Learning Disability Psychiatry

Question 1

What is a learning disability?

Answer 1

A condition of arrested or incomplete development of the mind which is characterised by impairment of skills manifested during the development period, contributing to the overall level of intelligence. E.g. cognitive, language, motor and social abilities.

Question 2

What is the criteria for learning disability?

Answer 2

-Intellectual impairment (IQ <70)
- Social or adaptive dysfunction:
deficits I 2 or more of the following; communication, self-care, home living, social skills, community use, self direction, health and safety, functional academic, leisure, work.
- Onset in developmental period (<18)

Question 3

How is the level of learning difficulty classified?

Answer 3

IQ
Mild = 50 to 69
Moderate = 35 to 49
Severe = 20 to 34
Profound = <20

Question 4

What are the causes of learning difficulties?

Answer 4

Genetic - single gene (fragile X, PKU, Retts syndrome)

• Microdeletion/duplication (DiGeorge syndorme, Prader-Willi, angelman syndrome)
• Chromosomal abnormality

Infective - antenatal e.g. rubella
- postnatal e.g. meningitis encephalitis

Toxic - foetal alcohol syndrome
Trauma - birth asphyxia, head injury.

Idiopathic

Question 5

What are some common conditions that are associated with learning difficulties?

Answer 5

Epilepsy
Sensory impairments
Obesity
Gastrointestinal - dysphagia, reflux oesophagitis, helicobacter pylori, constipation.
Respiratory - chest infections, aspiration pneumonia
Cerebral palsy
Orthopaedic problems - joint contractors, osteoporosis.
Dermatological and dental - unhealthy gums

Question 6

How does Schizophrenia and Psychosis present in LD?

Answer 6

3% prevalence compared to 1% general pop.
Associated change in personality and reduction in functional abilities.
Self-talk common in LD

Question 7

How do mood disorders present in LD?

Answer 7

Increased incidence

Less likely to complain of mood changes and noted by change in behaviour.

Question 8

How does OCD present in LD?

Answer 8

Ritualistic behaviour and obsessionally increased in LD.

Obsessions are hard to describe by people with lD but compulsions are more readily observed.

Question 9

How do overactivity syndromes present in LD?

Answer 9

ADHD much higher incidence in LD.

Many severe LD children are overactive, distractible and impulsive but do not have ADHD.

Question 10

How do challenging behaviour and self injury present in LD?

Answer 10

Mannerisms, head banging and rocking common in severe LD.

General trend is towards greater prevalence of problem with behaviour when increasing severity of LD.