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Psychiatry > Learning Disabilities > Flashcards

Learning Disabilities Flashcards

1
Q

what is the definition of learning disability?

A

condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills, manifested during the developmental period, which contribute to the overall level of intelligence, i.e. cognitive, language, motor, and social abilities. Refers to an outcome caused by a disparate disease process

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2
Q

what are the different types of causes of learning disability?

A

dominant conditions, recessive conditions, chromosomal, x-linked, genomic imprinting, genetic causes, prenatal factors, perinatal factors, postnatal factors

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3
Q

what are the dominant conditions that can cause learning disability?

A

neurofibromatosis and tuberose sclerosis

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4
Q

what are the recessive conditions that can cause learning disability?

A

largest group of specific genetic disorders – phenylketonuria, homocystinuria, galactosaemic

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5
Q

what are the chromosomal causes that can cause learning disability?

A

Downs syndrome, patau syndrome, Edwards syndrome, cri du chat, Angelman, prader-willi, velo-cardiofacial, Williams syndrome,
o Sex chromosomal – tuners, Klinefelter, fragile X

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6
Q

what are the x-linked causes that can cause learning disability?

A

leschynhan, retts

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7
Q

what are the genomic imprinting causes that can cause learning disability?

A

prader willi, angelmans syndrome

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8
Q

what are the pre-natal factors that can cause learning disability?

A

Maternal Infection-Rubella, CMV, Toxoplasmosis, Exposure to medication or drugs, alcohol (Foetal alcohol spectrum disorder), poor Diet, Substance abuse

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9
Q

what are the peri-natal factors that can cause learning disability?

A

Neonatal septicaemia, Pneumonia, Meningitis/encephalitis, Other problems at delivery – birth injury, Other newborn complications (respiratory distress, hyperbilirubinemia, hypoglycaemia, extreme prematurity)

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10
Q

what are the post-natal factors that can cause learning disability?

A

CNS infections, vascular accidents, tumours, hypoxic brain injury, head injury, NAI, exposure to toxic agents, psychosocial environment, infection (meningitis, encephalitis), Congenital hypothyroidism, Other disorders of unknown aetiology - Cerebral palsies, epilepsy, autistic spectrum disorders, childhood disintegrative disorders

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11
Q

what are the genetic causes that can cause learning disability?

A

phenylketonuria, mucopolysaccharidoses, neurolipidoses, tuberous sclerosis, congenital hypothyroidism, lesch nhyan

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12
Q

what is the IQ of someone with mild learning disability?

A

50-69

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13
Q

what is the IQ of someone with moderate learning disability?

A

35-49

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14
Q

what is the IQ of someone with severe learning disability?

A

20-34

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15
Q

what is the IQ of someone with profound learning disability?

A

less than 20

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16
Q

what is the mental age of someone with mild learning disability?

A

9 to under 12 years

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17
Q

what is the mental age of someone with moderate learning disability?

A

6 to under 9

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18
Q

what is the mental age of someone with severe learning disability?

A

3 to under 6

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19
Q

what is the mental age of someone with profound learning disability?

A

less than 3

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20
Q

what are the clinical features in mild learning disability?

A

Most Common, Delayed speech - able to use everyday speech, Full independence – Self care, practical & domestic skills, Difficulties in Reading and Writing, Capable of unskilled or semi-skilled work, Problems if Social or Emotional Immaturity, Rarely organic aetiology

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21
Q

what are the clinical features in moderate learning disability?

A

o Slow with Comprehension and Language, Limited Achievements, Delayed Self care and Motor Skills, Simple Practical Tasks - Often with Supervision, Usually Fully Mobile - Physically Active, Discrepant profiles, Majority Organic Aetiology, Epilepsy & Physical Disability common

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22
Q

what are the clinical features in severe learning disability?

A

o Generally more marked impairment than in moderate LD and achievements more restricted, Epilepsy

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23
Q

what are the clinical features in profound learning disability?

A

o Severe limitation in ability to understand or comply with requests or instructions, Little or no self-care., Often severe mobility restriction, Basic or simple tasks may be acquired

24
Q

what are the associated clinical features in those with learning disability?

A

o mental illness, epilepsy, discrimination, substance misuse, physical disability, sensory problems, mobility problems autistic spectrum disorder, sexual abuse, family dysfunction, different appearance, poor employment of prospects, low expectations of success, stigma, poor educational provisions, challenging behaviour

25
Q

how is learning disability diagnosed?

A

IQ standardised test

26
Q

how is learning disability diagnosed?

A
  • O-Brien Principles
  • Components – support for family at home; respite admissions, education, training and occupation, social activities, accommodation, help with financial and other problems, general medical services
27
Q

which psychiatric disorders can be dual diagnosed with learning disability?

A

psychosis, behavioural disturbance, autism, adhd, depression, anxiety disorders, self injury. Autism, Anticonvulsants - bipolar affective disorder episodic dyscontrol

28
Q

What are neurobiology factors associated with ADHD?

A

o underactive function in frontal lobe
o Frontal lobe responsible for reasoning, planning, impulse control, judgement, initiation of actions, social behaviour, long term memory

29
Q

What are neurochemistry factors associated with ADHD?

A

o excessively efficient dopamine removal system (higher concentrations of re-uptake inhibitors)
o symptoms may also be caused by the reduction of norepinephrine (can affect attention – stress hormone) and serotonin

30
Q

what are the different types of causes of ADHD?

