Learning Disability Psychiatry

Question 1

define learning disability

Answer 1

A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities.

Question 2

list the criteria that must be met to be diagnosed with a learning disability

Answer 2

•	Intellectual impairment (IQ < 70)
•	Social or adaptive dysfunction
o	Deficits/impairments in 2 or more of the following adaptive skills: 
	Communication
	Self-care
	Home living
	Social skills
	Community use
	Self-direction
	Health and safety
	Functional academics
	Leisure and work
•	Onset in the development period (age 18)

Question 3

what is the actual (not statistic) prevalence of people with a learning disability?

Answer 3

1-2%

Question 4

why is there a discrepancy between statistic and actual prevalence of learning disability?

Answer 4

differential mortality - more severe LD earlier death

Question 5

IQ classification of learning disability

Answer 5

Mild - 50-69
moderate 35-49
severe 20-34
profound < 20

Question 6

groups of aetiological factors that may result in LD

Answer 6

genetic
infective
toxic
trauma

Question 7

genetic causes of LD

Answer 7

single gene: fragile X, PKU, Retts syndrome
microdeletion/duplication: digeorge syndrome, Prader-Willi, Angelman syndrome
Chromosomal abnormality: Down syndrome

Question 8

infective causes of LD

Answer 8

ante-natal e.g. rubella

post-natal e.g. meningitis, encephalitis

Question 9

toxic causes of LD

Answer 9

foetal alcohol syndrome

Question 10

trauma causes of LD

Answer 10

birth asphyxia

head injury

Question 11

what is the most common cause of LD?

Answer 11

Unknown

Question 12

groups of common physical conditions associated with LD

Answer 12

epilepsy
sensory impairments
obesity
GI
Resp
Cerebral palsy
orthopaedic
dematological
Dental

Question 13

compared to normal individuals how is epilepsy different in those with LD

Answer 13

increased incidence and severity

Question 14

what kind of sensory impairment may those with LD suffer from?

Answer 14

hearing 40%
vision20%
earwax

Question 15

what kind of gastrointestinal problems may those with LD suffer from?

Answer 15

swallowing
reflux oesophagitis
helicobacter pylori
constipation

Question 16

what kind of respiratory problems may those with LD suffer from?

Answer 16

chest infections

aspiration pneumonia

Question 17

what kind of orthopaedic problems may those with LD suffer from?

Answer 17

joint contractures

osteoporosis

Question 18

what is the incidence of unhealthy gums in the normal population and Down’s syndrome?

Answer 18

33% normal

80% downs

Question 19

why is there a need for psychiatry in those with LD?

Answer 19

There is a higher incidence of psychiatric disorders in those with LD. More severe the LD the higher prevalence of psychiatric disorder. People with mild learning disability may present in a broadly similar way to the general population. Presentation of mental illness is different especially in moderate-profound LD. “Difficulties in describing internal world” e.g. fewer complex delusions. Those with lower IQ/communication difficulties often present with “challenging behaviour”. It is important to establish a baseline for the patient. Where there is less verbal communication, observable signs are relied on more in making the diagnosis e.g. weight loss, withdrawal, agitation, tearfulness in depression and behavioural disturbance in psychotic disorder. These is special training for psychiatrists specialising in LD. It is multidisciplinary working.

Question 20

what mental health problems may those with LD suffer from?

Answer 20

Schizophrenia/psychosis
Mood disorders
OCD
Autism
Over-activity syndromes
Challenging behaviour and self-injury
Forensics

Question 21

discuss schizophrenia/psychosis in those with LD

Answer 21

o 3% point prevalence compared to 1%in the general population
o Associated with change in personality and reduction in functional abilities
o Self-talk common in LD, particularly Down’s Syndrome

Question 22

discuss mood disorders in those with LD

Answer 22

increased incidence

less likely to complain of mood changes and noted by change in behaviour i.e. biological symptoms

Question 23

discuss OCD in those with LD

Answer 23

ritualistic behaviour and obsessional themes significantly increased in LD
obsessions hard to describe by people with LD ut compulsions more readily observed

Question 24

what proportion of people with autism have a LD?

Answer 24

2/3

Question 25

discuss overactivity syndromes in those with LD

Answer 25

ADHD much higher incidence

many severe LD children are overactive, distractible and impulsive but not to extent of ADHD diagnosis

Question 26

discuss challenging behaviour and self-injury in those with LD

Answer 26

o Mannerisms, head banging and rocking common with severe LD
o General trend is towards greater prevalence of problem behaviour with increasing severity of LD (but people with profound LD exhibit less outwardly)

Question 27

discuss forensics in those with LD

Answer 27

o Mild LD have similar rates of offending to the general population but different profile of offending
o IQ below 70 over represented for arson and sexual (usually exhibitionism) in prison population