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OPIC > Intellectual Disability Psychiatry > Flashcards

Intellectual Disability Psychiatry Flashcards

1
Q

Define disability

1.

A
  1. Significant impairment of intelligence (IQ 70 or less, bottom 2.5%)
  2. Significant impairment of adaptive functioning - activities of daily living (eg washing, dressing, finances, cooking)
  3. Both these impairments evident before adulthood (18 years, brain is mature)
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2
Q

Intellectual disability vs learning disability

A

Same thing
Intellectual is more medical language wise

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3
Q

Learning disability acquired during adulthood is called:

A

Acquired brain injury
Eg could be RTA, meningitis

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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

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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)
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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
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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
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8
Q

What is Down Syndrome associated with?

A
  • Depression
  • Early onset dementia
  • Hypothyroidism
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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
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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
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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
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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
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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
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14
Q

History for ID

A
  • HPC
  • Psychiatric/ID history
  • PMH, FH, DH
  • Developmental history
  • Social history
  • Risk assess
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15
Q

MSE components

A
  • Appearance and behaviour
  • Speech
  • Mood
  • Thoughts
  • Pereceptual disturbances
  • Cognition
  • Insight
  • Risk assessment
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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
Q

When do we use an INCA - independent capacity advocate?

A
  • When someone lacks the ability to make a decision for themselves
  • If important decision
  • Unpaid person to advocate for best interests - outside NHS
26
Q

Aids for patients with LD having surgery

A
  • Put first on the list
  • Use visual aids/books beyond words
  • Drawings
  • Carer support/family
  • Choose quiet environment
27
Q

How to know preferred method of communication in LD?

A

Using communication passports - created by SALT

28
Q

Issues in communication in patients with LD

A
  • Mask comprehension difficulties
  • Difficulty understanding medico-legal terms
  • Say yes to appease
  • Hallucinations and can respond
  • Sensory issues
29
Q

Distraction techniques if you notice someone is distressed

A
  • short break
  • Eat/drink
  • Favourite book/object
  • Offer reassurance
  • One person leads
30
Q

Mental health in autism

A

Anxiety is core feature
challenging behaviours are often due to anxiety

31
Q

Management of ASD

A
  • Social and educational input
  • Communication support
  • Need structure - eg day planner
32
Q

How common is challenging behaviour in ID?

A

Quite common

33
Q

Inv and exam for challenging behaviour

A
  • MSE
  • Physical exam - hearing/eye checks?
  • Observe
  • SALT, psychology, OT assess
  • Consider capacity and consent
34
Q

History PC for challenging behaviour

A

ODPARA
* What is behaviour?
* How has it changed?
* When, where, who what?

35
Q

Psychiatric medication and challenging behaviours?

A
  • Other interventions - try first
  • Only use if risk warrants it
  • Monitor - stop if not working
  • Use lowest dose
  • eg risperidone, olanzapine
36
Q
A

OPIC (17 decks)

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