build rapport
Use the knowledge and support of peoples carers (speech and language therapy are good resources)
