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Y4 OPIC SA > 12 - Learning Disability > Flashcards

12 - Learning Disability Flashcards

1
Q

What is the pathophysiology of Huntington’s disease?

A

Progress autosomal dominant neurodegenerative disorder

Expansion of CAG repeats on Chromosome 4 (over 38 repeats)

Atrophy and neuronal loss of striatum and cortex

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2
Q

What is the triad of Huntington’s Disease?

A

Motor, Cognitive, Psychiatric

(1) Progressive movement disorder (often chorea)
(2) Progressive cognitive disturbance ending in dementia
(3) Various behavioral disturbances that often precede diagnosis

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3
Q

How does HD present?

A

Prodrome: mild irritability, depression, incoordination

Late stages: chorea, dementia, seizures

Death within 15 years of diagnosis

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4
Q

What investigations are done when HD is suspected?

A
  • MRI and CT: loss of striatal volume and increased size of the frontal horns of the lateral ventricles.
  • Genetic testing to make diagnosis
  • Genetic counselling
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5
Q

How is HD managed?

A
  • Nothing to stop progression!!
  • Physical and emotional support from MDT
  • Chorea: Tetrabenazine
  • Depression: SSRI
  • Psychosis: antipsychotics, preferably newer atypical agents, lower rates of extrapyramidal side effects.
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6
Q

What is the prognosis with HD?

A

Always decline into chorea and dementia

Main causes of death: Pneumonia from physical decline, suicide

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7
Q

What is a learning disability?

(NB Image)

A

State of arrested or incomplete development of the mind

Impairment of skills manifested during the developmental period and skills that contribute to the overall level of intelligence

Develops when the brain is still developing

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8
Q

What are some different causes of a Learning Disability?

A

SPLIT INTO SURGICAL SIEVE

  • Genetic
  • Antenatal
  • Perinatal
  • Neonatal
  • Postnatal
  • Environmental
  • Psychiatric

Cerebral palsy and Epilepsy common causes!!

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9
Q

What are the organisms causing TORCH infections?
a group of infectious diseases that can be passed to your baby during pregnancy, at delivery or after birth

A
  • Toxoplasma Gondi
  • Other agents
  • Rubella
  • CMV
  • Herpes Simplex
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10
Q

If somebody of the age of 18 develops intellectual disability, what is this called?

A

ACQUIRED BRAIN INJURY!!!!

Only learning disability before 18 years of age

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11
Q

What is the most common learning disability?

A

Downs Syndrome

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12
Q

What is STOMP?

A

Reducing the amount of psychotropic/inappropriate drugs,to reduce adverse side effects and potential drug interactions

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13
Q

What IQ defines a LD and what are the different severities of LD?

A

An IQ below 70 defines it

20-34 is severe, <20 is profound

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14
Q

What are 5 common psychiatric comorbidities in learning disabilities?

A
  • ASD
  • Anxiety
  • ADHD
  • Psychosis
  • Dementia
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15
Q

How may the different categories of LD present e.g self care, reading and writing, social skills, and what support may they need?

A
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16
Q

Why may it be difficult to diagnose LD patients with mental health disorders?

A
  • May be unable to complain of or describe their distress
  • Carers may not recognise that they have changed behaviour
  • Diagnostic Overshadowin: symptoms may be attributed to their learning disabilities
  • Symptoms may be attributed to side effects of medications or to other disorders such as complex partial epilepsy
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17
Q

What happened at Winterbourne View?

A

Private hospital in Gloucestershire that was abusing adults with learning disabilities, most patients being detained under the Mental Health Act

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18
Q

Are Autism and Dyslexia learning disabilities?

A

NO!

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19
Q

What are some good ways to manage an appointment with a patient with a LD?

A
  • Book double appointment
  • Check understanding regularly
  • Take history from patient before talking to carer
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20
Q

What are the most common physical health comorbidities associated with learning disabilities?

A
  • Respiratory disease: most common cause of death in LD
  • Epilepsy
  • GI cancers
  • Coronary heart disease
  • Diabetes
  • Obesity
  • Constipation
  • Dental issues
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21
Q

What is borderline intellectual functioning?

A
  • Not classified as LD but still vulnerable
  • Living independently
  • Subtle communication difficulties
  • High-school ‘drop-out’
  • Difficulty keeping a job, receiving government assistance
  • At risk of abusive relationships
  • Challenges rearing children
22
Q

What is the common place of residence for the following categories of LD:

  • Mild
  • Moderate
  • Severe
  • Profound
A
  • Mild: home
  • Moderate: home/community with carers
  • Severe: residential home
  • Profound: 24h supervised care with family or carers
23
Q

What are some physical health problems that a person with Downs Syndrome is more at risk of?

A
  • Epilepsy
  • Hypothyrodism
  • Obesity
  • Dementia
  • C-spineabnormalities e.g Atlanto Axial Instability
  • Recurrent Respiratory Tract and ear infection
  • OSA
  • Cardiac issues
24
Q

What are some psychiatric associations with Downs Syndrome?

A
  • Dementia (often early)
  • Depression
  • Hyperactivity
  • OCD
  • Autism
25
Q

Why may there be some issues with obtaining a history from a patient with a LD?

