Learning Disability Psychiatry Flashcards Preview

Year 3 - Psychiatry > Learning Disability Psychiatry > Flashcards

Flashcards in Learning Disability Psychiatry Deck (23)
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1

What is the definition of 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’

2

What is the criteria for a learning disability?

1) Intellectual impairment (IQ < 70) (Wechsler)

2) Social or adaptive dysfunction (Vineland Scale)
Deficits/Impairments in 2 or more of following adaptive skills:
- Communication
- Self-care,
- Home living,
- Social skills,
- Community use,
- Self direction,
- Health and safety,
- Functional academics,
- Leisure & work

3) Onset in the developmental period (age 18)

3

What is the prevalence of intellectual disability?

Statistically the prevalence of people with IQ<70 should be 2.5% (2SD from mean)

Actually the prevalence of people with LD is 1-2%, because of:
1) Differential mortality (the more severe the degree of learning disability, the higher the mortality c.f. general population)

2) The role of functioning - those with IQ<70 but no problems functioning within their environment would not be defined as having a learning disability

4

IQ is used to classify the level of learning disability what is consider a mild learning disability?

IQ of 50 to 69

5

IQ is used to classify the level of learning disability what is consider a moderate learning disability?

IQ of 35 to 39

6

IQ is used to classify the level of learning disability what is consider a severe learning disability?

IQ of 20 to 34

7

IQ is used to classify the level of learning disability what is consider a profound learning disability?

IQ of <20

8

Aetiology of learning disabilities?

1) Genetic
2) Infective
3) Toxic
4) Trauma
5) Unknown

9

Aetiology of learning disabilities - Genetic?

Genetic: e.g.
> Single gene: Fragile X, PKU, Retts Syndrome

> Microdeletion/duplication: DiGeorge Syndrome, Prader-Willi, Angelman syndrome

> Chromosomal abnormality: Down Syndrome

10

Aetiology of learning disabilities - Infective?

ante-natal e.g. rubella;

post-natal e.g. meningitis, encephalitis

11

Aetiology of learning disabilities - Toxic?

foetal alcohol syndrome

12

Aetiology of learning disabilities - Trauma?

birth asphyxia, head injury

13

What common conditions are associated with learning disabilities?

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%

14

Assessment areas of learning disabilities?

Aetiology of LD

Associated biomedical conditions

Severity of LD

Psychiatric Disorders, their cause and consequences

15

Which mental health problems are associated with learning difficulties?

1) Schizophrenia / Psychosis
2) Mood Disorders
3) OCD
4) Autism
5) Over-activity syndromes
6) Challenging Behaviour and Self Injury
7) Forensic

16

Which mental health problems are associated with learning difficulties - Schizophrenia / Psychosis?

3% Point Prevalence compared to 1% in general population

Associated with change in personality and reduction in functional abilities

‘Self-Talk’ common in LD, particularly Downs Syndrome

17

Which mental health problems are associated with learning difficulties - Mood Disorders?

Increased incidence

Less likely to complain of mood changes and noted by change in behaviour ie biological symptoms

18

Which mental health problems are associated with learning difficulties - OCD?

Ritualistic behaviour and obsessional themes significantly increased in LD

Obsessions hard to describe by people with LD but compulsions more readily observed

19

Which mental health problems are associated with learning difficulties - Autism?

2/3 of persons with Autism have a LD

20

Which mental health problems are associated with learning difficulties - Over-activity syndromes?

ADHD much higher incidence

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

21

Which mental health problems are associated with learning difficulties - Challenging Behaviour and Self Injury?

Mannerisms, head banging and rocking common with severe LD

General trend is towards greater prevalence of problem behaviour with increasing severity of LD (but people with profound LD exhibit less outwardly)

22

Which mental health problems are associated with learning difficulties - Forensic?

Mild LD have similar rates of offending to the general population but diff profile of offending

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

23

What is diagnostic overshadowing?

Presenting symptoms are put down to their learning disability, rather than seeking another, potentially treatable cause

E.G: when a person presents with a new behaviour or existing ones escalate, consider:
1) Social cause - change in carers, lack of support, lack of social activities

2) Psychological issues - bereavement, abuse

3) Physical problems - pain or discomfort, e.g. from ear infection, toothache, constipation, reflux oesophagitis, deterioration in vision or hearing.

4) Psychiatric cause - depression, anxiety, psychosis, dementia