Mental Retardation and other psychiatric Disorders

1. CHILDHOOD &
ADOLESCENT DISORDERS
INCLUDING MENTAL
DEFICIENCY
Presented By:
Mr. Sathish. Rajamani M. Sc (N)
Department of Psychiatric Nursing

3. MR Means????
• Mental retardation (MR) diagnosed
before age 18, usually in infancy or
prior to birth, that includes below-
average general intellectual function,
and a lack of the skills necessary for
daily living.

4. IQ Formula
IQ = mental age ÷ Physical age × 100
Average IQ level is 100
IQ Level below 70 is Mentally Retarded

5. • General Intellectual Functioning is
determined by administering a
standardized intelligence test like
Wechsler Adult Intelligence Scale
(WAIS)

6. AdAptive BehAvior
• Degree with which the individual meets the
standards of personal independence and
social responsibilities expected of his age
and cultural group.

7. epideMioLoGY
• 3 % of general populations are MR.
• In india 5 : 1000 ratio of MR.
• Boys more than Girls
• Mortality High in severe and profound
MR due to associated physical illness.

9. Mild Mental Retardation
• IQ: 50-69
• Largest group of MR patients (about 85%)
• Used to be referred to as “educable”
• As a group, they often develop social, communication, and
motor skills during the preschool years without concern.
• In late teens, can acquire academic skills commensurate with a
6th
grader.

10. Mild Mental Retardation
(Cont...)
• Achieve social and vocational skills
adequate for minimum self-support, but
may need supervision, particularly when
stressed.
• Can usually learn to live independently or in
supervised settings.

11. Moderate Mental Retardation
• IQ = 35 to 49
• About 10% of the MR population
• Used to be called “trainable”
• Most acquire communication skills during
early childhood.
• Can benefit from vocational training and with
moderate supervision, attend to personal care.
• Unlikely to progress beyond 2nd
grade in
academic subjects.

12. Moderate Mental Retardation
• May learn to travel independently in familiar
places.
• Difficulties in social skills and recognizing
social conventions can interfere with peer
relationships in adolescence.
• As adults, most can perform unskilled or
semiskilled work under supervision.
• Can live in the community, usually with
supervision.

13. Severe MR
• IQ 20-34
• 3-4% of the MR population
• During early childhood, acquire little or no
communicative speech
• During school-age period, may learn to talk
and be taught elementary self-care skills.
• Unlikely to progress beyond pre-academic
skills (e.g., letter recognition, simple
counting) but can master some “survival”
sight words.

14. Severe MR
• Most adapt well to life in the
community in group homes or with
their family members.

15. Profound MR
• IQ below 20
• About 1-2% of the MR population
• Most of these individuals have an
identifiable neurological condition that
accounts for their MR
• Considerable impairments in early
childhood in sensorimotor functioning.
• Optimal development may occur in
highly-structured environments.

16. Profound MR
• Motor development, self-care,
and communication skills may
improve if appropriate training
is provided.

17. What are
the
causes of
MR?
What are
the
causes of
MR?

18. Causes
Time of onset
A. Prenatal or Biological (before birth)
B. Perinatal (during birth)
C. Postnatal and Environmental (after birth)

19. A. Prenatal or Biological (before birth)
Prenatal causes are those that originate
during conception or pregnancy until
before birth are chromosomal disorders
such as
 Trisomy 21 or Down Syndrome,
 Klinefelter syndrome,
 Fragile X syndrome,
 Prader-Willi syndrome,
 Phenylketonuria, and William Syndrome.
A. Prenatal or Biological (before birth)
Prenatal causes are those that originate
during conception or pregnancy until
before birth are chromosomal disorders
such as
 Trisomy 21 or Down Syndrome,
 Klinefelter syndrome,
 Fragile X syndrome,
 Prader-Willi syndrome,
 Phenylketonuria, and William Syndrome.

20. B. Perinatal (during birth)
Mental retardation may occur by:
- Intrauterine Disorders such as
maternal anemia,
premature delivery,
abnormal presentation,
umbilical cord accidents and multiple
gestations in the case of twins, triplets,
quadruplets and other types of multiple
births.
Birth trauma may result from anoxia or
cutting off of oxygen supply to the brain.
B. Perinatal (during birth)
Mental retardation may occur by:
- Intrauterine Disorders such as
maternal anemia,
premature delivery,
abnormal presentation,
umbilical cord accidents and multiple
gestations in the case of twins, triplets,
quadruplets and other types of multiple
births.
Birth trauma may result from anoxia or
cutting off of oxygen supply to the brain.

