Deck 12 Flashcards
What is the Stanford-Binet Scale (1905) of intelligence?
o Developed by Binet and modified at Stanford University
o Compared 1000s of children to produce age level norms of intelligence o Still used, especially in the USA
How is IQ calculated?
IQ = mental age / chronological age x 100
What is the Weschler Adult Intelligence Scale?
o Most commonly used scale today
o David Wechsler felt that S-B was inappropriate for adults as it relied too much on
language ability
o Includes verbal and performance subscales
How does IQ affect intelligence?
What is the medical model of disability?
Impariment - an abnormality of a structure or function (e.g. an abnormality of the ear)
Disability - the functional consequence of impairment (e.g. inability to hear certain sounds).
Handicab - the social consequence of impairment (e.g. isolation, loss of job due to communication difficulties).
What is the social model of disability?
Disability seen as a function of society.
What are broadly the main causes of learning disabilities?
Pre/Peri/Postnatal:
Trauma
Toxin
Tumour
Genetic (Chromosomal or Gene)
Metabolic
Infection
Give an example of infectious cause of learning disability.
50% of individuals with tuberous sclerosis also have LD. Tuberous sclerosis is an autosomal dominant disorder. 80% are new mutations, affecting one of two genes that contribute to the production of tuberin. Tuberin is responsible for halting the growth of tumours. Causes growth of hamartomas across the body – affecting brain, skin, kidneys and heart. Also associated with epilepsy and autism.
Give an example of a genetic cause of disability.
An example of a genetic cause would be Down’s syndrome. 95% is caused by trisomy of chromosome 21. 15% of sufferers develop hypothyroidism, and 50% have cardiac defects. Leukaemia affects 1%. People with DS are living longer, with 45% over 45 likely to develop Alzheimer’s Dementia. A feature of Alzheimer’s is cerebral atrophy.
Give an example of metabolic cause of learning disability.
A metabolic cause of learning disability would be Phenylketonuria (PKU), which affects 1/10000 births. It is caused by an autosomal recessive gene. PKU is the absence of phenylalanine hydroxylase. Build up of phenylalanine (an amino acid) causes microcephaly, epilepsy, over activity, autism, albinism and a musty odour (due to the ketones produced). People with PKU can’t produce tyrosine – an amino acid involved in melanin production. For this reason they are blue eyed and fair skinned. Babies are tested for PKU by analysing the levels of phenylalanine in a blood sample from their foot. This is referred to as the Guthrie test.
Infection in the developing foetus (TOxoplamosis, Rubella, Cytomegalovirus, Herpes TORCH)
Exmplain changes in morbidity/mortality of those with learning disabilities.
Significant physical health needs – 74% needed specialist care (Beange et al)
Life expectancy markedly reduced – directly proportional to level of disability
Death by Indifference
Significant increase in mental disorder compared to general population
Some of the deaths are by indifference: neglect; discrimination; delayed diagnosis and treatment; lack of reasonable adjustment; capacity decisions.
Do not let the developmental condition overshadow what could be a diagnosable condition.
Services Available
• Equal access to Health services o GP
o General Hospital
o Liaison nurse
o Community LD team o Inpatient services
Independent organisations such as Wilf Ward Family Trust and Mencap
Advocacy
Respite
What is the process of producing stigma?
- Labelling – Distinguishing and labelling human difference
- Stereotyping – Differences are linked to characteristics which form a stereotype, resulting in the development of cultural images that characterise a group (BBC)
- Othering – Using labels to separate oneself from social groups
- Stigmatisation – Devaluing people based on an attribute or behaviour which is considered
different or undesirable
- Discrimination – Acting differently towards people based on a characteristic or behaviour,
can be individual, institutional or structural.
What is Stigma in terms of ‘our social bodies’
- The construction of bodily based difference is based upon visibility
- Bodies considered inferior become a spectacle of otherness. They are highly visible e.g a person in a wheelchair, face with a scar…
- ‘Normality’ is invisible as unmarked bodies are sheltered within the neutral space of normality
What is Behaviour in terms of Stigma?
Behaviour may be seen as ‘different’ or inappropriate based on the social context
- We learn what is ‘normal’ behaviour
- Observing deviant behaviour helps us to behave ‘normally’
- Goffman (1963) showed that inmates in asylums had nuanced ways of behaving ‘normally’= (ie ‘mad’) in the context of life in the total institution
What are the types of stigma?
