Professional Documents
Culture Documents
Terminology
In ICD-10 and DSM- the term mental retardation denotes intellectual impairment starting early in life (as distinct from dementia !hich is intellectual impairment de"eloping later in life ) #ther terms of this condition include mental deficiency mental su$normality mental handicap and most recently learning difficulties%
2
Terminology
<hough the central feature is intellectual impairment the definition of mental retardation should include social criteria for the practical purpose of distinguishing $et!een people !ho can and those !ho cannot lead a near-normal life% Thus in DSM- the definition of mental retardation includes not only intellectual impairment $ut also the phrase' !ith concurrent deficits and impairments in adapti"e $eha"ior ta(ing into account the person's age'
3
Terminology
Su$groups of mental retardation are recogni)ed according to the degree of impairment* mild (I+ ,0--0) moderate (I+ .,-/0) se"ere (I+ 10-./) and profound (I+ $elo! 10)%
2pidemiology
&mong the population aged 1,-10 the pre"alence of moderate and se"ere mental retardation is a$out .%0 to /%0 per thousand The pre"alence of mental disorder among the mentally retarded increase !ith the se"erity of the retardation &mong people !ith mild mental retardation the pre"alence of mental disorder is similar to that among people of normal intelligence $ut among people !ith se"ere retardation it is greater
5
Clinical features of MR
the characteristic feature is lo! performance of all (inds of intellectual functioning including learning short-term memory the use of concepts and pro$lem sol"ing% Sometimes one specific function is impaired more than the rest for e3ample the use of language any of the common $eha"ioral pro$lems of childhood
6
Types of retardation
Mild
IQ50-70 80 percent of all retarded pecific causes uncommon !any need practical help and education "e# need special psychiatric or social ser$ices
Types of retardation
Moderate
IQ %5-&' () per cent of all retarded !ost can manage some independent acti$ities *e+uire special education, occupation, and super$ision
Types of retardation
Se"ere
IQ )0-%& 7 per cent of all retarded pecific causes usual ocial s-ills se$erely limited *e+uire close super$ision and much practical help
9
Types of retardation
4rofound
IQ .elo# )0 ( per cent of all retarded pecific causes usual /ery se$erely disa.led 0hysical pro.lems usual /ery poor self-care
10
4hysical disorders
&mong the se"erely and profoundly retarded most ha"e physical pro$lems such as sensory or motor disa$ilities or epilepsy% Disorders of hearing or "ision are important additional o$stacles% Motor disa$ilities are fre5uent including spasticity ata3ia and athetosis
11
4sychiatric disorder
&ll (inds of psychiatric disorder can occur in the mentally retarded% Diagnosis is often difficult $ecause symptoms may $e modified $y lo! intelligence
12
4sychiatric disorder
Schi)ophrenia &ffecti"e disorder &d6ustment disorder and neurosis 4ersonality disorder #rganic psychiatric disorder #"eracti"ity and autistic $eha"ior Se3ual pro$lems
13
&etiology
Mild mental retardation is usually due to a com$ination of genetic and ad"erse en"ironment factors Se"ere mental retardation is usually due to pathological conditions of !hich most can $e diagnosed in life and a$out t!o thirds $efore $irth% :oth mild and se"ere retardation are more common in the lo!er social classes possi$ly $ecause of less effecti"e pre"enti"e measures
16
&etiology
;eneral causes much mild mental retardation represents the lo!er end of the normal distur$ance of intelligence !hich is mainly determined $y polygenic inheritance% Specific genetic a$normalities are responsi$le for many of the meta$olic and other disorders that causes se"ere retardation% Some of these causes are discussed further $elo!
17
&etiology
Social factors* lo! I+ is associated !ith lo!er social class po"erty poor housing and an unsta$le family en"ironment &ntenatal damage may $e caused $y intrauterine infection or to3ic su$stances% 4erinatal damage* the causes include $irth in6ury (ernicterus and intra"entricular hemorrhage% Clinically recogni)a$le $rain in6uries at $irth account for a$out 10 per cent of mental retardation%
18
&etiology
4ost-natal damage* may $e due to in6ury infections and lead into3ication Malnutrition is a common cause in de"eloping countries though much less common in de"eloped countries
19
Specific causes
;enetic causes dominant conditions* neurofi$romatosis and tu$erose sclerosis are e3amples of these rare conditions recessi"e conditions* this is the largest group of specific disorders and includes most of the inherited meta$olic conditions such as phenyl(etonuria homocystinuria and galactosaemia
20
Specific causes
chromosome a$normalities : the most common chromosome a$normality is Do!n's syndrome% &$normalities in the num$er of se3 chromosomes such as <linefelter's syndrome and Turner's syndrome may also cause retardation se3-lin(ed conditions conditional (no!n to $e inherited $ut in a less !ell understood !ay* such as microcephaly
21
23
24
&ssessment
Se"ere mental retardation can usually diagnosed in infancy as it is often associated !ith physical a$normalities or delayed motor de"elopment% The diagnosis of less se"ere mental retardation is more difficult $ecause it is $ased on delays in psychological de"elopment
25
&ssessment
9istory ta(ing 4hysical e3amination :eha"ioral assessment
26
&ssessment
De"elopmental testing #"erall assessment Ser"ices for the mentally retarded
27
similar to that of the same disorder in a patient of normal intelligence 4articular care is needed
30