ADULTS WITH INTELLECTUAL DISABILITY - PowerPoint Presentation

1. ADULTS WITH INTELLECTUAL DISABILITY.IGBINOVIA IKPONMWOSA SHERIFATFEDERAL NEUROPSYCHIATRIC HOSPITAL, USELU.March 22nd ,2023.3/30/2023 9:03 AM1

2. 3/30/2023 9:03 AM2 To have a general overview about adults with Intellectual disabilities. Problems they are faced with.Management plan.

3. OUTLINEIntroductionEpidemiologyEtiology / Risk factorsClassification/ Clinical featuresProblems associated with Intellectual disabilityAssessment & ManagementPrognosis RecommendationsConclusion3/30/2023 9:03 AM3

4. INTRODUCTIONIntellectual disability (ID) was known as mental retardation(MR) in ICD 10 and now known as disorders of intellectual development in ICD 11.It’s a neurodevelopmental disorder characterized by significant limitations in both intellectual functioning ( Reasoning, learning and problem solving) and in the adaptive functioning ( conceptual, social and practical skills).¹Occurs before the age of 18years.¹3/30/2023 9:03 AM4

5. INTRODUCTIONFor an assessment to be made its being globally accepted that both the social adaptation and intelligence quotient of the individual is important to determine the level of intellectual disability.¹Emphasis on social adaptation. Given advances in health care and social rehabilitation for people living with ID have resulted in a tremendous increase in the life expectancy of this population resulting in a larger and growing number of adults living with ID.3/30/2023 9:03 AM5

6. EPIDEMIOLOGYIn 2018, WHO estimated that 29million people in NIGERIA were living with intellectual disability.²1.5 times more common in males than in females.¹According to a study done by Maulik et al.³ the highest prevalence of people with ID are seen in low and middle income countries.In the UK, 9-14 in 1000 children are seen to have ID and 3-8 in 1000 adults.43/30/2023 9:03 AM6

7. 3/30/2023 9:03 AM7ETIOLOGY/ RISK FACTORS GENETIC:Chromosomal disorders: Down’s syndrome, Edwards syndrome, turners syndrome, Klinefelter's.X linked disorders; fragile X syndrome, Rett'sAutosomal dominant disorders e.g., neurofibromatosis

8. DOWNS’ SYNDROME3/30/2023 9:03 AM8

9. FRAGILE X SYNDROME3/30/2023 9:03 AM9

10. 3/30/2023 9:03 AM10PRENATAL : Infections & toxins TORCH , toxins e.g lead, alcoholMaternal conditions ; pre-eclampsia, placental insufficiency.Nutritional ; malnutrition, iodine deficiency.Immune; RH incompatibilityENVIRONMENTAL:

11. 3/30/2023 9:03 AM11PERINATALObstetric complications; birth asphyxia, cerebral palsy, problems of prematurity.POSTNATALHead injuries, infections, impoverished societies.ENVIRONMENTAL:

12. 3/30/2023 9:03 AM12Inborn errors of metabolismSpina bifidasHydrocephalusMicrocephalyIdiopathicMISCELLAENOUS:

13. 3/30/2023 9:03 AM13

14. CLASSIFICATIONDiagnosis is made independent of a coexisting physical or mental disorder, however it can coexist with other physical or mental disorders.Standardized tests are used for assessing the IQ and adaptive functioning.Below 70 or 2 -3 SD below the mean for that particular test used.3/30/2023 9:03 AM14

15. CLASSIFICATION3/30/2023 9:03 AM15

16. CLINICAL FEATURES3/30/2023 9:03 AM16LEVEL OF DISABILITYSOCIAL AND VOCATIONAL ADEQUACYMILD : IQ 50 -70Difficulties in the acquiring and comprehension ofcomplex language concepts and academic skills.Can usually achieve social and vocational skills adequate to minimal self-support, but may need guidance and assistance when under unusual social or economic stress .MODERATE: IQ 35-49Language and capacity for acquisition of academic skills of persons vary but are generally limited to basic skillsMay achieve self-maintenance in unskilled or semi skilled work under sheltered conditions; needs supervision and guidance when under mild social or economic stress. SEVERE: IQ 20-34They exhibit very limited language and capacity for acquisition of academic skills.May contribute partially to self maintenance under complete supervision; can develop self protection skills to a minimal useful level in controlled environment PROFOUND: IQ <20They have very limited communication abilities and capacity for acquisition of academic skills is restricted to basic concrete skills.Some motor and speech development; may achieve very limited self-care; needs nursing care

17. PROBLEMS ASSOCIATED WITH IDThey experience a greater variety and complex nature of physical health problems than the rest of the population.Most may not be able to complain of feeling ill.Or articulate their symptomsConditions may also be noted when they present with behavioral changes.3/30/2023 9:03 AM17