-
Discreditable Stigma – keeping stigmatised conditions hidden except to close friends, family etc. For example, HIV/AIDS.
Discrediting Stigma – When a stigmatising condition cannot be hidden, e.g. wheelchair users, asperger syndrome, tourettes.
- Felt Stigma – a sense of fear and shame due to ones condition (e.g. Albinos in Africa)
- Enacted Stigma – discrimination by others (e.g. removing schizophrenic from a bus)
- Courtesy Stigma – stigma felt by someone who is with a person open to stigma, e.g. carer or parent of someone with Alzheimer’s.
What is the problem with internalising?
Internalising is absorbing the social views of being lower status and the impact on personal beliefs and behaviours.
How do you manage a spoiled identify?
Managing a Spoiled Identity:
Stigma is a process, not a static category. Those who feel subject of stigma have to chose, to ‘display’ or not, to ‘tell’ or not, to ‘let on’ or not, to ‘lie’ or not. To disclose information about stigma is to disclose a potentially damaging part of one’s identity. This may lead to discrimination. Not disclosing may involve ‘covering’, e.g. a blind person wearing glasses, or a smoker masking the smell of smoke with perfume.
Passing – Passing oneself off without acknowledging symptoms. Can still experience felt stigma, feel inferior as hiding a discreditable part of their character from the world outside. May involve high psychological cost – e.g. stress of hiding real you, risk of being found out
Covering – involves not disclosing, for example wearing cream to hide eczema. Condition is acknowledged and a solution is sought, unlike in passing.
Withdrawal – Process of socially acknowledging a symptom but withdrawing from generally expected social interactions and relationships into a social world where others have similar or related symptoms
Resisting
Stigma can provoke change, e.g. black liberation, gay movement, feminism etc. Stigma is applied by the more powerful to the less powerful
What are the implications of stigma in medicine?
Fear of stigma may act as barrier to seeking medical advice
Concern about confidentiality - patient records - especially in some professions e.g.
medicine, aviation …
To diagnose defines a need for treatment
In some cultures stigma attached to HIV contributes to lack of medical care
In some cultures stigma associated is strongly with mental health and sexual health
Role of doctor in public health education
Summarise Stigma.
Stigma is a social process
Stigma must be seen in context - place, time, culture and so forth
Medical science may generate classifications and declassification that contribute to stigma
Stigma may be shaped around bodily or/and behavioural differences
Stigma a label that may be internalised
Stigma may be resisted - justifications - covering …
Emergence of new forms of stigma eg obesity, poverty?
In terms of motivational interviewing, how would you help someone to detoxify from alcohol?
For people who typically drink over 15 units of alcohol per day, and/or who score 20 or more on the AUDIT, an assessment should be offered for delivery of a community-based assisted withdrawal. If there are safety concerns (see below) offer inpatient withdrawal.
Inpatient care is recommended for:
Patients at risk of suicide.
Those without social support.
Patients who have a history of severe withdrawal reactions.
Community detoxification requires:
Daily supervision to detect complications early, eg DTs, continuous vomiting, deterioration in mental state.
Multivitamin preparations to prevent Wernicke’s encephalopathy.
Benzodiazepines to prevent withdrawal symptoms (usually chlordiazepoxide).
Continuing support - primary healthcare team, community alcohol team, residential
rehabilitation programmes, voluntary organisations, referral to the specialist mental health team, disulfiram.
Following detox, abstinence is recommended with clear alcohol dependence and/or marked physical damage or controlled drinking ineffective. It is best practised long-term, but some patients may return to controlled drinking after a period of abstinence.
What medications are available to help people detoxify from alcohol, as reccomended by NICE?
1) Acamprosate - The mechanism of action of acamprosate in maintenance of alcohol abstinence is not completely understood. Chronic alcohol exposure is hypothesized to alter the normal balance between neuronal excitation and inhibition. in vitro and in vivo studies in animals have provided evidence to suggest acamprosate may interact with glutamate and GABA neurotransmitter systems centrally, and has led to the hypothesis that acamprosate restores this balance. It seems to inhibit NMDA receptors while activating GABA receptors.
