Common Psychiatric Conditions With Learning Disability

Question 1

ICD10

Answer 1

-mild- IQ 50-69
Delayed but norm speech, indep self care, poor aceademically, most have organic aetiology.
-mod- IQ 35-49
Delayed and deficits in speech and comprehension, lack numeracy and lit, most have organic aetiology.
-sev- IQ 20-34
Lower visuopspatial, lang and soc skills. Motor impairment and associated deficits.
-profound- IQ under 20
V lim comprehension and lang. alm always organic aetiology. Sev neuro and physical disabil affecting motil. More assoc probs eg atyp autism, PDD, epil, vis and hear impair.

Question 2

Defins

Answer 2

-impairment-
Loss or abn psycho, physio, or anat struc or func.
-disabil-
Restric or lack abil to perform an activ in the manner or within range considered norm.
-handicap-
Disadv for indiv due to impairment or disabil that lims or prevents fulfillment of a role that is normal for them.

Question 3

Aetiology

Answer 3

Genetic
CNS malformation unkn cause
Ext prenatal facs
Perinatal facs
Post natal facs
Most comm cause worldwide- malnutition.

Question 4

Mx

Answer 4

-bio-
AntiP, antiD, anticonvuls, lithium, BB, methylphenidate, opiate antag eg neltrexone, ani libidinals eg cyproterone. 
-psycho-
CBT for mild or mod
Psychodynamic
-soc-
Basic skills teaching
Behav techs

Question 5

Downs

Most comm genetic cause

Answer 5

IQ often under 50.
Short, overweight, hypotonia.
HN feats eg brachcephaly, reduc AP diam, reduc maxilla and nose bridge. Close eyes, low ears etc.
Congential heart defecs 50% eg ASD, VSD, MVD, PDA.
GI eg oes atresia, hirschprungs, hernia.
Hands- broad, single palmar crease, syn/clinodactyly.
Eyes- myopia, strabismus, nystagmus, cataracts.
Otitis media, sensorineural deafness.
High igG and M, low T cells.
Hypothyr, DM.
CNS struc abns.
Spermatogenesis and ovulation probs.
Alzheimers type dementia changes in 40s and 50s.

Question 6

Deletions and duplics

Answer 6

-prader willi- pat chrom 15 del.
Hyperphagia and comulsive food seek.
-angelman- mat chrom 15 del.
ataxia, epil, no speech, facial feats, profound LD.
-cri du chat- partial monosomy chrom 5.
Cat like cry, microcephaly, facial feats, sev/profound LD.
-digeorge- chrom 22 del.
mild or mod LD, heart abn, facial feats, hypoCa, hypospadias, long thin hands, blunt affect, schizo comm.

Question 7

Autosomal recess

Answer 7

PKU- defic phenylalanine hydroxylase.

Sev LD, fair skin and blue eyes as lack tyrosine, hyperactiv, stoopoed posture, broad gate, hypertonia/refelxia.

Question 8

X linked domin

Answer 8

Fragile X- MOST COMM INHERITED cause. triplet reps at fragile site of X chrom.
Retts (a PDD)- only females really.

Question 9

Sex chrom disorders

Answer 9

• turners- 45XO so sex chrom monosomy. Fem phenot.
• trisomy X- incr height, mild LD, reduc fert, possib more schizo.
• klinefelters- 47XXY. Reduc secondary chars and gynaecomastia. Tall.
• XYY- lower IQ, behav probs.

Question 10

Non genetic

Answer 10

• FAS- us mild LD, withdrawl at birth, microceph, facial feats, growth deficit, behav probs, sensory impair.
• iodine defic dis
• congenital hypothyr
• other toxins
• infection eg syphillis, HIV
• hypoxic dam
• CNS and skull dev abn.

Question 11

Pervasive dev disorders

Answer 11

Feat abn recip soc interac, comm and lang impair, restric interests.
ICD10- autism and atyp autism, asperger, retts, childhood disintegrative disorder, PDD NOS.

Question 12

LO
Psychiatric comorb in LD
Behav probs in LD

Answer 12

Schizo- talking to self may be part of their LD. Diffic to communicate symps. Alt behav or func. Diffic to disting own thoughts so may attrib to others.
BAD
Dep- bio feats may be reported by pt or carer, cog feats may not be reprted by pt. carers may report change behav eg irrit, aggress, self inj, reassurance seek. Diffs eg physical illn, med se, psychosis,d ementia.
AD, OCD- comorb with dep and autism. Specif fears rel to dev lev. Often undiag or put down to challenging behav.
ADHD
PD
Dementia- earlier and more, esp in downs. Specif assessment schedules avail. Need baseline cog ass. Monit skills changes. Exclude treatable causes eg thyr, B12,sensory impair, CHD, epil, dep etc.

Question 13

LO

Impact of soc, psych, and bio facs in genesis and maint of MH probs in LD pts

Answer 13

BIO:
Genetic- AD in downs, schizo in ASD and velo cardio facial synd. 
brain struc abn. 
Epilepsy. 
Abn thyr func
Sensory impair
Speech and lang diffic. 
PSYCHO:
Low intell
Poor prob solving
Low stress tol
Immat def mechs
Dysfunc coping 
Lowself esteem. 
SOCIAL:
Adverse env
Lack soc supp
Poverty
Unemploym
Dependancy on carer
Abuse vuln.

Question 14

LO

Effects and use of psychotropic meds in LD pts

Answer 14

• period of ass and obs, start low go slow, monit se, document capac to consent, DDIs with physical health drugs.
• consider monit sleep, weight, seiz, ABC etc.
• consider need referral eg comm nurse, psychologist, speech therap, autism/ADHD sepcialist.
• risk ass.

Question 15

LO

Effect of physic disorder and epil on sev LD pts

Answer 15

Bio RFs- abn thyr, other meds, sensory impair, speech and lang diffic, epil.
Comm physical disorders- hypothyr in downs, GI probs in cornelia de lange, epil in retts and angelman, CV in di george and fragile X, DM.