Intellectual Disability II

Question 1

Why is the number of people with learning disabilities growing?

Answer 1

Growing at 1% per year = due to increased life expectancy and survival of premature babies

Question 2

What are the O’Brien principles?

Answer 2

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

Question 3

What are the aspects of learning disabilities?

Answer 3

The impairment itself, the resulting disability and the resulting social handicap

Question 4

What are the social impacts of learning disabilities?

Answer 4

Discrimination, family dysfunction, sexual abuse, different appearance, poor employment prospects, low expectation of success, stigma, poor education provisions, autism

Question 5

What are the physical implications of learning disabilities?

Answer 5

Physical disability, sensory problems and mobility issues

Question 6

What are some health problems associated with learning disabilities?

Answer 6

Mental illness, epilepsy, substance misuse, physical illness

Question 7

Why are psychiatric illnesses more common in people with learning disabilities?

Answer 7

3x more common = organic vulnerability, social deprivation, life events, psychological reasons

Question 8

How do you assess for psychiatric disease in people with learning disabilities?

Answer 8

Open questions, check accuracy, assess suggestibility

Question 9

Why is the level of detail obtained in a psychiatric assessment of a patient with learning disabilities often limited?

Answer 9

Reduced comprehension and verbal skills = observation of behaviour is more important

Question 10

How are psychotic symptoms impacted by learning disability?

Answer 10

Symptoms will reflect developmental level so may lack detail

Question 11

How do you assess learning disability?

Answer 11

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

Question 12

What are some management options for patients with learning difficulties?

Answer 12

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

Question 13

What are some behavioural interventions?

Answer 13

Teach and improve basic skills, establish normal patterns, relaxation techniques, assertiveness training

Question 14

What areas are targeted in cognitive behavioural therapy?

Answer 14

Problem solving skills, anxiety and depression

Question 15

What areas are targeted by psychodynamic therapy?

Answer 15

Relationships and adjustment to life events

Question 16

What are some cautions that should be observed when giving pharmacological therapy for learning difficulties?

Answer 16

Comorbidities = epilepsy, constipation
Atypical reactions = decreased or increased sensitivity, paradoxical reactions
Evidence base often lacking

Question 17

What are some pharmacological agents used to treat learning disability?

Answer 17

Antipsychotics = psychosis, behavioural disturbance, autism
Stimulants = ADHD
Anticonvulsants = bipolar disorder, episodic dyscontrol
Antidepressants = depression, anxiety disorders, self injury, autism

Question 18

What is the link between schizophrenia and learning disability?

Answer 18

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

Question 19

How does schizophrenia present in people with severe learning disability?

Answer 19

Unexplained aggression, bizarre behaviour, social withdrawl, mood lability, increased mannerisms or stereotypies

Question 20

What are the features of depressive disorder in people with learning disabilities?

Answer 20

3x more common
Somatisation, reduced verbal expression of unhappiness and guilt all feature
Biological symptoms = sleep, appetite, energy, concentration, anhedonia

Question 21

How common in autism in people with learning disabilities?

Answer 21

Up to 30% of LD population = 70% have IQ <70, more common in men, 70% totally dependent on support and 2% have normal life

Question 22

What symptoms make up the triad of autism?

Answer 22

Abnormal social interaction, communication impairment and rigid/restricted or repetitive behaviour and interests

Question 23

What are the basic areas that make up the basis of autism treatment?

Answer 23

Structure, routine, predictability and communication

Question 24

What are some of the treatment options for autism?

Answer 24

Communication aids, Speech and Language therapy, picture boards, social stories, PECS, educational and vocational interventions, family support

Question 25

What does behavioural interventions for autism target?

Answer 25

Social skills training and behavioural modification