Comparing autism and Asperger’s syndrome, which of the following is true?
E. In both autism and Asperger’s syndrome, males outnumber females. Communications skills are generally poor in autism, but fairly developed in Asperger’s patients. Circumscribed narrow interests are usually severe in Asperger’s syndrome. Seizures are uncommon in Asperger’s patients while it is commoner in autism. Social skills are poorly developed in both autism and Asperger’s disorder. IQ ranges from mild learning disability to normal level in Asperger’s syndrome, while most patients with autism have low IQ. Head growth deceleration is not seen in both autism and Asperger’s syndrome; it is a feature of Rett’s disorder.
All of the following symptoms are more common in depression associated with learning disability than in those of normal intelligence except:
E. Though most symptoms of depression seen in learning disabled individuals are same as those seen in general population, certain differences exist. Cognitive syndrome of depression including memory disturbance and loss of concentration are often not detected. Similarly, guilt and recurrent thoughts of suicide are under-reported. But biological changes associated with depression such as psychomotor retardation, disturbed sleep, appetite and weight loss and diurnal variation in symptoms are more readily detected. Some symptoms may be more marked in depressed individuals with severe learning disability e.g. psychomotor agitation, irritability and behavioural disturbance. Decline in established activities of daily living and tearfulness may be signs of hidden depression in some patients. Hypochondriasis and other formed beliefs are rarely seen.
A residential care home has 12 residents with learning disability. The nurses at the care home want to use a screening instrument at regular intervals to detect likely mental health problems among the residents.
Which of the following would be most suitable?
A. Measurement of psychopathology in people with learning disabilities is difficult. This issue is partly addressed by the Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS–ADD) interview. A shorter version is also available and can be used as a screening tool by untrained people to identify clients with learning disabilities at risk of developing a psychiatric disorder. It contains 29 items concerning symptoms of psychiatric disorders, split into fi ve scales that combine to produce three total scores: 1, affective/neurotic disorder; 2, possible organic disorder; and 3, psychotic disorder. Scores equal to or above specified thresholds indicate if a further assessment is necessary.
An 8-year-old boy suffers from episodes of sudden but brief flexion of neck and trunk and flexion of legs at the hips since the age of one. He has severe mental retardation.
Which of the following EEG pattern is most likely in this boy?
C. This child is most likely to have infantile spasms. This condition appears usually at the ages of 4 to 6 months. The spasms are a form of epilepsy and are characterized by sudden, brief flexion of neck and trunk, raising both arms forwards or and flexion of legs at the hips. A cry may be associated with the attack. The EEG is generally chaotic with slow waves of high voltage intermixed with asynchronous spikes in both hemispheres. This pattern of EEG findings is called hypsarrhythmia. Patients with infantile spasms limited to one side may have a surgically removable cortical dysplasia. Infantile spasms are also noted in infants with Down syndrome or tuberous sclerosis. The term West syndrome is applied to the triad of infantile spasms, hypsarrhythmia, and mental retardation.
Which of the following is true with respect to the use of medications to treat behavioural problems in learning disabled individuals?
D. Despite widespread use of antipsychotics to treat challenging behaviour in learning disabled adults, the evidence is scarce. ‘Neuroleptics for Aggressive Challenging Behaviour in Intellectual Disability’ (NACHBID) was a multicentre study that compared first-generation and second-generation antipsychotic drugs with placebo in patients with aggressive challenging behaviour. A reduction in aggression was noted with both antipsychotic treatments and placebo use after 4 weeks; the greatest response was with placebo. No differences between groups were observed in terms of aberrant behaviour, quality of life, general improvement or effect on carers. The combination of placebo effect, the psychological effect of a formal external intervention and/ or spontaneous resolution surpasses than the effect of medications.
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