Learning disability psychiatry Flashcards
Mental disorder
mental illness
learning disability
personality disorder
Learning disability
incomplete development of the mind, impaired skills manifested during developmental period which contribute to overall intelligence
3 criteria for learning disability
intellectual impairment
social or adaptive dysfunction
onset in developmental period
Intellectual impairment
IQ<70
Wechsler
Social or adaptive dysfunction
vineland scale
2+: communication, adaptive skills, community use, self direction, health and safety, leisure and work, academics
Onset in developmental period
age 18
Prevalence of IQ<70 statistically
2.5%
Reality of prevalence <70
1-2%
mortality
functioning level
Mild learning disability IQ
50 to 60
Moderate learning disability IQ
35 to 49
severe learning disability IQ
20 to 34
profound learning disability IQ
<20
Aetiology of LD
genetics infective toxic trauma unknown
Genetics LD
single gene eg fragile x, PKU
microdeletion eg DiGeorge syndrome, Prader-Willi
chromosomal eg downs
Infective LD
ante-natal eg rubella, Zika
post-natal eg meningitis
Toxic LD
fetal alcohol syndrome
Trauma LD
birth asphyxia
head injury
Physical conditions associated with LD
epilepsy sensory impairment obesity GI - H pylori, reflux cerebral palsy chest infections osteoporosis
Why is there LD specialist psychiatry?
higher incidence of psych disorders in those with LD
different presentation
challenging behaviour
observable signs
Assessment areas of LD psychiatry
aetiology of LD
biomedical conditions
severity of LD
psych disorders, cause and consequences
Schizophrenia/psychosis in LD
3% point prevalence
change in personality
reduction in functional abilities
“self talk”
Moo disorders and LD
increased incidence
less likely to complain of changes - noted by change in behaviour
OCD and LD
ritualistic, obsessional
compulsions
Autism and LD
2/3 people with autism have LD
Over-activity syndromes and LD
ADHD much higher incidence
overactive, distractible, impulsive but NOT to extent of ADHD diagnosis
Challenging behaviour and self injury in LD
head banging and rocking
problem behaviour
Forensic and LD
mild LD - same prevalence as general population but different profile of offending
IQ<70 = arson, sexual
Health professionals need to…
take time and patience non-verbal cues alternative communication eg books beyond words clear explanations support carers
“Diagnostic overshadowing”
presenting symptoms are put down to LD
consider social cause, psychological issues, physical problems, psychiatric cause
Social causes
carers
lack of support
lack of social activities
Psychological causes
bereavement
abuse
Physical causes
pain or discomfort eg ear infection, toothache, oesophagitis
Psychiatric causes
depression
anxiety
psychosis
dementia
