Learning Disability Psychiatry Flashcards
define learning disability
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.
list the criteria that must be met to be diagnosed with a learning disability
• 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)
what is the actual (not statistic) prevalence of people with a learning disability?
1-2%
why is there a discrepancy between statistic and actual prevalence of learning disability?
differential mortality - more severe LD earlier death
IQ classification of learning disability
Mild - 50-69
moderate 35-49
severe 20-34
profound < 20
groups of aetiological factors that may result in LD
genetic
infective
toxic
trauma
genetic causes of LD
single gene: fragile X, PKU, Retts syndrome
microdeletion/duplication: digeorge syndrome, Prader-Willi, Angelman syndrome
Chromosomal abnormality: Down syndrome
infective causes of LD
ante-natal e.g. rubella
post-natal e.g. meningitis, encephalitis
toxic causes of LD
foetal alcohol syndrome
trauma causes of LD
birth asphyxia
head injury
what is the most common cause of LD?
Unknown
groups of common physical conditions associated with LD
epilepsy sensory impairments obesity GI Resp Cerebral palsy orthopaedic dematological Dental
compared to normal individuals how is epilepsy different in those with LD
increased incidence and severity
what kind of sensory impairment may those with LD suffer from?
hearing 40%
vision20%
earwax
what kind of gastrointestinal problems may those with LD suffer from?
swallowing
reflux oesophagitis
helicobacter pylori
constipation
what kind of respiratory problems may those with LD suffer from?
chest infections
aspiration pneumonia
what kind of orthopaedic problems may those with LD suffer from?
joint contractures
osteoporosis
what is the incidence of unhealthy gums in the normal population and Down’s syndrome?
33% normal
80% downs
why is there a need for psychiatry in those with LD?
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.
what mental health problems may those with LD suffer from?
Schizophrenia/psychosis Mood disorders OCD Autism Over-activity syndromes Challenging behaviour and self-injury Forensics
discuss schizophrenia/psychosis in those with LD
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
discuss mood disorders in those with LD
increased incidence
less likely to complain of mood changes and noted by change in behaviour i.e. biological symptoms
discuss OCD in those with LD
ritualistic behaviour and obsessional themes significantly increased in LD
obsessions hard to describe by people with LD ut compulsions more readily observed
what proportion of people with autism have a LD?
2/3
discuss overactivity syndromes in those with LD
ADHD much higher incidence
many severe LD children are overactive, distractible and impulsive but not to extent of ADHD diagnosis
discuss challenging behaviour and self-injury in those with LD
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)
discuss forensics in those with LD
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
