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Psychiatry > Intellectual Disability > Flashcards

Intellectual Disability Flashcards

1
Q

what conditions do PWLD have higher risk of getting

A 
epilepsy 
mental illness
dementia 
hypothyroidism 
diabetes 
heart failure 
CKD
stroke
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2
Q

define learning disability

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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3
Q

what is the criteria for diagnosis of a learning disability

A

IG < 70
must present <18 (developmental aetiology)
deficits in adaptive functioning

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4
Q

what is used for psychometric assessment

A

Wechsler Adult Intelligence Scale (WAIS)
In children depending on age (WISC)
WPPSI for primary and preschool children

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5
Q

what percent of population have an IQ < 70

A

3%

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6
Q

what is the average IQ

A

100

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7
Q

what is the difference between learning difficulties and disabilities

A

disability= affects overall IQ, affects all aspects of life ans caring for you self

difficulty= a specific problem e.g. dyslexia, dyscalculia, dyspraxia

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8
Q

what is the flynn effect

A

each generation smarter than the one before- slowing down in developed countries

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9
Q

what is not a learning disability

A

dyslexia/ other learning difficulties
not something that happens to an adult (brain injury/ dementia)
cognitive decline due to chronic psychosis

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10
Q

what are the IQ parameters for severities of LD

A

Mild LD IQ 50-69

Moderate LD IQ 35-49

Severe LD IQ 20-34

Profound LD IQ < 20

Borderline LD IQ 70+

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11
Q

what is the presentation of borderline LDs

A

IQ range 70-84, mental age 12 to under 15 years.
Not a category in DC-LD, ICD-10 or DSM-IV.
Usually able to read

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12
Q

what is the presentation of mild LDs

A

IQ range 50-69, mental age 9 to under 12 years.
Most Common
Delayed speech - able to use everyday speech
Full independence – Self care, practical & domestic skills
Difficulties in Reading and Writing
Capable of unskilled or semi-skilled work
Problems if Social or Emotional Immaturity
Rarely organic aetiology

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13
Q

what is the presentation of a moderate LD

A

I.Q. range 35-49, mental age 6 to under 9 years.
Slow with Comprehension and Language
Limited Achievements
Delayed Self care and Motor Skills
Simple Practical Tasks - Often with Supervision
Usually Fully Mobile - Physically Active
Discrepant profiles
Majority Organic Aetiology
Epilepsy & Physical Disability common

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14
Q

what is the presentation of a severe LD

A

IQ range 20-34, mental age 3 to under 6 years.
Generally more marked impairment than in moderate LD and achievements more restricted.
Epilepsy

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15
Q

what is the presentation of a profound LD

A

IQ less than 20 (difficult to measure), mental age less than 3 years.
Severe limitation in ability to understand or comply with requests or instructions.
Little or no self-care.
Often severe mobility restriction.
Basic or simple tasks may be acquired.

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16
Q

give three examples of trisomy conditions that can cause LDs

A

downs- 21
patau syndrome- 13
edwards syndrome- 18

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17
Q

what are the features of cri du chat 5p

A

microcephlay severe/profound LD

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18
Q

what are the features of angleman 15Q

A

(maternally derived) LD, ataxia, paroxysms of laughter

19
Q

what are the features of prader willi 15Q

A

(paternally derived) LD, over eating, self injurious behaviour

20
Q

what are the features of velo-cardiofacial syndrome 22Q

A

50% have LD, increased risk of schizophrenia

21
Q

what genetic abnormalities arising from the sex chromosomes can cause LDs

A 
tuners  45, XO
trisomy X, 47 XXX
klinefelter, XXY
XYY male (IQ lower than normal) 
fragile X, FMR1 gene, trisomy repeat
22
Q

what defects of protein, carbohydrate, lipid metabolism can cause severe LD

A

Tuberous Sclerosis
Congenital Hypothyroidism
Lesch Nyhan Syndrome (X Linked)

23
Q

what are the prenatal causes of a LD

A

Maternal Infection-Rubella, CMV, Toxoplasmosis
Exposure to medication or drugs
alcohol (Foetal alcohol spectrum disorder – mild LD, association with ADHD )
Poor Diet, Substance abuse

24
Q

what are the perinatal causes of LDs

A

Neonatal septicaemia
Pneumonia
Meningitis/encephalitis
Other problems at delivery – birth injury
Other newborn complications (respiratory distress, hyperbilirubinaemia, hypoglycaemia, extreme prematurity)

25
Q

what are the post natal causes of LDs

A

CNS infections, vascular accidents, tumours, hypoxic brain injury, head injury, NAI, exposure to toxic agents, psychosocial environment
Congenital hypothyroidism – now screened for neonatally, if untreated leads to mental and growth retardation.
Other disorders of unknown aetiology
Cerebral palsies, epilepsy, autistic spectrum disorders, childhood disintegrative disorders.

