intellectual disability Flashcards

1
Q

ICD 10 definition of intellectual disability

A

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

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2
Q

intellectual disability criteria

A
  1. intellectual impairment (IQ <70) e.g. Wechsler adult intelligence scale
  2. social or adaptive dysfunction (vineland adaptive behaviour scale)
    - deficits/impairments in ≥2 of following adaptive skills: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure and work
  3. onset in the developmental period (<18y/o)
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3
Q

prevalence of learning disabilities

A

statistically the prevalence of people w/ IQ<70 should be 2.5% but in practice is 1-2%:

  • differential mortality (more severe degree of intellectual disability –> higher mortality compared to general pop)
  • role of functioning (those w/ IQ <70 but have no problems functioning wouldn’t be defined as having a learning disability)
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4
Q

how do we classify the severity of learning disabilities

A

both intellectual and adaptive functioning is used to classify severity of LD

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5
Q

different severities of LD

A

mild LD - IQ 50-69 or functional age 9-12y/o
moderate LD - IQ 35-49 or functional age 6-9y/o
severe LD - IQ 20-35 or functional age 3-6y/o
profound LD - IQ <20 or functional age 3y/o

severe and profound LD are mainly based on clinical judgement rather than IQ

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6
Q

why do we not use the term mental age in describing people with learning disabilities

A

unhelpful term

treat the patients as adults

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7
Q

risk protection in intellectual disabilities

A

someone w/ a mild learning disability might be able to live independently to some extent but there would be concerns about their ability to recognise risk and safely manage difficult situations

there may be difficulty recognising social risks and dangers re. exploitation

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8
Q

verbal communication in moderate learning difficulties

A

some people w/ moderate LD have relatively good expressive verbal communication although their receptive may be more impaired

this can lead to difficulties w/ people appearing to understand more than they can and becoming distressed as a result of not understanding some of the things happening around them

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9
Q

what are the main causes of intellectual disability

A

inherited

acquired

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10
Q

inherited causes of LD

A

single gene: fragile X, PKU, Retts syndrome

microdeletion/duplication: DiGeorge syndrome, Prader-Willi, Angelman syndrome

chromosomal abnormality: Down’s syndrome

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11
Q

acquired causes of LD

A

infective: e.g. rubella, zika virus
traumatic: hypoxic injury during birth, head injury during childhood
toxic: foetal alcohol syndrome, sodium valproate use during pregnancy etc
idiopathic: for most pts the cause is unknown - ~70% of cases

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12
Q

health inequalities in people w/ LD

A

significant problem and recognised to lead to early death

social exclusion
socioeconomic deprivation 
inaccessible services
discrimination
challenges to communication
lack of appropriate knowledge and skills of professionals
minimal evidence base from research
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13
Q

common and/or important physical conditions associated w/ LD

A

epilepsy

sensory impairments

obesity

GI problems

resp problems

cerebral palsy

orthopaedic problems

dermatological and dental problems

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14
Q

epilepsy and LD

A

increased incidence and complexity w/ severity of LD (10-50%)

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15
Q

sensory impairments and LD

A

hearing 40%
vision 20%
earwax

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16
Q

obesity and LD

A

predisposes to other health problems

17
Q

GI problems and LD

A

swallowing problems

reflux oesophagitis

Helicobacter pylori

constipation

18
Q

resp problems and LD

A

chest infections

aspiration pneumonia

19
Q

cerebral palsy and LD

A

esp w/ severe LD

20
Q

orthopaedic problems and LD

A

joint contractures

osteoporosis

21
Q

dermatological and dental problems w/ LD

A

33% unhealthy gums

80%

22
Q

why is there a psychiatric speciality for those w/ LD

A

higher incidence of psychiatric disorders in those w/ LD

more severe LD - higher prevalence of psychiatric disorder

people w/ mild LD may present in broadly similar way to general pop

presentation of mental illness different, esp in mod-profound LD

difficulties in describing internal world, less complex delusions

baseline presentation is different

those w/ lower IQ/comms difficulties often present w/ challenging behaviour

where there is less verbal communication, observable signs are relied on more in making the diagnosis e.g. weight loss, withdrawal, agitation, tearfulness, behavioural disturbance

special training and MDT working

23
Q

assessment areas in psychiatry of LD

A
presence and severity of LD
aetiology incl. genetics
associated biomedical conditions 
psycho-social assessment 
psychiatric disorders, their cause and consequences
24
Q

schizophrenia/psychosis in LD

A

3% point prevalence compared to 1% general pop

associated w/ change in personality and reduction in functional abilities - people w/ LD often struggle to describe some of the more complex symptoms; -ve symptoms have a significant impact

‘self-talk’ common in LD - can be mistaken for psychosis

25
Q

mood disorders in LD

A

increased incidence

less likely to complain of mood changes and noted by change in behaviour e.g. biological symptoms - early morning waking, appetite and weight change

26
Q

anxiety disorders in LD

A

common

ritualistic behaviour and obsessional themes significantly increased in LD

obsessions hard to describe by people w/ LD but compulsions more readily observed

27
Q

what % of people w/ autism have a LD

A

50%

28
Q

over-activity syndromes in LD

A

ADHD much higher incidence
many severe LD children are overactive. distractible and impulsive but NOT to the extent that would indicate ADHD diagnosis (it is developmentally appropriate given their level of intellectual impairment)

29
Q

challenging behaviour and self-injury in LD

A

wide range of behaviours - socially constructed rather than diagnostic term e.g. aggression towards others and self-injury, destruction of property, wandering, oppositional behaviour, sexually inappropriate behaviour, pica etc

frequent end point for wide range of conditions

general trend is towards greater prevalence of problem behaviour w/ increasing severity of LD (BUT people w/ profound LD exhibit less outwardly)

usually a result of stress/distress

30
Q

forensic problems and LD

A

mild LD have similar rates of offending to the general pop but different profile of offending

IQ <70 over-represented for arson and sexual (usually exhibitionism) in prison pop

often inappropriate for people w/ LD to be managed in prison setting - diverted into mental health services

31
Q

what is diagnostic overshadowing

A

presenting symptoms are put down to the LD rather than seeking another, potentially treatable cause

often when someone is seen w/ challenging behaviour

32
Q

diagnostic overshadowing - causes of changes in behaviour

A

social - change in carers, lack of support, lack of social activities

psychological - bereavement, abuse

physical - pain/discomfort, e.g. ear infection, toothache, constipation, reflux oesophagitis, deteriorations in vision/hearing

psychiatric - depression, anxiety, psychosis, dementia

33
Q

what can health professionals do to prevent diagnostic overshadowing

A

take time and be patient

value what is being communicated

recognise non-verbal cues

find out about the person’s alternative communication strategies if verbal is difficult e.g. typical non-verbal cues, symbols, sign language

explain things clearly in an appropriate way (verbal, pictures); simple, jargon free language

be prepared to meet the person several times to build up rapport and trust

use the knowledge and support of carers

34
Q

orthopaedic problems and LD

A

joint contractures

osteoporosis