Lecture - Psychiatry of Intellectual Disabilities Flashcards
Define intellectual disability.
The presence of:
- a significantly reduced ability to understand new or complex information or to learn new skills;
- a reduced ability to cope independently;
- an impairment that started before adulthood, with a lasting effect on development.
What are the components of the Wechsler Adult Intelligence Scale?
2 main components:
Verbal scales: general knowledge, digit span, vocabulary, simple arithmetic, comprehension, similarities
Performance scale: picture completion, arrangement, block design, digit symbol, object assembly.
What is the average score for the WAIS scale?
- Average Range: 70-130.
- Average score: 100
What are the levels of ID?
- Profound: <20
- Severe: 20-35
- Moderate: 35-50
- Mild: 50-69
Define adaptive functioning.
Relates to a person’s performance in coping on a day-to-day basis with the demands of his/her environment
Related to a person’s age and socio-cultural expectancies associated with their environment as any time.
List some indicators of ID.
- Reports of difficulty in reading and writing
- Difficulty in achieving skills (academic or daily life skills) considered acceptable for age & socio economic group
- Attendance at specialist school
- LD register
- Special Education Needs Statement
- Experience of having to modify communication
- Previously known to specialist children services
How do you assess for ID?
- Intellectual impairment - assessed using the WAIS IV: 11 subtests to derive Verbal IQ + Performance IQ = Full Scale IQ
- Adaptive/Social functioning - established via clinical interview and ABAS II (Adaptive Behaviour Assessment System)
Presence in childhood established using clinical interview and school reports
How common is ID?
2-3/100 affected
What is the aetiology of ID?
Usually no specific cause e.g. brain damage, genetic abnormalities, hypothyroidism
What condition causing ID do these patients have?
Fragile X
What is the physical health of those with ID like?
- More likely to be obese and have a poor diet
- Epilepsy common (~16-32%)
- Sensory impairment e.g. hearing loss (25-42%), poor visual acuity (40%)
What psychiatric comorbidities are common in those with ID?
ALL categories of mental illness can occur in those with ID
- Schizophrenia (3%)
- Mood disorders (x4 depression or anxiety)
- Autism (75% of those diagnosed haveID)
What is challenging behaviour?
Culturally abnormal behaviour
Often persistent
Not a diagnosis
How do you assess mental health problems in those with ID?
- Bio/psycho/social approach
- Change in baseline behaviour/mental state/skills
- Rule out physical causes
- Consider recent life events/changes
- Consider developmentally normal phenomena
What should you do to communicate effectively with someone with ID? What if they are visually or hearing impaired?
Allow time in relaxed environment
Use open questions - be careful not to ask leading questions
Pictorial and symbolised material may be useful
If visually impaired, touch hand before speaking and start sentence with name
If hearing impaired, check that they can see your mouth and face and place yourself on side of best hearing
What tool can be used to promote normal daily living e.g. choice-making, in ID?
Choice board - with pictures; fosters sense of control and independance
Self-help board - helps service users learn new skills or activities; each picture is in order of the task
Schedule board calendar - provides structure to person’s day /life
Communication board - with emojis or emotions
What is the general management of mental health problems in ID?
General - MDT, use mainstream services, assess capacity to consent (MCA 2005), Care Program Approach
Psychotropic medication - Treat the illness but ‘start low, go slow’ as they may be sensitive to SE and therapeutic effects
Psychological interventions - CBT, family education and therapy, creative/complimentary therapies
Social intervention - community inclusion, skills training, environmental change
Who is included in the community learning disability teams?
- Community Learning Disability Nurses
- Psychiatrists
- Psychologists
- Occupational Therapists
- Speech and Language Therapists
- Physiotherapists
- Dieticians
- Care Managers
What is the importance of the Equality Act (2010) in treatment of patients with ID?
People with learning disabilities to utilise mainstream services as much as is possible
Ensuring equity of access to health care for people with a learning disability is every health professional’s business.
