Psychiatry of learning disability Flashcards
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
Normalisation
Figure who first developed the idea of normalisation
Bengt Nirje
Figure who further developed the idea of normalisation and wrote ‘The principle of Normalization in human service’
Wolf Wolfensberger
Figure who coined the idea of social role valorisation
Wolf Wolfensberger
Idea behind social role valorisation
The idea that people with LD could be given opportunities to take on valued social roles which would improve attitudes towards them
Four key principles in the UK government paper Valuing People which looked at treatment of people with learning disabilities
Rights
Independence
Choice
Inclusion
Decade in which institutionalisation of people with learning disabilities began to be phased out in the UK
1980s
Percentage of offenders in the UK with a learning disability
1-10%
Percentage of adults in prison with an IQ <70
7%
Percentage of adults in prison with an IQ <80
25%
Percentage of adults with LD who have schizophrenia
3%
Percentage of adults with LD who have bipolar affective disorder
1.5%
Percentage of adults with LD who have depression
4%
Percentage of adults with LD who have agoraphobia
1.5%
Percentage of adults with LD who have OCD
2.5%
The idea that once a diagnosis is made of a major condition all other symptoms are attributed to that diagnosis
Diagnostic overshadowing
Semi structured interview that is used to diagnose psychiatric disorders in patients with LD
Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS-ADD)
Increased risk of schizophrenia in patients with LD compared to the general population
3x higher
Clinical features specific to schizophrenia in patients with LD compared to the general population
Earlier age of onset - average 23
Formal thought disorder less common
Complex persecutory delusions less common
With severe LD - impulsive and unpredictable behaviour
Behaviour common in patients with LD, especially in children with Down’s syndrome, which should be differentiated from psychosis
Self talk
Named syndromes associated with both LD and psyhosis
Usher’s syndrome
Velo-cardio-facial syndrome (DiGeorge syndrome)
Prader Willi syndrome
Percentage of patients with Usher’s syndrome who have psychosis
15%
Clinical features specific to bipolar affective disorder in patients with LD compared to the general population
Mania less likely to be expressed verbally and more likely to be expressed through behaviour
Clinical features specific to depression in patients with LD compared to the general population
Marked biological features
Marked diurnal variation
Irritability common
Aggressive and self injuring behaviour common
Regressive behaviours can be seen
Anxiety type associated with fragile X syndrome
Social anxiety
Anxiety type associated with Prader-Willi syndrome
OCD
Anxiety type associated with Rubinstein-Taybi syndrome
OCD
Anxiety type associated with Williams syndrome
Phobias
Anxiety type associated with Cornelia de Lange syndrome
Compulsive behaviours
Percentage of young people with mild/borderline LD who have conduct disorder
30%
Percentage of people with mild LD who have autism
10%
Percentage of people with severe LD who have autism
40%
Proportion of people with Down’s syndrome aged 30-39 who have dementia
1 in 50
Proportion of people with Down’s syndrome aged 40-49 who have dementia
1 in 10
Proportion of people with Down’s syndrome aged 50-59 who have dementia
1 in 3
Proportion of people with Down’s syndrome aged >60
More than half
Percentage of people with LD who display challenging behaviours
7%
Percentage of people with LD who display challenging behaviours in hospital
14%
Setting where self injuring behaviour is most common among people with LD
Hospital
Peak age for self injuring behaviour in people with LD
15-20
Conditions associated with LD and self injuring behaviour
Prader-Willi
Fragile X
Tourettes
Smith-Magenis
Cornelia de Lange
Lesch-Nyhan
Most common form of self injuring behaviour among people with Prader-Willi
Skin picking
Most common form of self injuring behaviour among people with Lesch-Nyhan
Finger biting or lip biting
Persistent eating of non-nutritive items
Pica
Percentage of children aged 1-4 in the general population who display pica
30%
Percentage of adults with LD in the community who display pica
5%
Percentage of adults with LD in hospitals or care settings who display pica
10-20%
LD related conditions which lithium is licensed for aside from bipolar affective disorder
Control of aggressive behaviour
Intentional self harm
Investigation required before starting lithium in patients with LD
EEG
Complications of lithium more common in patients with LD
Seizures
Toxicity
Use for naltrexone within LD
Treatment of repetitive self injury
Criteria for clinically significant challenging behaviour
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
Drugs which can be used to treat severely problematic sexual behaviour
Cyproterone acetate
Medroxyprogesterone acetate
Questionnaire used to diagnose dementia in patients with LD
Dementia questionnaire for people with learning disabilities
Most common presentation of PTSD in patients with LD
Aggression
IQ below which schizophrenia cannot be reliably diagnosed
45
Most common presenting symptom of PTSD among patients with learning disabilities
Aggression
Most common cause of PTSD in patients with learning disabilities
Abuse
Percentage of patients with Down syndrome who have dementia by aged 35
25%
Percentage of patients with Down syndrome who have dementia by aged 65
75%
First symptom in Alzheimer’s dementia which is more common in patients with Down syndrome than the general population
Personality changes
Risk factors associated with self injury in people with a learning disability
Younger age
Lower developmental ability
Autistic symptoms
Sensory impairment
Recommended treatment for PTSD for patients with learning disability
As per the general population - SSRI and psychological therapy