A
  • Can mask comprehension difficulties
  • Difficulty understanding medical terms
  • Will say ‘yes’ to appease
  • Suggestible
  • Difficulty waiting their turn
26
Q

How can communication be improved on our behalf in a consultation with a patient that has a learning disability?

A
  • Communication Passport
  • Environmental alterations
  • Use simple language, check if they have understood
  • Phrase questions carefully in order to avoid interrogative suggestibility
  • Give enough time for responses
  • Write things down / draw pictures to aid understanding
27
Q

What are some communication ‘don’ts’ when working with people with a LD?

A
  • Avoid asking yes/no questions as they will answer yes to please you
  • Don’t pretend to understand if you don’t
28
Q

What is the definition of autism?

A

Common in Fragile X

29
Q

What are some examples of challenging behaviour that people with LD’s may display?

A
30
Q

What are some examples of challenging behaviour that people with LD’s may display?

A
31
Q

How do you perform a mental state exam in a person without an LD?

A

10 Point Checklist

https://geekymedics.com/mental-state-examination/

32
Q

What are some tools you can use to do a mental state examination in a patient with a LD?

A
  • Diagnostic Manual – Intellectual Disability [DM-ID]
  • Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation [DC-LD]

Assess recent changes in behaviour using information from family members and carers. Take into account the nature, quality and length of their relationship with the person.

33
Q

What things do you need to look at in a risk assessment for a patient with LD and a co-morbid mental health condition?

A
  • risk to self
  • risk to others (including sexual offending)
  • risk of self-neglect
  • vulnerability to exploitation
  • likelihood and severity of any particular risk
  • potential triggers
  • causal or maintaining factors
  • whether safeguarding protocols should be implemented.
34
Q

If a patient with a LD needs a risk management plan following a risk assessment for a mental health condition, what needs to be included in this?

A
35
Q

What are psychotropic drugs used for in patients with LD?

A
  • Manage behaviour that challenges by reducing excitation and aggression
  • May use antipsychotics, antidepressants, mood stabilisers and sedatives.
  • Antipsychotics are the most frequently used
  • Off-label use of a licensed medicine
36
Q

When are antipsychotics introduced in patients with LD that have challenging behaviour?

A

ONLY IF

  • psychological or other interventions alone do not produce change within an agreed time
  • treatment for any coexisting mental or physical health problem has not led to a reduction in the behaviour
  • the risk to the person or others is very severe (for example, because of violence, aggression or self-injury).
37
Q

How are LD patient’s started on psychotropic drugs?

A
  • Single antipsychotic
  • Start low go slow
  • Review response and side effects after 3 or 4 weeks
  • Stop if no effect after 6 weeks
38
Q

How can epilepsy be different in a patient with a LD?

A

Often more prolonged and frequent

Can be difficult to initially diagnose due to diagnostic overshadowing

39
Q

How do taking AEDs differ in patient’s with LD’s?

A
  • May need multiple AEDs as prolonged more frequent seizures
  • More susceptible to side effects as areas of brain damage
  • Difficult to tell apart side effects from learning disability behaviours e.g may be low in mood because of AED but cannot communicate this
40
Q

What is the most common comorbidity with intellectual disability?

A

Epilepsy!!

The more severe the disability the more likely they are to have epilepsy

41
Q

What are some criteria for consent to be valid?

A
  • Must have capacity
  • Must be voluntary
  • Must be fully informed e.g risks and benefits
42
Q

What is the Mental Capacity Act and the 5 main principles of this?

A

Law that protects vulnerable people over the age of 16 around decision-making

Every adult, whatever their disability, has the right to make their own decisions wherever possible.

43
Q

How can you support someone to aid them in their ‘capacity’ assessment?

A
44
Q

If a person lacks capacity you have to make a decision in their best interest. What are some things included in the best interest checklist?

A
  1. Will the person regain capacity?
  2. Involve the person
  3. Consult all relevant people.
  4. Consider all the information.
  5. Do not make any assumptions
  6. Consider past, present and future wishes
  7. Always pick the very least restrictive option
45
Q

If a patient who lacks capacity has no family or friends who can you get involved to help make a best interests decision?

A

IMCA

46
Q

What are the four points of capacity assessment?

A
47
Q

What are some things that cannot be decided for somebody else under the MCA?

A
  • Getting married
  • Consenting to sex
48
Q

What is the difference between a learning disability and a learning difficulty?

A

Learning disability is a reduced intellectual ability and difficulty with everyday activities

Learning difficulties affect the way someone learns and processes information, aren’t related to intelligence.

49
Q

What are some ethical issues when working with patients with Learning Disabilities?

A
  • Diagnostic Overshadowing
  • Institutional discrimination e.g letter to someone about appt who can’t read
  • Issues around consent
50
Q

What happened at Winterbourne View?

A

Private hospital in Gloucestershire that was abusing adults with learning disabilities, most patients being detained under the Mental Health Act

51
Q

when taking a learning disabilities history what are some things to ask about

A
  1. developmental history : birth, and have they reached developmental milestones
  2. educational : schools did they attend, did they struggle with reading or writing and did they get help
    3.FH: relationships with others - neglect abuse?
  3. Physical health - difficulties with coordination mobility, bladder or bowel incontinence
  4. behavioural difficulties - daily living understanding new information, learning skills or budgeting
    mental health - cognitive assessment
    medications

Y4 OPIC SA (14 decks)

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