What is the definition of learning disabilities?
Significant impairment of intelligence = <70 IQ w impairment of adaptive functioning eg. ADLs. Both need to be present before adulthood.
Learning disability vs learning difficulty
Disability - affects learning and intelligence across all areas of life eg. Down’s syndrome
Difficulty - obstacle to a specific form of learning but doesn’t affect overall IQ eg. dyslexia
However learning difficulties are more common in the learning disability population.
What are the classes of learning disability?
Mild - IQ 50-69, some learning difficulties in school, independent w self care and often w living, capable of work, maybe delayed speech
Mod - IQ 35-49, delays in childhood but some degree of independence and communication skills
Severe - IQ 20-34, continuous need of support
Profound - IQ under 20, severe limited self-care skills, continence and communication
Not really important for treating a person.
What are some of the RFs for learning disabilities?
- Chromosomal and genetic anomalies eg. Down’s, William’s
- Congenital malformations eg. spina bifida, hydrocephalus
- Prenatal exposures eg. fetal alcohol syndrome, congenital rubella, Zika virus
- Birth complications eg. hypoxic brain injury, cerebral palsy
- Prematurity
- Childhood illness eg. meningitis, measles, encephalitis
- Childhood brain injury, neglect and lack of stimulation in early life
What conditions are more common in the learning disability population?
- Cerebral palsy - 50% of cerebral palsy have ID
- Epilepsy - 40% of people w epilepsy have ID
- Higher rates mental illness
- Visual and auditory impairments
- Significantly reduced life expectancy
- ADHD
- Autism
What are the symptoms of learning disability?
- Poor performance on learning, short term mem and problem solving
- Association w specific congenital syndromes eg. Down’s syndrome, fragile X syndrome
- Challenging behaviour
- Reduced capacity for complex language or in profound ID complete lack of communication skills
What are some physical problems associated w learning disability?
- Motor and mobility problems
- Urinary and faecal incontinence
- Increased risk of obesity - lack of physical exercise
- Poor oral health and diet
- Sleep disorders
- Speech, hearing and visual impairment
- More likely to smoke - increased risk COPD
What are some psychological problems associated w learning disabilities?
All overrepresented in the learning disability population.
- Schizophrenia
- Anxiety and depressive disorders
- Personality disorder
- Early onset dementia
- Eating disorders eg. rumination, food fadism
What are some conditions associated w Down’s?
- Gastro intestinal problems
- Depression
- Dementia - Alz
- Cardiac issues
- Hypothyroidism
What is Fragile X syndrome?
Trinucleotide repeat disorder ?
Physical features - high forehead, large ears, long face and prominent jaw, weak connective tissue, large testes
Psychiatric associations - anxiety, aggression, adhd, self injury
What are some of behavioural problems associated w learning difficulties?
- Poor self care
- Lack of supportive network, regular employment and income
- Boredom
- Temper tantrums
- Criminal activity, can be unintentioanl
- Challenging behaviour - threatening themselves or others
- Communication difficulties
- Vulnerable to all types of abuse
What is involved in assessment of ID pt in ID psychiatry?
- Person w ID the focus of the consultation and check pt understanding
- Check collateral hx
- Mental state examination
- Risk assessment
What is involved in reducing premature death in learning disability pt?
- Standardisation of Annual Health Checks
- Referral to specialist learning disability services
- Named healthcare co ordinator to people w complex health needs
- Adults w learning disabilities considered high risk group for deaths from resp problems
- Used of the Mental Capacity Act to ensure decisions are made in the pt best interest
What are some complications of learning disabilities?
- Behavioural problems and their consequences eg. problems w criminality, inappropriate behaviour
- Sexual problems - sexually inappropriate behaviour
- Consequences of abuse eg. distress, increased mental health problems, pregnancy, STI
What adaptions are needed for seeing a pt w learning disabilities?
- Longer appointments
- Talk to informants - collateral
- Reduce stress - see them at home if can, avoid long waits
What is autism? What are the characteristics?
Neuro developmental condition characterised by:
- Difficulties w social interaction and communication - not good at sharing emotions, normal convo and non verbal communication, hard to maintain relationships
- Rigid and repetitive behaviours - repetitive motor movements, peculiar phrases, repetitive speech
- Resistance to change - inflexible routines
- Restricted interests, preoccupied w unusual objects
- Over reaction to normal sensations - hyper or hypo sensitive
What mental health problems do people w autism suffer with?
- Anxiety
- Challenging behaviour, often due to anxiety eg. meltdowns
- Depression
- OCD - repetitive behaviours
What is the management of autism?
- Help w learning how to interact socially
- Communication support eg. SALT and behavioural therapy
- Coping strategies for life skills
- Intervention for sleep disorders
- Need for structure and activities
- Vulnerability
- Poor evidence for medication, may be used to treat associated conditions eg. ADHD or anxiety and depressive sx
What are some CF of autism in pre school children?
- Delay in lang or regression of language
- Unusual characteristics of spoken language - echolalia, non speech like vocalisation
- Not responding to name, not enjoying physical touch, reduced eye contact
- Reduced or absent imagination
- Unusual interests and rigid behaviours
What is the diagnostic criteria for autism?
- Persistent deficits in social communication and social interaction - deficits in all: social emotional reciprocity, nonverbal communicative behaviours, relationships
- Restricted patterns of behaviour - 2 or more of the following: repetitive movements, speech and objects, sameness, fixated interests, increased or decreased response to sensory input
What is involved in a mental state exam ?
Behaviour - eye contact, body lang, facial expression, psychomotor activity (retardation vs restlessness)
Speech - rate, quantity, tone
Mood and affect - what pt describes and what you see
Thought - speed, flow, coherence, content eg. delusions, obsessions, compulsions, suicidal/violent, thought insertion, w/drawal, broadcasting
Perception - hallucinations, illusions, derealisation and depersonalisation
Cognition
Insight and judgement
What is the trend of prescription of psychotropic medication in learning disability pt?
Antipsychotics and antidepressants have previously been overprescribed in the learning disability population. Some pt need them but many don’t and they have SEs that affect pt QOL:
- Putting on weight
- Feeling tired and lethargic - drugged up
- Serious problems w physical health
STOMP pledge - stopping over medication of people w a learning difficulty.
What is the use of pyschotrophic medication in learning disabilities?
- Those w learning disabilities have a higher rate of epilesy - anti epileptic drugs are appropriate here
- Those w learning disabilities have a higher rate of depression and anxiety - anti depressants are appropriate here
- Those w learning disabilities can have challenging behaviour, this should mostly be managed using behavioural strategies but in more severe cases antipsychotics may be needed, they may be appropriate here
- There are some appropriate uses but many pt are inappropriately on meds
