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Psychiatry > Intellectual disability | > Flashcards

Intellectual disability | Flashcards

1
Q

What is the definition of intellectual disability (3)?

A
  1. Significantly sub-average intellectual functioning: An IQ below 70 on an individually administered IQ test
  2. Deficits or impairments in adaptive behaviour, taking into account the person’s age.
  3. Onset of intellectual impairment before the age of 18 years
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2
Q

In ICD-10, what are the 4 categories of severity of intellectual disability?

A
  1. Mild
  2. Moderate
  3. Severe
  4. Profound
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3
Q

For Mild ID, what is the IQ score, prevalence and general functioning?

A

IQ score: 50-69

Prevalence: 1.5-3% (account about 85% of all IDs)

  • Often not recognised as learning disabled. Only need help if problems arise
  • Often can sustain relationships, and hold a routine job
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4
Q

For Moderate ID, what is the IQ score, prevalence and general functioning?

A

IQ score 35-49

Prevalence: 0.5% (with severe LD)

  • Often capable of substantial autonomy in daily living with some supervision
  • Normally able to communicate adequately, to do simple household jobs
  • May need a supervised environment and work in a sheltered workshop
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5
Q

For Severe ID, what is the IQ score, prevalence and general functioning?

A

IQ score 20-34

Prevalence: 0.5% (with moderate LD)

  • Need help with daily living, though can be able to wash and usually continent; often physically disabled
  • Capable of only limited communication often not by speech
  • Usually need continuous care
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6
Q

For Profound ID, what is the IQ score, prevalence and general functioning?

A

IQ score below 20

Prevalence: 0.05%

  • Usually need extensive or total help with daily living
  • Minimal ability of communication
  • Needs continuous care
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7
Q

What is ID associated with (risk factors)?

A
  1. Males
  2. Higher in the lower social classes
  3. Association with overcrowding , poverty, irregular unskilled employment
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8
Q

What is the aetiology of ID?

A
  1. 30% with no identifiable cause
  2. Polygenic inheritance of low intelligence
  3. Social and educational deprivation (environment)
  4. Other aetiological factors:
    - Genetic/chromosomal
    - Pre-natal
    - Perinatal
    - Post-natal
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9
Q

What are some examples of chromosomal/genetic syndromes causing ID?

(nice to know)

A
  1. Down’s syndrome
  2. Fragile X syndrome
  3. Cri du chat syndrome
    etc
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10
Q

What are some examples of pre-natal causes of ID?

nice to know

A
  1. Foetal alcohol syndrome
  2. Pre-eclampsia
  3. Infections such as rubella, toxoplasmosis, CMV and syphilis
  4. Placental insufficiency
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11
Q

What are some examples of peri-natal causes of ID?

nice to know

A
  1. Intraventricular haemorrhage
  2. Hyperbilirubinaemia
  3. Birth trauma and hypoxia
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12
Q

What are some examples of post-natal causes of ID?

nice to know

A
  1. Head injury
  2. Brain infection
  3. Childhood brain tumour
  4. Neglect and abuse
  5. Malnutrition
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13
Q

In the management of ID, what are the professionals involved in the MDT?

A
  1. Psychiatrists and Psychologists
  2. Community Nurses
  3. Speech and Language Therapists
  4. Social Workers
  5. Occupational Therapists
  6. Physiotherapists
  7. Music therapist
  8. Support Staff
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14
Q

What are the different accommodation types available for people with ID?

A
  1. Living alone or with family
  2. Adult family placements
  3. Fostering
  4. Short-term care
  5. Lodgings
  6. Group homes
  7. Staffed homes
  8. Hospitals
  9. Security provision
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15
Q

What are some day services available for people with ID?

A
  1. Day centres
  2. Day hospitals
  3. Colleges
  4. Leisure and recreation
  5. Work
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16
Q

Risk assessment is important in ID, what are the possible risks you should assess for depending on level of ID (5)?

A
  1. Suicide
  2. Self-harm
  3. Damage to property
  4. Harm towards others
  5. Unsupervised exit, harm from others
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17
Q

What is the concept of risk assessment and management plan (RAAMP)?

A
  1. Collecting evidence
  2. Identifying triggers and context
  3. Plan the consequences
  4. Develop strategies to minimise risky behaviour
18
Q

What can the family response to ID be?

A

Affects the whole family.

Some emotions they can feel are:

  1. Shock
  2. Denial
  3. Grief
  4. Overprotection/rejection
  5. Guilt -> isolation/chronic sorrow
  6. Anger -> at relative/professionals -> disharmony/scapegoating
  7. Bargaining -> late rejection
  8. Acceptance -> Infantilsation
  9. Ego-centred work -> over-identification
19
Q

What % of people with autisim have intellectual disabilities?

A

66%

20
Q

What are the 3 classical impairments in autism?

A
  1. Social interaction
  2. Communication
  3. Imagination/repetition/routines
21
Q

What are some possible presentations of autism?

A
  1. Aloof
  2. Repetitive movements
  3. Little /no interaction with mother
  4. Do not bring toys to show to mother
  5. Do not run to greet parents
  6. Do not follow mother around the house
  7. Little eye contact
  8. Speech :
    - 49 % no speech
    - Exact repetition
    - Pronoun reversal
    - Difficulty with abstraction
    - Poor non-verbal communication
  9. No imaginative play
  10. Carry same object around
  11. Can be agile, but clumsy at copying movements
  12. Cannot understand the world: temper tantrums
22
Q

What is Asperger syndrome?

