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Psychiatry > Learning Disability > Flashcards

Learning Disability Flashcards

1
Q

What is learning disability?

A

A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of sills, manifested during the developmental period, which contribute to the overall level of intelligence

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2
Q

What is the LD criteria?

A

IQ <70
Developmental aetiology <18yo
Deficits in adaptive functioning

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3
Q

What is the commonly used psychometric assessment?

A

Wechsler Adult Intelligence Scale (WAIS)`

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4
Q

How is LD diagnosed?

A

Clinical Findings
Adaptive Behaviour
Psychometric Assessment

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5
Q

What is the average IQ?

A

100

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6
Q

What is the prevalence of an IQ < 70 in gen. population?

A

About 3%

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7
Q

What is the Flynn effect?

A

Average rate of increase in IQ seems to be about 3 points per decade in US
About 10 points per generation
Also increases in attention and semantic and episodic memory

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8
Q

What are the causes of the Flynn effect?

A

Schooling- less evidence for tests, but regular attendance causes higher score
Test familiarity- internet, MENSA
Stimulation- Baby Einstein, Sesame Street, different intelligence
Nutrition- height increase, iodine deficiency-iodised salt
Infections- Metabolically demanding to fight off infections in the developmental period

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9
Q

How could you tell if someone has a learning disability?

A

May be apparent: genetic testing, dysmorphic features
Information from self/carers
History of special schooling
Behaviour/communication

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10
Q

What is the scale of LD severity?

A 
Mild: 50-69
Moderate: 35-49
Severe: 20-34
Profound: <20
Borderline: 70+
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11
Q

How does Mild LD present?

A 
IQ 50-59
Mental age 9 to under 12yo
Most common
Delated speech-able to use everyday speech
Full independence
Reading/writing difficulties
Unskilled/semi skilled work
Problems if social or emotional immaturity
Rarely organic aetiology
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12
Q

How does Moderate LD present?

A 
I.Q. range 35-49
Mental age 6 to under 9 years
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 &amp; Physical Disability common
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13
Q

How does Severe LD present?

A

IQ 20-34
Mental age 3 to under 6yo
More marked impairment than in moderate LD, and achievements more restricted
Epilepsy

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14
Q

How does Profound LD present?

A 
IQ <20
Mental age <3yo
Severe limitation to understand or comply with requests or instructions
Little or no self care
Often severe mobility restriction
Basic or simple tasks may be acquired
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15
Q

Prior to conception, what is the aetiology of LD?

A

Genetics

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16
Q

At conception, what is the cause of LD?

A

Chromosomal

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17
Q

During the antenatal period, what are the causes of LD?

A

Maternal infections
Poor diet
Substance abuse

18
Q

At birth, what are the causes of LD?

A

Extreme prematurity
Birth injury
Cerebral anoxia

19
Q

During the postnatal period, what are the causes for LD?

A

Metabolic causes
Hypoglycaemia
High bilirubin

20
Q

During infancy/childhood, what are the causes for LD?

A

Infections
NAI
Trauma
Toxins

21
Q

What chromosomal abnormality causes Patau syndrome?

A

Trisomy 13

22
Q

What chromosomal abnormality causes Edwards syndrome?

A

Trisomy 18

23
Q

What chromosomal abnormality causes Turners?

A

45, XO

24
Q

What chromosomal abnormality causes Klinefelters?

A

XXY

25
Q

What gene causes Fragile X?

A

Faulty FMR1 gene

26
Q

What maternal infections cause cause LD?

A

Rubella
CMV
Toxoplasmosis

27
Q

What % of mild LD cases may be causes by Foetal alcohol spectrum disorder?

A

10-20%

association with ADHD

28
Q

What perinatal factors can cause LD?

A

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

29
Q

What postnatal factors can cause LD?

A

CNS infections, vascular accidents, tumours, hypoxic brain injury, head injury, NAI, exposure to toxic agents, psychosocial environment
Congenital hypothyroidism – now screened for neonatally, if untreated leads to mental and growth retardation.
Other disorders of unknown aetiology
Cerebral palsies, epilepsy, autistic spectrum disorders, childhood disintegrative disorders.

30
Q

What are some associated features of LD?

A 
Mental Illness
Epilepsy
Discrimination 
Substance Misuse
Physical Disability
Sensory problems
Mobility problems Autistic Spectrum Disorder
Sexual Abuse
Family Dysfunction
Different Appearance
Poor employment prospects
Low expectation of success
Stigma
Poor educational provisions
31
Q

How many times more common is a psychiatric disorder in someone with LD?

A

3x

32
Q

Why is mental disorder more common in people with LD?

A

Organic vulnerability-brain damage
Social deprivation/disadvantage
Life events
Psychological reasons- learned helplessness

33
Q

What is important to note regarding psychotic symptoms in LD patients?

A

Psychotic symptoms reflect developmental level- may lack in detail

34
Q

What is important to note regarding paranoid ideas in LD patients?

A

May be reality based- misinterpretation of a situation

35
Q

How should comorbidities be managed generally in patients with LD?

A

Therapeutic environment- general support, specific support (psychiatric problems)
Education
Social needs
Communication- hearing aids, glasses, pictorial, Makaton

36
Q

What behavioural treatment can be used in LD?

A

Teach/improve basic skills
Establish normal patterns
Relaxation techniques
Assertiveness training

37
Q

What CBT can be used in LD?

A

Problem solving skills
Anxiety and depression
Offending behaviour

38
Q

What psychodynamic therapy can be used in LD?

A

Relationships

Adjustment to life events

39
Q

What cautions are involved in pharmacological treatment of LD patients?

A

Comorbid physical disorders-epilepsy, constipation
Atypical responses- decreased or increased sensitivity, paradoxical reactions
Evidence base often lacking

40
Q

What is different in Schizophrenia in LD patients?

A 
3x more common
Age of onset earlier (mean 23)
-ve symptoms more common
Main PC may be behaviour change
Severe LD
41
Q

What is different in Depression in LD patients?

A

3x more common
Somatisation ++
Reduced verbal expression of unhappiness, guilt
Biological symptoms- sleep, appetite, energy, concentration, anhedonia

Psychiatry (29 decks)

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