18. PROBLEMS ASSOCIATED WITH IDSome of the PHYSICAL problems may include;Obesity Premature deathEpilepsy ( 22% compared to the general population 5%)SUDEP is increased in them.4. Diagnostic overshadowing 3/30/2023 9:03 AM18

19. PROBLEMS ASSOCIATED WITH IDPSYCHIATRIC Mood disorders ( depression, mania)Anxiety disorders, OCDConversion disorders ( worse when routine changes in their lives)Eating disordersDelirium ( response to infections, medications or other organic causes)Dementia ( life expectancy has increased esp. those with Downs)Psychosis 3/30/2023 9:03 AM19

20. PROBLEMS ASSOCIATED WITH IDNote that they often coexist with other mental disorders e.g., ASD, ADHD, Substance use disorders etc.PSYCHOSOCIALSex / sexuality/relationshipsMaltreatment and abuse. Stigma ( self and others)Employment/ HousingFinances3/30/2023 9:03 AM20

21. PROBLEMS ASSOCIATED WITH IDAgeingSocial isolation( bereavement of care givers)Crime and Law ( impulsive, easily suggestible,vulnerable to exploitation,desire to please, likely be detected.)PHARMACOLOGICALPolypharmacy3/30/2023 9:03 AM21

22. ASSESSMENT AND MANAGEMENTAssessment & management is directed towards 5 main areas;The cause and severity of the disorder.Intellectual and social skills development. Associated medical conditions. Associated psychiatric disorders.Assessment of needs and support. 3/30/2023 9:03 AM22

23. ASSESSMENT AND MANAGEMENTFull assessment involves several stages:History takingMental state examinationPhysical examination with a detailed neurologic examinationVisual and auditory domains Investigations ( Genetic, laboratory )EEGXrays Neuroimaging ( brain CT, MRI) 3/30/2023 9:03 AM23

24. ASSESSMENT AND MANAGEMENTDevelopmental assessmentIQ assessment ; WAIS-IV, Stanford-Binet intelligence scale 4th editionWeschlers abbreviated scale of intelligence (WASI).Peabody picture vocabulary test.Raven progressive matrices ( non verbal)Vineland adaptive behavioural scaleKaufman Adolescent and adult intelligence test.3/30/2023 9:03 AM24

25. MANAGEMENTManagement should be ;Individualized ( level of ID, Degree of physical impairments, comorbidities, psychosocial problems)MultidisciplinaryMainstay of treatment is supportive( educational interventions, social interventions, behavioral therapies, family therapies etc.)RehabilitationPharmacotherapy3/30/2023 9:03 AM25

26. MANAGEMENTThe management is based on the social, educational , psychiatric and environmental needs of these individuals. Treat any comorbidities as they arise.Support for the patient and their families is crucial in their management.3/30/2023 9:03 AM26

27. PROGNOSISIntellectual impairments may or may not improve in some cases.Level of adaptive functioning can increase with age & this can be influenced positively by an enriched and supportive environments.Persons with mild to moderate forms are more flexible in adaptation and rehabilitation.Co-morbid psychiatric illnesses further worsens prognosis.3/30/2023 9:03 AM27

28. RECOMMENDATIONSIndividuals who are above 18years should be left with C & A Unit up they 21years to enable them get the adequate support and follow up.Social welfare should help advocate for job roles and employment for these adults within the health facility.Residential/ half way homes can be looked into, where these individuals can have a place to stay.Trainings and seminars can be done for caregivers 3/30/2023 9:03 AM28

29. RECOMMENDATIONSHealth talks and advocate programmes against stigma amongst people living with intellectual disabilities.Support groups for care givers should be looked into.Regarding the mental health bill, on the government level, it should be ensured that part ii regarding the rights of persons with mental health conditions be implemented.3/30/2023 9:03 AM29

30. CONCLUSIONIntellectual disability is one of the neurodevelopmental disorders resulting from an arrest in the development of the brain thereby affecting cognitive functions and adaptive functioning of that individual.Diagnosis is often made in childhood, however if made in adulthood a significant deficit in development is often noted.A wholistic and individualized approach is often essential for a better management and rehabilitation of these adults with ID. 3/30/2023 9:03 AM30

31. REFERENCES Sadock, B.J. & Sadock, V.A. (2015). Synopsis of psychiatry(11ed). Philadelphia: Wolters Kluwer. Scholarly community encyclopedia. (2022, September 06). People with intellectual disability in Nigeria. Retrieved from encyclopedia.pub/entry/26668Maulik, P.K; Mascarenhas,M.N; mathers, C.D; Dua,T.; Saxena, S. prevalence of intellectual diasability: A meta-analysis of population-based studies.Res.Dev.Disability.2011,32,pg 419-436 Harrison,P. & Cowen,P. (2018). Shorter oxford textbook of psychiatry (7ed). India: Oxford university press. International classification of diseases- morbidity and mortality statistics; chapter 6; 6A00 ( ICD 11)3/30/2023 9:03 AM31