21. B. Perinatal (during birth)
-Neonatal Disorders such as
intracranial hemorrhage,
neonatal seizures,
respiratory disorders,
meningitis, encephalitis,
head trauma at birth.
B. Perinatal (during birth)
-Neonatal Disorders such as
intracranial hemorrhage,
neonatal seizures,
respiratory disorders,
meningitis, encephalitis,
head trauma at birth.

22. . Postnatal and Environmental (after
birth)
mental retardation may occur due to:
- head injuries cerebral concussion,
contusion or laceration
- infections encephalitis, meningitis,
malaria, German measles, rubella;
- demyelinating disorders post
infectious disorders, post immunization
disorders
. Postnatal and Environmental (after
birth)
mental retardation may occur due to:
- head injuries cerebral concussion,
contusion or laceration
- infections encephalitis, meningitis,
malaria, German measles, rubella;
- demyelinating disorders post
infectious disorders, post immunization
disorders

23. . C. Postnatal and
Environmental (after birth)
- Degenerative disorders Rett syndrome,
Huntington disease, Parkinson’s disease;
- Seizure disorders – epilepsy, toxic-
metabolic disorders such as Reye’s syndrome,
lead or mercury poisoning
- Malnutrition – especially lack of
proteins and calories;
. C. Postnatal and
Environmental (after birth)
- Degenerative disorders Rett syndrome,
Huntington disease, Parkinson’s disease;
- Seizure disorders – epilepsy, toxic-
metabolic disorders such as Reye’s syndrome,
lead or mercury poisoning
- Malnutrition – especially lack of
proteins and calories;

24. . C. Postnatal and
Environmental (after birth)
- Environmental deprivation such as
psychosocial disadvantage, child abuse and
neglect, chronic social/sensory deprivation
. C. Postnatal and
Environmental (after birth)
- Environmental deprivation such as
psychosocial disadvantage, child abuse and
neglect, chronic social/sensory deprivation

25. Signs & Symptoms
Failure to achieve developmental milestone
Deficiencies in cognitive functions.
Decreased ability to learn
Difficulties in expression of emotions
Psychomotor skill deficits
Difficulties in performing self care activities
Neurologic impairments
Seizures
Irritability when frustrated or upset
Lack of curiosity

26. DIAGNOSIS
1. History taking
2. PE, MSE, NEUROLOGICAL EXAMINATIONS
3. Assessment of Milestone development
4. Investigations includes
5. Urine & blood investigations
6. Biochemical studies
7. Hearing & Speech evaluation
8. Amniocentesis
9. Chorionic Villi Sampling
10. EEG
11. CT Scan, MRI
12. Thyroid Function Test
13. Psychological Tests {Stanford Binnet Intelligence Scale,
Wechsler Intelligence Scale for Children.

27. TREATMENT
• Behavior Management
• Environmental Supervision
• Monitoring the child developmental needs
and problems
• Speech and Language Therapy
• Family Therapy
• Vocational training

28. PREVENTION

30. PRIMARY PREVENTION

31. PRIMARY PREVENTION
• Preconception
1.Genetic counselling,
2.Immunization for maternal rubella,
3.Adequate maternal nutrition,
4.Family planning (size. spacing and age of
parents)

32. PRIMARY PREVENTION

33. PRIMARY PREVENTION
• Gestation
• Prenatal care – fetal monitoring and
avoidance of teratogenic substances ,
exposure to radiation and avoidance of
alcohols.
• Analysis of fetus by Amniocentesis,
Fetoscopy, biopsy and ultra sound,

34. PRIMARY PREVENTION
• Delivery
• Delivery at hospital by doctors
• APGAR Scoring
• Close monitoring of mother and child
• Injection of gamma globulin (Rh –ve
mother)

35. PRIMARY PREVENTION
• Childhood
• Proper nutrition (1st
6 months)
• Dietary restrictions for specific metabolic
disorders.
• Hazards prevention in child environment.
(lead poisoning, head injury etc)

36. Secondary Prevention
• Early detection and prevention of
preventable diseases like PKU,
Hypothyroidism.
• Early detection of MR.
• Psychiatric treatment for Emotional &
Behavioural problems.

