Mental Retardation(MR)

Department of psychology The first affiliated hospital of ZZU Huirong guo

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
&lthough 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

2ffects of mental retardation on the family

7hen a child is found to $e retarded shortly after $irth ine"ita$ly the parents are distressed% Some parents re6ect the child at first though seldom for long% More often mental retardation is not diagnosed until after the first year of life8 the parents may then ha"e e"en greater changes in their hopes and e3pectations for the child
14

2ffects on the family

They often e3perience prolonged depression !ith guilt shame or anger & fe! parents re6ect the child !hile others $ecome o"erin"ol"ed in caring for the child to the detriment of their other children Most parents e"entually achie"e a satisfactory ad6ustment although they are still tempted to o"erindulge the child 9o!e"er !ell they ad6ust psychologically parents are faced !ith the prospect of prolonged hard !or( and social pro$lems% If the child also has a physical handicap these pro$lems are increased%
15

&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

2tiology of $eha"ior pro$lems and psychiatric disorder

genetic organic psychological and social The genetic causes of psychiatric disorder amongst the mentally retarded seem to unconnected !ith the genetic causes of retardation and to $e the same as those causing the corresponding psychiatric disorder in people of normal intelligence%
22

2tiology of $eha"ior pro$lems and psychiatric disorder

#rganic $rain pathology is a common cause of $eha"ior pro$lems in the most se"eral retarded people% There is a particularly close association $et!een epilepsy and $eha"ior disorder especially hyper(inetic $eha"ior 4sychological causes account for some of the $eha"ioral pro$lems of mentally retarded people% These causes include frustration associated !ith communication difficulty ina$ility to ac5uire social s(ills and educational failure%

23

2tiology of $eha"ior pro$lems and psychiatric disorder

Social factors such as family tensions or $erea"ement are important causes of $eha"ior pro$lems in mentally retarded people 6ust as in people of normal intelligence% &n o"erstimulating en"ironment may cause $eha"ior pro$lems and an understimulating one may lead to !ithdra!al and self-stimulation

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

Ser"ices for mentally retarded

4re"ention ;enetic counseling 2arly detection &nte-natal screening &nte-natal o$stetric care 4ost-natal screening &ssessment and periodic reassessment
28

Ser"ices for mentally retarded

&d"ice and support to families 4ractical help for families 9ealth care Respite admission to hospital Special education training and occupation Residential accommodation ;eneral medical ser"ices
29

Treatment of psychiatric disorder in the mentally retarded

similar to that of the same disorder in a patient of normal intelligence 4articular care is needed

30

Than- you ee you ne1t time

Than- you ee you ne1t time