Lecture 12 - Clinical Aspects of Intellectual Disability Flashcards
What is intellectual disability?
Neurodevelopmental disorder that begins in childhood and is characterised by limitations in both intelligence and adaptive skills.
What is used to define and determine the severity of ID?
Adaptive skills - conceptual, social and practical.
IQ less than or equal to 70.
What are the causes of ID?
Genetic - > 50%, could be mitochondrial disorders, Down syndrome.
Environmental - perinatal causes such as alcohol/drug abuse, infection. Postnatal causes such as trauma infection.
What is the LeDeR?
Learning disabilities mortality review.
Created in response to the confidential enquiry to the premature deaths of people with learning disabilities. People with LD had a life expectancy of 19.7 years lower than general pop.
People with LD died from an avoidable cause of death twice as frequently as general pop.
A third of deaths of LD were from treatable medical causes, compared to 8% general pop.
What IQs are for mild ID, moderate ID, severe ID, profound ID?
Mild = IQ 50-70
Moderate = 35-50
Severe = 20-35
Profound = <20
Describe autism.
Lifelong disability affecting how people communicate and interact with the world.
7000 adults and children on the spectrum.
Changes can be stressful.
Sensory overload > meltdowns.
Increased risk for mental health problems.
Describe problems with social communication in autism.
Difficulties interpreting verbal and non-verbal language like gestures.
Taking things literally and not understanding abstract concepts.
Needing extra time to process information and answer questions.
Repeating what others say to them.
Describe problems with social interaction in autism.
Difficulty ‘reading’ others and expressing their own emotions making it hard to navigate the social world so autistic people may:
-appear to be insensitive
-seek out time alone when overloaded
-not seek comfort from others
-appear to behave strangely or socially inappropriate
-find it hard to make friends
What is sensory sensitivity?
Autistic people may suffer with over or under sensitivity to sounds, touch, tastes, smell, light colours, temperatures or pain.
What is the testing criteria for epilepsy.
Unexplained epilepsy with clinical suspicion of a monogenic cause including onset under 2 years or clinical features suggestive of specific genetic epilepsy or additional clinical features such as ID, autism etc.
When treating for ID what must be considered?
Dose
Timing
Formulation
Interactions
Side effects
Secondary effects
Why is there usually over prescription in ID?
Drugs started when someone is in adolescence but as the person gets older there is no need for those drugs - deprescribing.
What is the best clinical approach for treating ID?
Always personalise treatment
Use lowest possible dose, escalate slowly
Listen
Aware of additive effects
Make sure the patient is willing so they will actually take them
What is the link between valproate and ID?
Epileptic pregnant mothers given valproate continuously through pregnancy.
Children ended up with higher incidence of ID if their mother was on a high dose of valproate.
