Intellectual Disability II Flashcards
Why is the number of people with learning disabilities growing?
Growing at 1% per year = due to increased life expectancy and survival of premature babies
What are the O’Brien principles?
LD people continue to grow and develop given appropriate environment
LD people are worthy of all the dignity and rights of any person
Concept of learning through risk taking and the avoidance of overprotection
Availability of everyday normal living conditions and generic environments and services
What are the aspects of learning disabilities?
The impairment itself, the resulting disability and the resulting social handicap
What are the social impacts of learning disabilities?
Discrimination, family dysfunction, sexual abuse, different appearance, poor employment prospects, low expectation of success, stigma, poor education provisions, autism
What are the physical implications of learning disabilities?
Physical disability, sensory problems and mobility issues
What are some health problems associated with learning disabilities?
Mental illness, epilepsy, substance misuse, physical illness
Why are psychiatric illnesses more common in people with learning disabilities?
3x more common = organic vulnerability, social deprivation, life events, psychological reasons
How do you assess for psychiatric disease in people with learning disabilities?
Open questions, check accuracy, assess suggestibility
Why is the level of detail obtained in a psychiatric assessment of a patient with learning disabilities often limited?
Reduced comprehension and verbal skills = observation of behaviour is more important
How are psychotic symptoms impacted by learning disability?
Symptoms will reflect developmental level so may lack detail
How do you assess learning disability?
Nature and severity of LD
Current problem and its history
Full physical exam and mental exam
Predisposing, precipitating and perpetuating factors
Environmental and social factors, plus support network
What are some management options for patients with learning difficulties?
Therapeutic environment = general (e.g school) or specific (e.g psychiatric)
Psychoeducation, behavioural, cognitive + medication
Social = unmet needs, support network
Physical interventions = headgear, isolation
Admission = respite, specialist unit
What are some behavioural interventions?
Teach and improve basic skills, establish normal patterns, relaxation techniques, assertiveness training
What areas are targeted in cognitive behavioural therapy?
Problem solving skills, anxiety and depression
What areas are targeted by psychodynamic therapy?
Relationships and adjustment to life events
What are some cautions that should be observed when giving pharmacological therapy for learning difficulties?
Comorbidities = epilepsy, constipation
Atypical reactions = decreased or increased sensitivity, paradoxical reactions
Evidence base often lacking
What are some pharmacological agents used to treat learning disability?
Antipsychotics = psychosis, behavioural disturbance, autism Stimulants = ADHD Anticonvulsants = bipolar disorder, episodic dyscontrol Antidepressants = depression, anxiety disorders, self injury, autism
What is the link between schizophrenia and learning disability?
3x more common in people with LD = age of onset is earlier (mean is age 23), negative symptoms more common, main symptom may be behaviour change
How does schizophrenia present in people with severe learning disability?
Unexplained aggression, bizarre behaviour, social withdrawl, mood lability, increased mannerisms or stereotypies
What are the features of depressive disorder in people with learning disabilities?
3x more common
Somatisation, reduced verbal expression of unhappiness and guilt all feature
Biological symptoms = sleep, appetite, energy, concentration, anhedonia
How common in autism in people with learning disabilities?
Up to 30% of LD population = 70% have IQ <70, more common in men, 70% totally dependent on support and 2% have normal life
What symptoms make up the triad of autism?
Abnormal social interaction, communication impairment and rigid/restricted or repetitive behaviour and interests
What are the basic areas that make up the basis of autism treatment?
Structure, routine, predictability and communication
What are some of the treatment options for autism?
Communication aids, Speech and Language therapy, picture boards, social stories, PECS, educational and vocational interventions, family support
What does behavioural interventions for autism target?
Social skills training and behavioural modification
