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6. Learning disability psychiatry > Psychiatry of learning disability > Flashcards

Psychiatry of learning disability Flashcards

1
Q

Social principle that aims to allow people with LD to have life experiences such as having a job, having relationships and living in their own home

A

Normalisation

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2
Q

Figure who first developed the idea of normalisation

A

Bengt Nirje

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3
Q

Figure who further developed the idea of normalisation and wrote ‘The principle of Normalization in human service’

A

Wolf Wolfensberger

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4
Q

Figure who coined the idea of social role valorisation

A

Wolf Wolfensberger

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5
Q

Idea behind social role valorisation

A

The idea that people with LD could be given opportunities to take on valued social roles which would improve attitudes towards them

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6
Q

Four key principles in the UK government paper Valuing People which looked at treatment of people with learning disabilities

A

Rights
Independence
Choice
Inclusion

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7
Q

Decade in which institutionalisation of people with learning disabilities began to be phased out in the UK

A

1980s

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8
Q

Percentage of offenders in the UK with a learning disability

A

1-10%

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9
Q

Percentage of adults in prison with an IQ <70

A

7%

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10
Q

Percentage of adults in prison with an IQ <80

A

25%

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11
Q

Percentage of adults with LD who have schizophrenia

A

3%

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12
Q

Percentage of adults with LD who have bipolar affective disorder

A

1.5%

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13
Q

Percentage of adults with LD who have depression

A

4%

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14
Q

Percentage of adults with LD who have agoraphobia

A

1.5%

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15
Q

Percentage of adults with LD who have OCD

A

2.5%

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16
Q

The idea that once a diagnosis is made of a major condition all other symptoms are attributed to that diagnosis

A

Diagnostic overshadowing

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17
Q

Semi structured interview that is used to diagnose psychiatric disorders in patients with LD

A

Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS-ADD)

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18
Q

Increased risk of schizophrenia in patients with LD compared to the general population

A

3x higher

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19
Q

Clinical features specific to schizophrenia in patients with LD compared to the general population

A

Earlier age of onset - average 23
Formal thought disorder less common
Complex persecutory delusions less common
With severe LD - impulsive and unpredictable behaviour

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20
Q

Behaviour common in patients with LD, especially in children with Down’s syndrome, which should be differentiated from psychosis

A

Self talk

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21
Q

Named syndromes associated with both LD and psyhosis

A

Usher’s syndrome
Velo-cardio-facial syndrome (DiGeorge syndrome)
Prader Willi syndrome

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22
Q

Percentage of patients with Usher’s syndrome who have psychosis

A

15%

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23
Q

Clinical features specific to bipolar affective disorder in patients with LD compared to the general population

A

Mania less likely to be expressed verbally and more likely to be expressed through behaviour

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24
Q

Clinical features specific to depression in patients with LD compared to the general population

A

Marked biological features
Marked diurnal variation
Irritability common
Aggressive and self injuring behaviour common
Regressive behaviours can be seen

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25
Q

Anxiety type associated with fragile X syndrome

A

Social anxiety

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26
Q

Anxiety type associated with Prader-Willi syndrome

A

OCD

27
Q

Anxiety type associated with Rubinstein-Taybi syndrome

A

OCD

28
Q

Anxiety type associated with Williams syndrome

A

Phobias

29
Q

Anxiety type associated with Cornelia de Lange syndrome

A

Compulsive behaviours

30
Q

Percentage of young people with mild/borderline LD who have conduct disorder

A

30%

31
Q

Percentage of people with mild LD who have autism

A

10%

32
Q

Percentage of people with severe LD who have autism

A

40%

33
Q

Proportion of people with Down’s syndrome aged 30-39 who have dementia

A

1 in 50

34
Q

Proportion of people with Down’s syndrome aged 40-49 who have dementia

A

1 in 10

35
Q

Proportion of people with Down’s syndrome aged 50-59 who have dementia

A

1 in 3

36
Q

Proportion of people with Down’s syndrome aged >60

A

More than half

37
Q

Percentage of people with LD who display challenging behaviours

A

7%

38
Q

Percentage of people with LD who display challenging behaviours in hospital

A

14%

39
Q

Setting where self injuring behaviour is most common among people with LD

A

Hospital

40
Q

Peak age for self injuring behaviour in people with LD

A

15-20

41
Q

Conditions associated with LD and self injuring behaviour

A

Prader-Willi
Fragile X
Tourettes
Smith-Magenis
Cornelia de Lange
Lesch-Nyhan

42
Q

Most common form of self injuring behaviour among people with Prader-Willi

A

Skin picking

43
Q

Most common form of self injuring behaviour among people with Lesch-Nyhan

A

Finger biting or lip biting

44
Q

Persistent eating of non-nutritive items

A

Pica

45
Q

Percentage of children aged 1-4 in the general population who display pica

A

30%

46
Q

Percentage of adults with LD in the community who display pica

A

5%

47
Q

Percentage of adults with LD in hospitals or care settings who display pica

A

10-20%

48
Q

LD related conditions which lithium is licensed for aside from bipolar affective disorder

A

Control of aggressive behaviour
Intentional self harm

49
Q

Investigation required before starting lithium in patients with LD

A

EEG

50
Q

Complications of lithium more common in patients with LD

A

Seizures
Toxicity

51
Q

Use for naltrexone within LD

A

Treatment of repetitive self injury

52
Q

Criteria for clinically significant challenging behaviour

A

Behaviour causes more than minor injuries to the person or others
At least weekly the behaviour requires intervention by staff
At least weekly the behaviour causes damage that cannot be rectified
At least weekly the behaviour causes 1 hour of disruption
At least weekly the behaviour places staff in danger
Daily the behaviour causes over a few minutes’ disruption

53
Q

Drugs which can be used to treat severely problematic sexual behaviour

A

Cyproterone acetate
Medroxyprogesterone acetate

54
Q

Questionnaire used to diagnose dementia in patients with LD

A

Dementia questionnaire for people with learning disabilities

55
Q

Most common presentation of PTSD in patients with LD

A

Aggression

56
Q

IQ below which schizophrenia cannot be reliably diagnosed

A

45

57
Q

Most common presenting symptom of PTSD among patients with learning disabilities

A

Aggression

58
Q

Most common cause of PTSD in patients with learning disabilities

A

Abuse

59
Q

Percentage of patients with Down syndrome who have dementia by aged 35

A

25%

60
Q

Percentage of patients with Down syndrome who have dementia by aged 65

A

75%

61
Q

First symptom in Alzheimer’s dementia which is more common in patients with Down syndrome than the general population

A

Personality changes

62
Q

Risk factors associated with self injury in people with a learning disability

A

Younger age
Lower developmental ability
Autistic symptoms
Sensory impairment

63
Q

Recommended treatment for PTSD for patients with learning disability

A

As per the general population - SSRI and psychological therapy

6. Learning disability psychiatry (3 decks)

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