Learning disability psychiatry

Question 1

Mental disorder

Answer 1

mental illness
learning disability
personality disorder

Question 2

Learning disability

Answer 2

incomplete development of the mind, impaired skills manifested during developmental period which contribute to overall intelligence

Question 3

3 criteria for learning disability

Answer 3

intellectual impairment
social or adaptive dysfunction
onset in developmental period

Question 4

Intellectual impairment

Answer 4

IQ<70

Wechsler

Question 5

Social or adaptive dysfunction

Answer 5

vineland scale

2+: communication, adaptive skills, community use, self direction, health and safety, leisure and work, academics

Question 6

Onset in developmental period

Answer 6

age 18

Question 7

Prevalence of IQ<70 statistically

Answer 7

2.5%

Question 8

Reality of prevalence <70

Answer 8

1-2%
mortality
functioning level

Question 9

Mild learning disability IQ

Answer 9

50 to 60

Question 10

Moderate learning disability IQ

Answer 10

35 to 49

Question 11

severe learning disability IQ

Answer 11

20 to 34

Question 12

profound learning disability IQ

Answer 12

<20

Question 13

Aetiology of LD

Answer 13

genetics 
infective 
toxic 
trauma 
unknown

Question 14

Genetics LD

Answer 14

single gene eg fragile x, PKU
microdeletion eg DiGeorge syndrome, Prader-Willi
chromosomal eg downs

Question 15

Infective LD

Answer 15

ante-natal eg rubella, Zika

post-natal eg meningitis

Question 16

Toxic LD

Answer 16

fetal alcohol syndrome

Question 17

Trauma LD

Answer 17

birth asphyxia

head injury

Question 18

Physical conditions associated with LD

Answer 18

epilepsy 
sensory impairment 
obesity 
GI - H pylori, reflux
cerebral palsy 
chest infections 
osteoporosis

Question 19

Why is there LD specialist psychiatry?

Answer 19

higher incidence of psych disorders in those with LD
different presentation
challenging behaviour
observable signs

Question 20

Assessment areas of LD psychiatry

Answer 20

aetiology of LD
biomedical conditions
severity of LD
psych disorders, cause and consequences

Question 21

Schizophrenia/psychosis in LD

Answer 21

3% point prevalence
change in personality
reduction in functional abilities
“self talk”

Question 22

Moo disorders and LD

Answer 22

increased incidence

less likely to complain of changes - noted by change in behaviour

Question 23

OCD and LD

Answer 23

ritualistic, obsessional

compulsions

Question 24

Autism and LD

Answer 24

2/3 people with autism have LD

Question 25

Over-activity syndromes and LD

Answer 25

ADHD much higher incidence

overactive, distractible, impulsive but NOT to extent of ADHD diagnosis

Question 26

Challenging behaviour and self injury in LD

Answer 26

head banging and rocking

problem behaviour

Question 27

Forensic and LD

Answer 27

mild LD - same prevalence as general population but different profile of offending
IQ<70 = arson, sexual

Question 28

Health professionals need to…

Answer 28

take time and patience 
non-verbal cues 
alternative communication eg books beyond words
clear explanations 
support carers

Question 29

“Diagnostic overshadowing”

Answer 29

presenting symptoms are put down to LD

consider social cause, psychological issues, physical problems, psychiatric cause

Question 30

Social causes

Answer 30

carers
lack of support
lack of social activities

Question 31

Psychological causes

Answer 31

bereavement

abuse

Question 32

Physical causes

Answer 32

pain or discomfort eg ear infection, toothache, oesophagitis

Question 33

Psychiatric causes

Answer 33

depression
anxiety
psychosis
dementia