A

A mild form of autism, they do not have ID, fewer problems with speech but have difficulties with social skills

23
Q

What are some behaviours of Asperger’s sydrome?

A
  1. Good speech, but long winded and literal
  2. Long monologues, regardless of response
  3. Monotonous
  4. Good memories, but not interested in wider applications
  5. Lack of common sense in social interactions
  6. Physically clumsy
  7. Intelligence - variable but usually at least average, but sometimes highly intelligent
  8. Obsessive - collecting, knowing everything about a certain topic
24
Q

What are some basic principles of the management of autism (8)?

A
  1. Sufficient personal space is important for individuals with autism
  2. Quiet location - they can engage in their respective behaviour
  3. Each day to be organised and explained
  4. Planned space for their rituals
  5. Content of activities must not be beyond their capabilities
  6. Organised physical activities can reduce challenging behaviour
  7. Treatment of epilepsy and other physical problems
  8. Obsessions: behavioural approach
25
Q

What are 2 behavioural approaches in the management of ASD?

A
  1. Graded changes

2. Setting limits

26
Q

What are the aims of graded changes and how does it work?

A
  1. To deal with obsessions
  2. Aim to reduce frequency gradually - e.g. remove an item at a time in the case of obsessive collection of items
  3. Positive Reinforcers (e.g. reward)
    - Immediate
    - Appropriate
    - Consistent
    - Paired with attention and praise
    - Every time (at least initially)
27
Q

What are the aims of setting limits and how does it work?

A
  1. Mainly for challenging behaviours - some behaviour might need to be interrupted
  2. First to gain attention of individual
  3. Warn before interruption
  4. Any destructive behaviour should be interrupted quickly
  5. Avoid ‘No’ : use positive direction
  6. Use short and concrete explanation
  7. Allow tantrum to run itself out
28
Q

What is the role of education in ASD?

A
  1. Can provide a framework for order, routines and structure
  2. Understanding is difficult - try physical prompting and visual demonstration
  3. Teaching material has to be precise and specific
  4. Help to develop any skills
29
Q

What is the role of medication in ASD?

A

Not very useful. Excitability may be reduced by antipsychotics

30
Q

How can parents of children with ASD be helped?

A

Counselling important

31
Q

What is the prognosis of ASD (5)?

A
  1. Life-long disorder
  2. Normal life expectancy
  3. Some improvement with age
  4. Does not develop into schizophrenia
  5. Better prognosis if early speech and higher intelligence
32
Q

What is the risk of mental illness in ID compared to the gen pop?

A

3x higher

Individuals with ID may present differently as well.

33
Q

What are things you need to look for to identify depression in someone with ID (5)?

A
  1. Look for any family history of depression
  2. Observed behaviour - e.g.
    - Diurnal mood or activity variation
    - Agitation may lead to wandering
    - Loss of appetite
    - Sleep disturbance
    - Speech or motor retardation
  3. Observed anxiety
  4. Exaggeration of a need for sameness
  5. Depressive ideas and suicidal ideas rare and poorly planned
34
Q

What are things you need to look for to identify mania/bipolar in someone with ID (5)?

A
  1. Family history of bipolar disorder (may help to distinguish from schizophrenia)
  2. Challenging behaviour
  3. Giggling
  4. Overactivity and excitement
  5. Inappropriate masturbation or exposure (disinhibition)
  6. Delusions are not as elaborate
35
Q

What are things you need to look for to identify schizophrenia in someone with ID (9)?

A
  1. Difficult to diagnose below IQ of 45
  2. Commoner with more severe intellectual disability
  3. Poverty of thought
  4. Delusions: less elaborated
  5. Hallucinations: simpler and repetitive, may respond to unseen stimuli
  6. Distinguish negative symptoms from developmental history (deterioration from the previous level of functioning)
  7. Persecutory delusions and thought disorder less common
  8. Earlier age of onset
  9. Can present with :
    - fear
    - withdrawal
    - challenging behaviour (in particular out of character)
    - sleep disturbances
36
Q

What are some causes of challenging behaviour in ID (4)?

A
  1. Social / environmental factor (e.g. new environment, new carer)
  2. Mental illness
  3. Side effects of medication
  4. Physical illness - e.g.
    - Ear infections
    - Dental problems
    - Urinary tract infections
    - Respiratory infections
    - Thyroid problems
37
Q

What are the issues with capacity in people with ID (3)?

A
  1. ID may affect individuals capacity in decision making
  2. The principles of assessing capacity in intellectual disability are the same as listed in the Mental Capacity Act
  3. Depending on the level of intellectual disability, you may need to consider providing information to individuals according to their intellectual level, e.g. using pictures
38
Q

What is the prevalence of epilepsy in ID?

A

More likely in severe intellectual disability

School children: 0.6 %
Mild ID: 3 - 6 %
At least moderate ID: 44 % had epilepsy by age 22

39
Q

What is the ratio of epilepsy in people with ID in M:F?

A

4:1

40
Q

What are the issues of epilepsy in ID (9)?

A
  1. Fit frequency and psychotropic medications - psychiatric medications may affect the seizure threshold
  2. Compliance can be an issue
  3. Inadequate control of fits - leading to polypharmacy
  4. Recording of fits may be difficult
  5. Need to assess side effects of medication
  6. Recognition of non-epileptic attacks
  7. Frequent attacks may cause over-protection by carers / parents
  8. Education of patient and carer is important - e.g. Emergency treatment of prolonged fits
  9. Social implications

Psychiatry (16 decks)

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