Intellectual Disability Psychiatry Flashcards
1
Q
Define disability
1.
A
- Significant impairment of intelligence (IQ 70 or less, bottom 2.5%)
- Significant impairment of adaptive functioning - activities of daily living (eg washing, dressing, finances, cooking)
- Both these impairments evident before adulthood (18 years, brain is mature)
2
Q
Intellectual disability vs learning disability
A
Same thing
Intellectual is more medical language wise
3
Q
Learning disability acquired during adulthood is called:
A
Acquired brain injury
Eg could be RTA, meningitis
4
Q
What is NOT intellectual disability?
A
- Isolated with specific skills eg reading - learning difficulty
- Emotional/behavioural problems that may have disrupted schooling and had an impact on achievement later in life
- ADHD or autism
- Head injury/cognitive decline in adult life
Autism is more common in people with ID but it does not count as ID
5
Q
Epidemiology/associations of of ID
A
- Neurological disorders eg cerebral palsy, epilepsy
- Visual and auditory impairments
- More males
- Ill mental health
- Reduced life expectancy (22 years for men)
6
Q
Causes of ID
A
- Pre-natal - eg genetic (down syndrome), drugs/alcohol, cerebral palsy, malnutrition, diseases from mother
- Perinatal - premature birth, asphyxia, intrauterine infection eg toxoplasmosis
- Post-natal - meningitis, head injury, measles, non-accidental injury
7
Q
Phenotype for people with down syndrome
A
- Broad flat face
- Slanting eyes
- Epicanthal eyefold
- Short nose
- Short and broad hands
- Big toes widely spaced
8
Q
What is Down Syndrome associated with?
A
- Depression
- Early onset dementia
- Hypothyroidism
9
Q
Fragile X syndrome
FINISH
A
- Trinucleotide repeat disorder (CGG)
- Most common cause of inherited LD
- Physical features - high forehead, large ears, long face, prominent jaw, large testes
- Connective tissue weakness
- Hyperextensible joints
- Striae on skin
- Psychiatric- social anxiety, aggression, hyperactivity, ADHD, self injury
10
Q
Levels of ID
A
- ICD-10 (international classification of disease) has guide to assessing degree of intellectual disability
- Mild 69-50
- Moderate 49-35
- Severe - 34 or less
11
Q
Mild LD
A
- Delayed but everyday speech normal
- Good non-verbal communication
- Normal continence
- May live independently
- Able to read, write and do simple maths
- Can describe feelings/emotions but may need help
12
Q
Moderate LD
A
- Unlikely to be living independently - need some supervision with ADLS
- Language is delayed but use simple phrases
- Fully mobile but maybe delayed
- Increased risk of neurological disorders esp epilepsy
- Mainly continent
- Some describe basic emotions - happy/sad
13
Q
Severe LD
A
- Severe delay lamnguage. few words or absent speech
- Need supervision 24hrs
- Mainly incontinent
- Autism common
- Neurological and sensory deficits common
- MSK abnormalities - mobility limited
- Cannot describe feelings
14
Q
History for ID
A
- HPC
- Psychiatric/ID history
- PMH, FH, DH
- Developmental history
- Social history
- Risk assess
15
Q
MSE components
A
- Appearance and behaviour
- Speech
- Mood
- Thoughts
- Pereceptual disturbances
- Cognition
- Insight
- Risk assessment
16
Q
MDT for ID
A
- Community learning disability nurses
- SALT
- Occupational therapists
- PT
- Clinical psychologist
- Care managers/carers
- Teachers
17
Q
Adaptations for LD appointments
A
- Allocate more time
- Talk to informants
- Reduce stress - see at home, avoid long waits
- If communcation is difficult get help
18
Q
What is diagnostic overshadowing?
A
- Missing the underlying condition due to everything being pinned on intellectual disability
19
Q
Treatments for people with LD - generic principles
A
- MCA
- May need extra support - accessible information
- Low and slow with medications
20
Q
Wing and Goulds triad - autism
A
Triad of impairemnts
* Social spectum - aloof –> sociable with one person
* Communication spectrum - none –> unusual/metaphorical
* Restricted activities/imagination spectrum - handles objects for sensation –> associated with rigid, repetitive behaviour
21
Q
Sensory sensitivities autism
A
- Hyper/hyposensitivity
- Can be to pain, sound, touch
- Sound most common
- Sensory block/tune out with humming for example
22
Q
What are challenging behaviours?
A
- Culturally abnormal behaviour
- Intensity, frequency or duration means that physical safety of the person or others is jeopardized
- Or will mean that the person could be denied access to ordinary community facilities
23
Q
Examples of challenging behaviours
A
- Aggressive
- self injury
- Destructive
- Loud
- Inappropriate sexual behaviour
- Spitting/smearing
- Sexist, racist or other upsetting
24
Q
Common health problems of those with disability
A
- Constipation
- Dental problems
- Epilepsy
- GORD
- Infections - ear, URTI
- Mobility problems
- Obesity
- Swallowing problems
25
When do we use an INCA - independent capacity advocate?
* When someone lacks the ability to make a decision for themselves
* If important decision
* Unpaid person to advocate for best interests - outside NHS
26
Aids for patients with LD having surgery
* Put first on the list
* Use visual aids/books beyond words
* Drawings
* Carer support/family
* Choose quiet environment
27
How to know preferred method of communication in LD?
Using communication passports - created by SALT
28
Issues in communication in patients with LD
* Mask comprehension difficulties
* Difficulty understanding medico-legal terms
* Say yes to appease
* Hallucinations and can respond
* Sensory issues
29
Distraction techniques if you notice someone is distressed
* short break
* Eat/drink
* Favourite book/object
* Offer reassurance
* One person leads
30
Mental health in autism
Anxiety is core feature
challenging behaviours are often due to anxiety
31
Management of ASD
* Social and educational input
* Communication support
* Need structure - eg day planner
32
How common is challenging behaviour in ID?
Quite common - 15%
33
Inv and exam for challenging behaviour
* MSE
* Physical exam - hearing/eye checks?
* Observe
* SALT, psychology, OT assess
* Consider capacity and consent
34
History PC for challenging behaviour
ODPARA
* What is behaviour?
* How has it changed?
* When, where, who what?
35
Psychiatric medication and challenging behaviours?
* Other interventions - try first
* Only use if risk warrants it
* Monitor - stop if not working
* Use lowest dose
* eg risperidone, olanzapine
36
