Learning disability

Question 1

define learning disability

Answer 1

IQ SCORE <70
Sig reduction in ability to understand/learn new things, to cope socially independently. Normally started before adulthood.

Question 2

Prevalence in uk for LD

Answer 2

1.5M people in uk have a learning disability

Question 3

How to access LD?

Answer 3

• Measure intelligence quotient (IQ)

- Wecshler adult intelligence scale (WAIS-IV)

Question 4

Explain how does WAIS-IV work?

Answer 4

Score on each subtest, compare with average score within person’s age group. Similar subtests grouped together to form ‘indexes’ e.g. VCI verbal comprehension indexes, PRI perceptual reasoning indexes, WMI working memory indexes, PSI processing speed indexes
All 10 subtests indexes together to form full scale IQ

Question 5

what is the historical prob with treating LD

Answer 5

use anti-psychotics to treat challenging symp
long hosp stay pt subject to drug trails
Meds that we use to try help is causing more prob s/e than we are solving

Question 6

legislation and guidance relevant to LD

Answer 6

Mental Capacity Act (2005)- to consent interventions
Healthcare for All (2008)- Michael’s report highlighting increased morbidity rate in people with LD- separate avoidable (insufficient screening, HCPs lack of knowledge) and unavoidable LD 
“Nothing about us without us”
LeDer Programme (2015)- invest death due to LD (premature dealth)

Question 7

Describe the recent LD service development, and the relevant reports helps with this development

Answer 7

Group homes- be a part of the community
Supported living
Individualised care
Modern day scandals – cornwall report 2007, winterbourne view 2012. People were treated inhumanly!!
Disability hate crime- crime that preceived to be committed due to hostility against person’s disability

Question 8

Drugs that are used today to manage challenging behaviour:

what are the s/e

Answer 8

behaviour: 
Risperidone-TA
Haloperidol-TA
Mitrazepine-antidepressant- wt gain 
Sertraline - SSRI
Citalopram -SSRI
Aripiprazole-AA

Weight gain
Tremor
Drowsiness
Behavioural disturbances 
Nausea/vomiting

Question 9

Drugs that are used today to manage epilepsy:

Answer 9

Epilepsy:
Lacosimide- new - VnaC blocker 
Rufidimide- new
Keppra - levetiracetam
Briviact - brivaracetam
Zonisimide - VnaC blocker
Perampanel – AMPA blocker
Epilim –MR sodium valpoate 
Lamotrigine – VnaC blocker
Midazolam – GABAa agonist

Headache
Behavioural disturbances
Tremor
Nausea/vomiting
Weight gain

Question 10

Vulnerabilities in Adults with Learning Disabilities

Answer 10

Higher prevalence of co-morbidity
Mental health, Physical health
Communication
Compliance - check understanding, consent

Question 11

Positive developments in service provision

Answer 11

• Hospital Passports
• LD liaison nurses in hospital prescribing
• STOMP- health campaign to stop over-use of psychotropic medication
• annual health checks
• mental capacity act

Question 12

what is the key thing in adapting psychological approaches, working with people with LD

Answer 12

The relationship with therapist is key

Question 13

Mindfulness is …

Answer 13

…Paying attention in a particular way, on purpose, in the present moment and non-judgementally

Question 14

mindfulness groups in BANES

Answer 14

• run 6 groups
• 5 attendants each group
• focus on mindfulness skills