Primary Care and Learning Disability

Question 1

Key symptoms of Depression

Answer 1

Persistent sadness/low mood
Anhedonia
Fatigue/low energy

Question 2

Associated symptoms of depression

Answer 2

Disturbed sleep 
Poor concentration 
Low self-confidence 
Poor or increased appetite 
Suicidal thoughts or acts 
Agitation or slowing of movements 
Guild or self-blame

Question 3

Which criteria is required for mild depression

Answer 3

4 symptoms

Least 2 key

Question 4

Which criteria is required for moderate depression Dx

Answer 4

5-6 symptoms

least 2 key

Question 5

Which criteria is required for severe depression dx

Answer 5

Seven or more (all 3 key)

Question 6

What must you ALWAYS ask a patient in a psychiatric history

Answer 6

suicidal thoughts

Question 7

What should you ask regarding suicide in a history

Answer 7

How far have they gone to plan it?
Previous attempts
Homicidal risk

Question 8

if patient presents with considerable immediate risk to themselves or other what is the management

Answer 8

Refer urgently to specialise mental health services

Question 9

Which criteria is often used by GPs to diagnose depression

Answer 9

DSM

Question 10

Which is the 1st line anti-depressant

Answer 10

SSRI

Question 11

Which psychological therapy should you use for depression

Answer 11

CBT

Question 12

Rules for switching anti-depressant

Answer 12

initially switch to a different SSRI 
or SNRI 
Subsequently to another class which may be less well tolerated

Question 13

Who should prescribe MAOI

Answer 13

Specialist care only

Question 14

Define prolonged grief disorder

Answer 14

Marked distress and disability caused by the grief reaction.
AND the persistence of this distress and disability more than 6m after a bereavement.

Question 15

What are the treatment options for prolonged grief disorder

Answer 15

Counselling
Antidepressant for co-morbid depression
Behavioural/cognitive/exposure Refer if significant impairment in functioning

Question 16

1st line Rx for OCD

Answer 16

CBT including exposure and response prevention

Question 17

2nd line Rx for OCD

Answer 17

SSRI

Question 18

3r line Rx for OCD

Answer 18

Clomipramine

Question 19

Examples of SSRIs

Answer 19

Sertraline
Citalopram
Fluoxetine
Paroxetine

Question 20

2ndry causes of insomnia

Answer 20

Anxiety/depression 
Physical health problem 
Obstructive sleep apnoea 
Excess alcohol or illicit drugs 
Parasomnias 
Circadian rhythm

Question 21

Primary care for eating diroders

Answer 21

Recognise and refer to 2ndry care

Question 22

Expected SE of lithium treatment

Answer 22

Fine tremor 
Dry mouth 
Altered taste sensation 
Increased thirst 
Urinary frequency 
Mild nausea 
Weight gain

Question 23

Toxicity symptoms of lithium

Answer 23

Vomiting and Diarrhoea 
Coarse tremor 
Muscle weakness
 Lack of co-ordination including ataxia 
Slurred speech 
Blurred vision 
Lethargy 
Confusion 
Seizures

Question 24

How often do lithium levels need to be checked

Answer 24

3/12

Question 25

What should you not start Rx in the depressed phase

Answer 25

Refer/discussed with 2yr care

Question 26

What is GAD?

Answer 26

Generalised Anxiety Disorder (GAD) | Excessive worry about a number of different events

Question 27

What is panic disorder

Answer 27

Recurrent panic attacks Persistent worry about further attacks

Question 28

What is social anxiety disorders

Answer 28

persistent fear of, or anxiety about one or more social or performance situations that is out of proportion to the actual health posed by the situation

Question 29

ICD 10 definition of learning disability

Answer 29

• ‘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 30

Criteria for LD

Answer 30

1.Intellectual impairment (IQ < 70) (Wechsler) 2.Social or adaptive dysfunction (Vineland Scale) a. 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)

Question 31

IQ of mid learning disability

Answer 31

50-59

Question 32

IQ of moderate LD

Answer 32

35-49

Question 33

IQ of severe learning disability

Answer 33

20-34

Question 34

IQ of profound LD

Answer 34

<20

Question 35

Genetic aetiology of LD

Answer 35

Single gene: Fragile X, PKU, Retts Syndrome Microdeletion/duplication: DiGeorge Syndrome, Prader-Willi, Angelman syndrome Chromosomal abnormality: Down Syndrome

Question 36

Infective aetiology of LD

Answer 36

Ante-natal e.g rubella, Zika virus Post-natal e.g meningitis, encephalitis

Question 37

Toxic aetiology of LD

Answer 37

Fetal alcohol syndrome

Question 38

What is the main aetiology of LD

Answer 38

unknown for most individuals

Question 39

Trauma aetiology of LD

Answer 39

Birth asphyxia | Head injury

Question 40

Which neuro condition is more common in LD

Answer 40

Epilepsy

Question 41

Which sensory impairments are more common in LD

Answer 41

Hearing | Vision

Question 42

Which GI problems are more common in LD

Answer 42

Swallowing problems Reflux oesophagitis Helicobacter pylorii | Constipation

Question 43

Which respiratory problems are more common in LD

Answer 43

Chest infections Aspiration Pneumonia

Question 44

Is cerebral palsy more or less common in LD

Answer 44

more common

Question 45

Which orthopaedic problems are more common in LD

Answer 45

Joint contractures | Osteopororsis

Question 46

How many of those with LD have autism

Answer 46

2/3

Question 47

Is ADHD higher or lower incidence in LD

Answer 47

Much higher