26
Q

what are the infant. childhood causes of LDs

A

NAI, trauma, infections, toxins

27
Q

what are the different terms for a learning disability

A

Mental Retardation - ICD10/DSMIV

Mental Handicap - Legislation

Intellectual Disability

Intellectual Developmental Disorder DSMV/ICD11

28
Q

what are the obrien principles

A

Learning disabled people will continue to grow and develop given an appropriate environment
Learning disabled people are worthy of all the dignity and rights of any citizen
Concept of learning through risk taking and the avoidance of over-protection
The availability of everyday, normal conditions of life
The availability of generic environments and services

29
Q

what are the social impacts of LDs

A 
discrimination 
family dysfunction 
sexual abuse
different appearance
poor employment 
stigma 
poor educational provisions 
autistic spectrum disorder
30
Q

what are the physical implications of LDs

A

physical disability
sensory problems
mobility problems

31
Q

what are the associated health problems with LDs

A

mental illness
epilepsy
substance misuse
physical illness

32
Q

what puts someone at risk of a LD

A

Organic vulnerability – ‘brain damage’

Social deprivation/disadvantage

Life events

Psychological reasons – learned helplessness

33
Q

why are other conditions underdiagnosed in people with LDs

A

Intellect
trouble labelling emotions and experiences

Diagnostic overshadowing-
Symptoms attributed to LD

Compliance
“Talked out of” symptoms

Eager to please

34
Q

how do you assess LDs

A 
Nature and severity of LD
Current problem, Hx of
Predisposing, precipitating and perpetuating factors
Full History – Family Hx
Full physical exam
Mental state exam
Environmental and social factors
Support network
Reliance on informants
35
Q

what is the management for LDs

A 
Therapeutic environment
General support (eg school), Specific support (eg psychiatric problems)
Education
Patient, Carers
Social
Unmet needs, Support network
Communication
Hearing aids, glasses, Pictorial, Makaton
Behavioural
Cognitive
Pharmacological
Physical interventions
Headgear
Isolation
Admission
Respite
Specialist unit
36
Q

what are the possible psychological therapies for LDs

A 
behavioural (basic skills, normal patterns, relaxation, assertiveness training) 
CBT (problem sloving, anxiety, depression, offending behaviour)
psychodynamic therapy (relationships, adjustments)
37
Q

what are the possible pharmalogical treatments for LDs

A 
Antipsychotics
Psychosis
Behavioural disturbance
Autism
ADHD
Antidepressants
Depression
Anxiety disorders
Self injury
Autism

Anticonvulsants
Bipolar affective disorder
Episodic dyscontrol

38
Q

how might schizophrenia present in LDs

A

3 times more common
Age of onset earlier (mean 23)
Negative symptoms more common
Main presenting symptom may be behaviour change
Severe LD
Unexplained aggression, bizarre behaviour, social withdrawal, mood lability, increased mannerisms or stereotypies
Significant proportion undiagnosed

39
Q

how might depression present in LDs

A

Three times as common
Somatisation ++
Reduced verbal expression of unhappiness, guilt…
Biological symptoms – sleep, appetite, energy, concentration, anhedonia

40
Q

what are the cautions of pharmacological treatments in LDs

A 
Comorbid physical disorders
Epilepsy
Constipation
Atypical responses
Decreased or increased sensitivity
Paradoxical reactions
Evidence base often lacking
41
Q

what is the triad of symptoms of ASD

A

Abnormal social interaction
Communication impairment
Rigid/restricted or repetitive behaviour, interests and activities

42
Q

is ASD a learning disability

A

no develomental disorder

43
Q

what is the management for ASD

A

STRUCTURE, ROUTINE, PREDICTABILITY, COMMUNICATION

Communication aids and Speech and Language Therapy
Picture boards, Social stories
Educational and vocational interventions
Mainstream vs specialist
Behavioural interventions
Behaviour modification, Social skills training
Family intervention
Education, Support, Advocacy

Psychiatry (27 decks)

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