Mental Retardation Significantly subaverage general intellectual functioning resulting in or associated with, concurrent impairment in adaptive behavior &

; manifested during developmental period, b4 18 y/o Significantly subaverage = defined as : IQ approximately 70 OR IQ below 70 OR 2 standard deviation below mean for particular test Genereal intellectual functioning = determined by standardized tests in intelligence DSM A Significantly subaverage intellectual functioning : an IQ of approximately 70 individually administered IQ test (for infants, a clinical judgement of significantly subaverage intellectual functioning) B Concurrent deficit or impairment in present adaptive functioning in 2 of following : Communication Home living Social/interpersonal skills Use of community resources Self direction Functional academic skills Work Leisure Health Safety C Onset b4 18 y/o Code based on degree of severity reflecting level of intellectual impairment Mild MR IQ level 50-55 to approximately 70 Moderate MR IQ level 35-40 to 50-55 Sevre MR IQ level 20-25 to 35-40 Profound MR IQ level below 20 or 25 MR, severity Strong presumption of MR but person unspecified intelligence untested by standard test
nha 0813 : source Kaplan synopsis of psychiatric

Degree o MR profound

Sevre

Mental retardation

Preschool age (0-5 y/o) Maturation & dvlpmnt Gross retardation Minimal capacity for functioning in sensorimotor areas Needs nursing care Constant aid & supervision required Poor motor dvlpmnt Speech minimal Generally unable to profit from training in self help Lilltle or no communication skills

School age (6-20 y/o) Training & education Some motor dvlpmt present May respond to minimal or limited training in self help Can talk or learn to communicate Can be trained in elemental health habits Profits from systematic habit training Unable to profit from vocational training Can profit from training in social & occupational skills Unlikely to progress beyond 2nd grade level in academic subjects May learn to travel alone in familiar places Can learn academic skills up to 6th grade lvl by late teen Can b guided toward social confirmity

Adult ( 20 y/o) Social & vocational adequacy Some motor & speech dvlpmnt May achieve very limited slf-care Needs nursing care May contribute partially to self maintenance under complete supervision Can dvlp selfprotection skills to minimal useful level in controlled environment May achieve selfmaintenance in unskilled or semiskilled work Under sheltered cond Needs supervision & guidance when under mild spocial or economic stress Can usually achieve social & vocational skills adequate to minimal self-support But may nid guidance & assistance when under unusual social or economic stress

moderate

Can talk or learn to communicate Pooor social awarens Fair motor dvlpmnt Profits from training in self-help Can be managed with moderate supervision Can dvlp social & communication skills Minimal retardation in sensorimotor areas Often x distinguished from norm until later age

Mild

Acquired & develpmntal Factors

Etiology

Genetic etiological factor

Genetic MR Syndromes & Behaviour Phenotypes Behaviour phenotypes : a syndrome of observable behavior that occur wif a greater probability than expected among those individuals wif specific genetic abnorm Down Phenyketonuria Lesch-Nyhan syn Syndrome Fragile X Retts d/o Adrenoleukodystrophy synd Prader-Willi Neurofibromatosis Maple syrup urine dz syn Cri-Du-Chat Tuberous sclerosis Enzyme def d/o : syn -galactosemia -glycogen storage dz

Environmental & sociocultural factors Significant deprivation of nutrition & nurturance Poor medical care & poor maternal nutrition Teenage pregnancy Poor postnatal care, malnutrition Family instability Multiple, inadequate caretakers

nha 0813 : source Kaplan synopsis of psychiatric

Prenatal period Uncontrolled DM Anemia Emphysema HPT Long term use of alcohol Narcotic substance Maternal infxn during pregnancy Rubella Cytomegalic Inclusion dz Syphilis Toxoplasmosis Herpes simplex AIDS Prenatal drug exposure Opiods withdrawal sx : Irritability, hypertonis, tremor, vomiting, abnorm sleep pattern CX of pregnancy Toxemia of pregnancy Uncontrolled DM Maternal malnutrition Vaginal h/rage PP Premature separation of placenta Cord prolapse Perinatal period Premature infants Low birthweight infants Infants that experiences : Intracranial h/rage Cerebral ischaemia Socioeconomic deprivation Acquired childhood d/o infxn Encephalitis Meningitis Head trauma d/t : seizures MVA Child abuse Others Cardiac arrest during anaesthesia Asphyxia a/w near drowning Long term exposure to lead intracranial tumour Maternal chronic illnes

History

PE

Diagnosis From parents or caretaker Include : Mothers pregnancy, labour, delivery Family hx of mental illns Consanguinity of parents Hereditary d/o Assess overall level of fx & intellectuality o parents Size of head Microcephaly Hydrocephalus Down syn face Hypertelorism Flat nasal bridge Prominent etebrow Corneal opacities Retinal Protruding tongue Facial expression Dermatoglyphics Diagnostic tool Abnorm in : chromosome d/o person who is prenatally infected w rubella

Neuro exam (sensory impairment)

Hearing diff Visual disturbance

Disturbance o motor areas

Imaging

Blindns Disturbance of spatial concepts Design cognition Concpts of body image Abnor in muscle tone (spasticity or hypotonia) Reflexes (hyperreflexia) Involuntary mvmnt (choreoathetosis) Loss of coordination Skull X-ray,Ct scan, MRI, EEG

Course & prognosis Mostly intellectual impairment does not improve BUT level of adaptation DEPENDS on supportive environment Mild & moderate MR = hv most flexibility in adapting to various environmental cond IF hv MENTAL d/o + MR = standard tx for mental d/o r REQUIRED

nha 0813 : source Kaplan synopsis of psychiatric

Chromosome studies

Urine & blood analysis

Electroencephalopathy Neuroimaging Hearing & speech evaluation Psychological assessment

Lab exam Karyotype in genetic lab indicated when : Suspected chromosomal d/o Cause of MR is unknown Amniocentesis Chronic villi sampling Using enzyme or organix or AA : Lesch-Nyhan syn Galactosemia PKU Hurlers syn Test metabolic fx in : Unexplained growth abnorm Seizure d/o Ataxia Bone or skin abnorm Eye abnorm When seizue d/o is suspected As above Should b done routinely Infants : Gesell & Bayley scale Cantell Infant Intelligence scale Children Standard Binet Intelligence scale 3rd edition o Wenchsler Intelligence scale for chidren

DDX Cerebral palsy Convulsice d/o Chronic brain syn Isolated handicaps : Fail to read (alexia) Fail to write (agraphia) Fail to communicate (aphasia) Delay or failure in dvlpmnt in specific are : reading or math but norm dvlpmnt in other areas BUT MR general delay in most areas May co-exist Hv IQ <70 Hv distortion of timing, rate & sequence of many basic psychological fx necessary for social dvlpmnt Hence > problem in socializing Children < 18y/o who met criteria for dementia & hv IQ < 70 = dementia AND MR Px that hv IQ <70 aftr age 18 y/o & new onset of cognitive d/o = DEMENTIA

Children w learning d/o Pervasive dvlpmntal d/o

Hellers dz Dementia

10 Prevention general public knowledge & awarens Continuing effeort of health professional to ensure & upgrade prevention public health policies Legislation tp provide maternal & child health care Family & genetic ounselling\proper prenatal & postnatal 20 & 30 prevention medical care Education for child Behavioural, cognitive & psychodynamic theraphy Family education Social intervention

nha 0813 : source Kaplan synopsis of psychiatric