A

genetic predisposition
perinatal precipitants
psychosocial

31
Q

what are the genetic causes of ADHD?

A

familial clustering, mainly DA and 5-HT transporter genes involved

32
Q

what are the perinatal causes of ADHD?

A

smoking and alcohol use, foetal alcohol syndrome and use of other illicit substances, significant prematurity and perinatal hypoxia, short or long labour foetal distress, low forceps delivery and eclampsia, viral infection during pregnancy

33
Q

what are the psychosocial causes of ADHD?

A

parenting styles, severe marital discord, low social class, large family size, paternal criminality, maternal mental health disorder, maltreatment, emotional trauma

34
Q

what are the clinical features of ADHD?

A

Inattention
Hyperactivity
Impulsivity

35
Q

what is the child diagnostic criteria for ADHD?

A

o 6 or more symptoms of inattentiveness; and/or
o 6 or more symptoms of hyperactivity and impulsiveness
o Present before age 5 (or 3)
o Reported by parents, school and seen in clinic
o Symptoms get in the way of daily life

36
Q

what is the adult diagnostic criteria for ADHD?

A

o 5 or more symptoms of inattentiveness; and/or
o 5 or more symptoms of hyperactivity and impulsiveness
o Historical concerns from early age

37
Q

what are the two parts of ADHD management?

A

Psychosocial interventions and pharmacological

38
Q

what are the psychosocial interventions in ADHD management?

A

parent training, social skills training, sleep and diet. behavioural classroom management strategies, specific educational interventions

39
Q

what is the 1st line pharmacological management in ADHD?

A

methylphenidate, dexamfetamine, lisexamgetamine

40
Q

what is the 2nd line pharmacological management in ADHD?

A

(SNRI) – atomoxetine

41
Q

what is the 3rd line pharmacological management in ADHD?

A

(alpha agonists) – clnidine, guanficine

42
Q

what is epidemiological factor of ASD?

A

boys:girls 5:1

43
Q

what is the neuroanatomy features of ASD?

A

o frontal lobes
o amygdala – larger (associated with more severe anxiety, worse social and communication skills
o cerebellum
o not clear

44
Q

what is the neurochemsitry features of ASD?

A

o glutamate receptors – essential excitatory neurotransmitter which dysregulated can lead to neuronal damage
o GABA – regulation of early developmental stages of cell migration, neuronal differentiation and stages of maturation (development of social pathways)
o serotonin – critical role in the regulation of crucial steps in neuronal development

45
Q

what is the cause of ASD?

A

unknown – environmental, biological and genetic factors

46
Q

what are the genetic causes of ASD?

A

hereditability, deletion, duplication and inversions are all chromosomal abnormalities involved

47
Q

what are the environmental causes of ASD?

A

teratogens in 8 weeks, alcohol, heavy metals, diets

48
Q

what are the biological causes of ASD?

A

umbilical cord complications, fetal distress, birth injury or trauma, multiple birth and maternal haemorrhage, low birth weight/small for gestational age, congenital malformation, meconium aspiration, neonatal anaemia, ABO or Rh incompatibility

49
Q

what are the additional causes of ASD?

A

rubella in the pregnant mother, Tuberous Sclerosis, Fragile X Syndrome, Encephalitis, Untreated phenylketonuria

50
Q

what is the mechanism of gender differences in ASD?

A

sex hormones play an important role in the organisation of bairn circuits during early development, receptors for sex hormones are widely distribute in the brain and influence neural signalling, some evidence with Sex Hormone Binding levels are reduced in females with Autism – pointing to higher free testosterone, males have higher inflammatory markers

51
Q

what is the diagnostic criteria of ASD?

A

o Symptoms must be present in the early developmental period
o Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning (more than one setting)
o Disturbances are not better explained by other mental health problems, learning disabilities

52
Q

what are the diagnostic symptoms of ASD?

A
  1. Social Communication & interaction deficits – social reciprocity, joint attention, non-verbal communication, social relationships
  2. Restricted or Repetitive behaviour/interests/activities - Lining up toys, flapping hands, imitating words/phrases, fixed on routines, restrictive thinking, specific knowledge
53
Q

how will a child typically present with ASD?

A

don’t babble or use other vocal sounds, can repeat words or phrases spoken by others without formulating their own language, play alone, can’t initiate or sustain friendships, don’t understand people’s emotions, don’t demonstrate imaginative play, senses can be hyperactive – flavours too strong, smells to strong, noises can be too loud or too difficult to cut out, touch painful and uncomfortable, don’t wear shoes,

54
Q

how will a adult typically present with ASD?

A

Same as children but better adjusted to social conventions

55
Q

how is ASD diagnosed?

A
  • History - developmental history, collateral history’s
  • Screening questionnaires and semi structured interviews (3di, disco)
  • Standardised assessment tools (autism diagnostic observation schedule – ados)
56
Q

how is ASD managed?

A

• Supportive - self and family psychoeducation, applied behavioural analysis, speech and language therapy, social skills training, family and school based supports, social care (adults)

57
Q

what is the medical management of ASD?

A

Medication – Risperidone, Co-morbidities – antiepileptics, antipsychotics, Oxytocin?

Psychiatry (11 decks)

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