2) Disulfiram – Irreversible inhibitor of acetaldehyde dehydrogenase, resulting in build up of acetaldehyde in the blood and unpleasant symptoms, encouraging abstinence.
3) Naltrexone – Opiate receptor antagonist. Naltrexone competitively binds to such receptors and may block the effects of endogenous opioids. This leads to the antagonization of most of the subjective and objective effects of opiates, including respiratory depression, miosis, euphoria, and drug craving.
What is motivational interviewing?
MI is a particular kind of conversation about change (counseling, therapy, consultation, method of communication)
MI is collaborative (person-centered, partnership, honors autonomy, not expert-recipient)
MI is evocative, seeks to call forth the person’s own motivation and commitment
Cognitive deficits might make it more difficult for people to plan ahead or consider the consequences of their actions. A lowered tolerance of frustration can lead to anger management problems - and thus greater discrimination by other people.
Adults with mild intellectual disability (ID) experience stressful social interactions and often utilize maladaptive coping strategies to manage these interactions. There are two coping strategies they use, what are they?
Active coping (i.e., efforts to gain control over a stressful situation or over one’s emotions) was negatively related to psychological distress and there was a trend suggesting that
Avoidant coping (i.e., efforts to avoid or disengage from a stressful situation or one’s emotions) is a maladaptive coping strategy that is positively related to symptoms of depression and anxiety.
People with LD are reported to utilise more avoidant mechanisms than active, particularly in situations where someone has mistreated them or is upset with them. More coping efforts aimed at suppressing, denying, and avoiding stressful events and thoughts about the event.
What types of active coping are there?
Problem-Focused coping, which involves attempts to alter the stressful situation itself
Emotion-Focused coping, which involves efforts to alter negative affect surrounding the stressful situation
Support-Seeking coping, is defined as the involvement of other people as resources to seeking solutions to a stressful situation or to listen to and provide understanding for emotions surrounding the stressor
Whattypes are there of Avoidant coping?
- Behavioral Avoidance coping (i.e., staying away from the stressful situation) involves attempts to physically avoid stressful situations
- Cognitive Avoidance coping (i.e., wishing the stressful situation did not happen or repressing thoughts about it) involves attempts to ignore or avoid thinking of the stressor
What types of stigma may exist on people with learning disabilities?
Discreditable Stigma – keeping stigmatised conditions hidden except to close friends, family etc. For example, HIV/AIDS.
Discrediting Stigma – When a stigmatising condition cannot be hidden, e.g. wheelchair users, asperger syndrome, tourettes.
Felt Stigma – a sense of fear and shame due to ones condition (e.g. Albinos in Africa)
Enacted Stigma – discrimination by others (e.g. removing schizophrenic from a bus)
Courtesy Stigma – stigma felt by someone who is with a person open to stigma, e.g. carer or
parent of someone with Alzheimer’s.
Stigma is a process, not a static category. Those who feel subject of stigma have to chose, to ‘display’ or not, to ‘tell’ or not, to ‘let on’ or not, to ‘lie’ or not. To disclose information about stigma is to disclose a potentially damaging part of one’s identity. This may lead to discrimination. Not disclosing may involve ‘covering’, e.g. a blind person wearing glasses, or a smoker masking the smell of smoke with perfume.
How do you manage a spoiled identity?
Passing – Passing oneself off without acknowledging symptoms. Can still experience felt stigma, feel inferior as hiding a discreditable part of their character from the world outside. May involve high psychological cost – e.g. stress of hiding real you, risk of being found out
Covering – involves not disclosing, for example wearing cream to hide eczema. Condition is acknowledged and a solution is sought, unlike in passing.
Withdrawal – Process of socially acknowledging a symptom but withdrawing from generally expected social interactions and relationships into a social world where others have similar or related symptoms
Resisting - Stigma can provoke change, e.g. black liberation, gay movement, feminism etc. Stigma is applied by
the more powerful to the less powerful.
What are the implications of stigma for Medicine?
Fear of stigma may act as barrier to seeking medical advice
Concern about confidentiality - patient records - especially in some professions e.g.
medicine, aviation …
To diagnose defines a need for treatment
In some cultures stigma attached to HIV contributes to lack of medical care
In some cultures stigma associated is strongly with mental health and sexual health
Role of doctor in public health
