Psychiatric syndromes in LD Flashcards
Self-talk
- a developmental phenomenon that is not psychosis
- common in children with Downs and autism
Schizophrenia in LD
- 3x increase in prevalence- 3-3.5%
- age of onset is earlier
Usher’s syndrome
-syndrome of retinitis pigmentosa, congenital deafness, vestibulocochlear ataxia, LD (23%) and psychosis (schizophrenia) in 15% cases
Velocardiofacial syndrome
-associated with high prevalence of severe psychiatric disorders
Prader Willi syndrome
- this condition is associated with a high rate of psychotic disorders
- associated with chromosome 15 maternal uniparental disomy
BPAD in LD
- greater prevalence than in the general population (2-12%)
- you can use the biological symptoms of mania
Depression in LD
- prevalence is 2-4%
- biological symptoms seen
Suicide in LD
- very rare
- suicidal thoughts and acts may occur in borderline-moderate LD
Anxiety
- likely to be more common
- OCD more common
Fragile X
-associated with social anxiety disorder
Prader Willi syndrome
-associated with OCD
Rubinstein-Taybi
-associated with OCD
Williams syndrome
-associated with anxiety disorder and phobias
Cornelia de Lange
-associated with compulsive behaviour
ADHD
increasingly common in those with higher severity of LD
-stimulants may help in mild LD with clear symptoms of ADHD but have no clear efficacy in severe-profound LD
Conduct disorder
- affects 30% of young people with mild/borderline mental retardation, particularly in males
- there is an association between antisocial behaviour and low verbal intelligence skills which is strongly influenced by family and sociocultural deprivation
Pervasive developmental disorders
- 75-80% of children with autism also have LD
- autism spectrum disorder is estimated in 10% of people with mild LD and 40% with severe LD
Dementia
- Downs is strongly associated
- Alzheimers is 3x more common
Dementia in Downs
- 1 in 50 of those aged 30-39
- 1 in 10 of those aged 40-49
- 1 in 3 of those aged 50-59
- > 50% of those over 60
Challenging behaviour
-culturally abnormal behaviours of such intensity, frequency or duration that the physical safety of the person or others is likely ti be put at risk, or behaviour which is likely to seriously limit the use of or result in the person being denied access to ordinary community facilities.
Criteria for clinically significant challenging behaviour
- at some time the behaviour has caused more than minor injuries to themselves or others or destroyed their immediate living environmnet
- at least weekly behaviours requiring intervention by staff and placed them in danger, causing 1 hr of disruption
- behaviour causing over a few minutes of disruption on at least a daily basis
Predisposing factors for behavioural problems in LD
- sensory disabilities
- poor communication
- epilepsy
- physical illness-ear infections, dental problems and constipation
- medication
- limited range of coping strategies
- abuse
- environmental factors
Challenging behaviour occurrence
- in at least 7% of all people with LD
- in hospital this increases to 14%
- challenging behaviour is more common in people with severe LD
- it is more common in men
- more common 15-34
Aggressive behaviour
- often a feature of an associated mental disorder such as psychosis, depression and antisocial PD
- seen in fragile X, Prader-Willi and Klinefelters
Self-injurious behaviour
- 10-50% of people with LD may show elf-injurious behaviour
- higher rates in hospitals
- living at home has lowest incidence
- more common in patients with epilepsy and autism
Conditions with self-injury
- Prader-Willi (skin picking)
- Fragile X
- Tourettes
- Smith Magenis
- Cornelia de Lange
- Lesch-Nyan
Theories for self-injurious behaviour
- Wiseley identified endogenous opioids to produce morphine-like effect that can account for the development of some forms of self-injurious behaviour
- may stimulate endorphins
- may help with other pains
- pleasurable feels and euphoria
Naltrexone and Naloxone
- can help in LD self-injurious behaviour
- dopamine and serotonin also help
Prader willi and self-injury
- mild
- reported in 81%
- skin picking is the most prevalent form
- front of legs are preferred sites
Lesch-Nyhan and self-injru
- more violent self-injury
- biting of lips and/or fingers
Pica
- more common
- 20-30% of LD patients in hospital
- 5% in community
- more common in males
- more common in poor functioning, autism and non-verbal
- less common with advancing age
