Learing Disabilities

Question 1

what is a learning disability

Answer 1

• significantky reduced ability to undertsand new or complex info or learn new skills
  with
  -reduced ability to cope independantly (social function)
  -started before adulthood - with lasting effects on development

Question 2

NICE criteria for a learning disability

Answer 2

1. low intellect (IQ <70)
   2.significant impairment of social or adaptive functioning
   3.onset in childhood

Question 3

Mild LD

Answer 3

85% have Mild LD where they can generally read and write and be independant

Question 4

moderate LD

Answer 4

10% of Px most can read and write but require some supervision/oversight

Question 5

severe LD

Answer 5

3% of Px not able to read or write may be able to learn routines require supervision

Question 6

profound LD

Answer 6

1-2% of Px require intensive support

Question 7

how many people have LD in UK

Answer 7

1.1 million almost 1in 218 have a LD

Question 8

risk factors of LD

Answer 8

-childhood brain injury
-childhood illness
-prenatal exposrures (eg alcholol, sodium valporate)
-chromosonal/genetic anomolies
-non genetic congenital malformations
-birth complications
-extreme prematurity (<33 weeks gestation)

Question 9

approx 50% of Px suffer from co-morbidities because they find it difficult to assess health needs and/or communicate - what are some comorbidities

Answer 9

-obesity or underweight
-20x increase in risk of epilepsy
-increased rate of constipation/ dyspepsia/thyroid/ eczema/parkinsons /dysphagia
-visual/hearing impairments

Question 10

chances of mental health co-morbidities

Answer 10

Adults 40%
children 36%
22% cvhnace of dementia over 6% in general population

Question 11

Social inequlaities

Answer 11

-live in rented/overcrowded accom
-be exposed to tobbaco smoke
-be bullied and/or physically, sexually, emotionally abused
-have less social support

60% of LD children live in poverty

Question 12

why are Px with learning disabilities more likely to die 13-20yrs earlier than general population?

Answer 12

• due to co-morbidities
  -higher risk of inadequate/ innapropriate treatment

Question 13

challenging behaviour is seen in 5-15% of Px in eductaional health settings and 30-40% in hospital settings - What is it?

Answer 13

-aggression
-self-injury
-sterotypical behaviour
-withdrawal
-destructive/disruptive behaviour

Question 14

risk factors of challenging behaviour

Answer 14

• severe LD
  -autism
  -dementia
  -communication difficulties
  -visual impairment
  -age
  -living in innapropriate environment

Question 15

management of challenging behaviour

Answer 15

1st line treatment psychiatric intervention
1. assessment of Px - environmental/biologic triggers
2. prevention and overcoming triggers (eg reducing loud noise)
3.improve QoL
4. second line treatment combination therapy with medication

Question 16

conditions of using medication for challenging behaviours

Answer 16

1. psychyatric intervation alone was innafective
2. treatment of co-existing mental health issues has not reduced behaviour
   3.severe risk of harm to self and others

Question 17

What should be included in LD annual health check

Answer 17

• physical health review
  -medication review
  -agreed shared care plan for management of physical health

note - checks are not usually carried out properly and uptake rate is only around 50%

Question 18

STOMP

Answer 18

• stopping overmedicating of people with LD and/or autism
  -encourage Px to have regular checkups about psychotropic meds
  -make sure Px and fam are involved in decisions
• implement non medication therapies

Question 19

Role of a pharmacist in STOMP

Answer 19

-Active role/lead in STOMP
-review medications
-deprescribe medications not indicated or causing problems
-ensure appropriate monitoring