Learning Disabilities Psychiatry Flashcards
What is the definition of learning disabilities?
- Condition of arrested or incomplete development of the mind
- Characterised by impairment of skills normally developed during the developmental period that contribute to overall intelligence:
1) Cognitive abilities
2) Language abilities
3) Social abilities
4) Motor abilities
What are the criteria used to establish if someone has a learning disability?
1 - Intellectual impairment (IQ<70, Wechsler)
2 - Social or adaptive dysfunction (Vineland scale), defined by having deficitis in 2 or > of the following:
- Communication
- Self-care
- Home living
- Social skills
3 - Onset in developmental period
What is the prevenlance of learning difficulties?
1-2%
What is the relationship between degree of learning difficulty and mortality?
The greater the learning disability the higher the mortality amongst the general population
If a patient with IQ<70 is able to function within their environment with no problems, would they classified as having a learning disability?
No
What are the classifications of learning disability according to IQ?
Mild LD - 50-69
Moderate LD - 35-49
Severe LD - 20-34
Profound LD - < 20
What are the common genetic conditions associated with LD’s?
- Fragile X
- PKU
- Retts syndrome
- DiGeorge syndrome
- Prader-willi
- Angelman syndrome
- Down syndrome
What infective conditions are associated with LD’s?
Ante-natal - Rubella
Post-natal - Meningitis, Encephalitis
Apart from genetic and infective causes of LD’s, what else can cause LD’s?
1 - Alcohol foetal syndrome
2 - Birth Asphyxia
3 - Head Injury
What is the most common aetiology of LD’s?
Unknown
What are the common physical conditions associated with LD’s?
1 - Epilepsy (positively correlated with severity of learning disability)
2 - Sensory impairments (hearing & vision)
3 - Obesity
4 - GI problems (swallowing problems, reflux oesophagitis, H.pylori infections, constipation)
5 - Cerebral plasy (common in severe learning disabilities)
What is the correlation between LD’s and psychiatric disorders?
1 - Higher incidence of psychiatric disorders in those with LD
2 - More severe LD’s = higher prevalence of psychiatric disorders
In what ways can the presentation of psychiatric disorders in those with LD’s differ to psychiatric patients without LD’s?
With LD’s:
- Less complex delusions (if psychotic)
- Those with lower IQ’s have difficulties in communicating their symptoms/feelings and can often present with difficult behaviour
- Observable/physical signs relied upon more (weight loss, withdrawal, agitation)
How are psychiatric patients with learning difficulties assessed?
1 - Aetiology of LD
2 - Associated biomedical conditions
3 - Severity of LD (assess by IQ score)
4 - Any psychiatric disorders (causes and consequences)
What psychiatric disorders/problems are more pevalent in those with LD’s?
1 - Schizophrenia/Psychosis (3 times more pevalent compared to general population)
2 - Mood disorders (increased incidence however less likely to report changes of mood)
3 - OCD (obsessions will be harder to describe for patient with LD)
4 - Autism (2/3rd of autistic patients have an LD)
5 - ADHD
6 - Challenging behaviour
7 - Forensic (IQ < 70 associated with arson and sexual misconduct)
