Psychiatry of learning disability

Question 1

Social principle that aims to allow people with LD to have life experiences such as having a job, having relationships and living in their own home

Answer 1

Normalisation

Question 2

Figure who first developed the idea of normalisation

Answer 2

Bengt Nirje

Question 3

Figure who further developed the idea of normalisation and wrote ‘The principle of Normalization in human service’

Answer 3

Wolf Wolfensberger

Question 4

Figure who coined the idea of social role valorisation

Answer 4

Wolf Wolfensberger

Question 5

Idea behind social role valorisation

Answer 5

The idea that people with LD could be given opportunities to take on valued social roles which would improve attitudes towards them

Question 6

Four key principles in the UK government paper Valuing People which looked at treatment of people with learning disabilities

Answer 6

Rights
Independence
Choice
Inclusion

Question 7

Decade in which institutionalisation of people with learning disabilities began to be phased out in the UK

Answer 7

1980s

Question 8

Percentage of offenders in the UK with a learning disability

Answer 8

1-10%

Question 9

Percentage of adults in prison with an IQ <70

Answer 9

7%

Question 10

Percentage of adults in prison with an IQ <80

Answer 10

25%

Question 11

Percentage of adults with LD who have schizophrenia

Answer 11

3%

Question 12

Percentage of adults with LD who have bipolar affective disorder

Answer 12

1.5%

Question 13

Percentage of adults with LD who have depression

Answer 13

4%

Question 14

Percentage of adults with LD who have agoraphobia

Answer 14

1.5%

Question 15

Percentage of adults with LD who have OCD

Answer 15

2.5%

Question 16

The idea that once a diagnosis is made of a major condition all other symptoms are attributed to that diagnosis

Answer 16

Diagnostic overshadowing

Question 17

Semi structured interview that is used to diagnose psychiatric disorders in patients with LD

Answer 17

Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS-ADD)

Question 18

Increased risk of schizophrenia in patients with LD compared to the general population

Answer 18

3x higher

Question 19

Clinical features specific to schizophrenia in patients with LD compared to the general population

Answer 19

Earlier age of onset - average 23
Formal thought disorder less common
Complex persecutory delusions less common
With severe LD - impulsive and unpredictable behaviour

Question 20

Behaviour common in patients with LD, especially in children with Down’s syndrome, which should be differentiated from psychosis

Answer 20

Self talk

Question 21

Named syndromes associated with both LD and psyhosis

Answer 21

Usher’s syndrome
Velo-cardio-facial syndrome (DiGeorge syndrome)
Prader Willi syndrome

Question 22

Percentage of patients with Usher’s syndrome who have psychosis

Answer 22

15%

Question 23

Clinical features specific to bipolar affective disorder in patients with LD compared to the general population

Answer 23

Mania less likely to be expressed verbally and more likely to be expressed through behaviour

Question 24

Clinical features specific to depression in patients with LD compared to the general population

Answer 24

Marked biological features
Marked diurnal variation
Irritability common
Aggressive and self injuring behaviour common
Regressive behaviours can be seen

Question 25

Anxiety type associated with fragile X syndrome

Answer 25

Social anxiety

Question 26

Anxiety type associated with Prader-Willi syndrome

Answer 26

OCD

Question 27

Anxiety type associated with Rubinstein-Taybi syndrome

Answer 27

OCD

Question 28

Anxiety type associated with Williams syndrome

Answer 28

Phobias

Question 29

Anxiety type associated with Cornelia de Lange syndrome

Answer 29

Compulsive behaviours

Question 30

Percentage of young people with mild/borderline LD who have conduct disorder

Answer 30

30%

Question 31

Percentage of people with mild LD who have autism

Answer 31

10%

Question 32

Percentage of people with severe LD who have autism

Answer 32

40%

Question 33

Proportion of people with Down's syndrome aged 30-39 who have dementia

Answer 33

1 in 50

Question 34

Proportion of people with Down's syndrome aged 40-49 who have dementia

Answer 34

1 in 10

Question 35

Proportion of people with Down's syndrome aged 50-59 who have dementia

Answer 35

1 in 3

Question 36

Proportion of people with Down's syndrome aged >60

Answer 36

More than half

Question 37

Percentage of people with LD who display challenging behaviours

Answer 37

7%

Question 38

Percentage of people with LD who display challenging behaviours in hospital

Answer 38

14%

Question 39

Setting where self injuring behaviour is most common among people with LD

Answer 39

Hospital

Question 40

Peak age for self injuring behaviour in people with LD

Answer 40

15-20

Question 41

Conditions associated with LD and self injuring behaviour

Answer 41

Prader-Willi Fragile X Tourettes Smith-Magenis Cornelia de Lange Lesch-Nyhan

Question 42

Most common form of self injuring behaviour among people with Prader-Willi

Answer 42

Skin picking

Question 43

Most common form of self injuring behaviour among people with Lesch-Nyhan

Answer 43

Finger biting or lip biting

Question 44

Persistent eating of non-nutritive items

Answer 44

Pica

Question 45

Percentage of children aged 1-4 in the general population who display pica

Answer 45

30%

Question 46

Percentage of adults with LD in the community who display pica

Answer 46

5%

Question 47

Percentage of adults with LD in hospitals or care settings who display pica

Answer 47

10-20%

Question 48

LD related conditions which lithium is licensed for aside from bipolar affective disorder

Answer 48

Control of aggressive behaviour Intentional self harm

Question 49

Investigation required before starting lithium in patients with LD

Answer 49

EEG

Question 50

Complications of lithium more common in patients with LD

Answer 50

Seizures Toxicity

Question 51

Use for naltrexone within LD

Answer 51

Treatment of repetitive self injury

Question 52

Criteria for clinically significant challenging behaviour

Answer 52

Behaviour causes more than minor injuries to the person or others At least weekly the behaviour requires intervention by staff At least weekly the behaviour causes damage that cannot be rectified At least weekly the behaviour causes 1 hour of disruption At least weekly the behaviour places staff in danger Daily the behaviour causes over a few minutes' disruption

Question 53

Drugs which can be used to treat severely problematic sexual behaviour

Answer 53

Cyproterone acetate Medroxyprogesterone acetate

Question 54

Questionnaire used to diagnose dementia in patients with LD

Answer 54

Dementia questionnaire for people with learning disabilities

Question 55

Most common presentation of PTSD in patients with LD

Answer 55

Aggression

Question 56

IQ below which schizophrenia cannot be reliably diagnosed

Answer 56

45

Question 57

Most common presenting symptom of PTSD among patients with learning disabilities

Answer 57

Aggression

Question 58

Most common cause of PTSD in patients with learning disabilities

Answer 58

Abuse

Question 59

Percentage of patients with Down syndrome who have dementia by aged 35

Answer 59

25%

Question 60

Percentage of patients with Down syndrome who have dementia by aged 65

Answer 60

75%

Question 61

First symptom in Alzheimer's dementia which is more common in patients with Down syndrome than the general population

Answer 61

Personality changes

Question 62

Risk factors associated with self injury in people with a learning disability

Answer 62

Younger age Lower developmental ability Autistic symptoms Sensory impairment

Question 63

Recommended treatment for PTSD for patients with learning disability

Answer 63

As per the general population - SSRI and psychological therapy