37. Tertiary Prevention
• Training in Vocational, Physical and Social
areas.
• Rehabilitation is aimed at reducing the
disability and to provide optimal
functioning in a child with MR.

38. BREAK

39. F8 – DISORDERS OF
PSYCHOLOGICAL
DEVELOPMENT
• Specific development of speech and
language disorder.
• MR is an generalized impairment in all
areas of functioning.
• SDD are characterized by an inadequate
development in any one specific area of
functioning.

40. SDD INCLuDES
• Reading - Dyslexia • Symptoms
includes
1. Late talking
2. Learning new words
slowly
3. Delay in learning to
read.

41. DYSARTHRIA &
DYSPHASIA
• Dysarthria is a
disorder of speech
whilst dysphasia is a
disorder of language.

42. DYSCALCULIA
• Severe
difficulty in
making
arithmetical
calculations, as
a result of brain
disorder.

43. DYSLALIA
• A speech defect
caused by
malformation of or
imperfect
distribution of
nerves to the
organs of
articulation (as the
tongue)

44. PERVASIVE
DEVELOPMENTAL
DISORDER• PDD’s refers to a group of conditions that
involve delays in the development of many
basic skills. Most notable among them are the
ability to socialize with others, to
communicate, and to use imagination.

46. HYPERKINETIC DISORDERS
{ADHD}

47. HYPERKINETIC DISORDERS
{ADHD}

48. CHARACTERISTICS
• Neurobiological disorder.
• Inappropriate attention, Impulsiveness and
hyperactivity.
• May progress to conduct disorders.

49. Aetiology of ADHD
• Genetic
– monozygotic twins greater
– Twice risk for siblings of hyperactive children
• Biochemical
– Deficit of D2 & Norepinephrine.
• Pre, Peri and Postnatal factors
– Prenatal toxic exposure
– Prematurity, fetal distress, prolonged labor,
asphyxia and low APGAR score.

50. Aetiology of ADHD
• Postnatal factors includes CNS
abnormalities
• Environmental Influences
– Food additives, coloring preservatives and
use of sugar.
• Psycho – social factors
– Prolonged emotional deprivation
– Stressful psychic events
– Disruption of family equilibrium

51. RISK FACTORS OF
ADHD
• Drug exposure in utero
• Birth complications
• Low Birth Weight
• Lead Poisoning

52. Signs & Symptoms

53. TYPES

55. TREATMENT
• Pharmacotherapy
– CNS Stimulants: Dextroamphetamine,
Methylphenidate, Pemoline.
– TCA, Antipsychotics, SSRI and Clonidine.
• Psychological Therapies
– Behavior modification techniques
– Cognitive Behavior Therapy
– Social Skills Training
– Family Education.

57. CONDUCT DISORDERS
• Persistent and significant pattern of
conduct in which the basic rights of others
are often violated or rules of society are not
followed.
• Characteristic Features of Conduct
Disorders
– Frequent Lying
– Stealing and robbery
– Running away from home and school
– Physical violence like rape, fire setting, assault,
and use of weapons.

58. ETIOLOGY
• Genetic Factors: Higher risk among those
family members affected. Alcoholism and
personality disorders in father will increase
the chance of illness.
• Biochemical Factors: Elevated plasma
levels of testosterone and agressive
behavior.
• Organic factors: Brain damage and Epilepsy
will increase the risk.

59. ETIOLOGY
• Psycho Social Factors:
– Parental rejection
– Harsh discipline
– shifting of parental figures
– Large family size
– Absent father
– Parents with ASPD
– Divorce in parents
– Inadequate communication pattern in the family.

60. TREATMENT
Placement in a corrective
institutions.
Behavioural education
Psychotherapeutic measurements
Drug therapy includes
Anticonvulsant drugs
Stimulant medications
Lithium and Carbamazapine
Antipsychoctics

61. JUVENILE
DELINQUENCY
Juvenile delinquent is a person
who is below 16 yrs of age (18
yrs, in case of girls) who indulges
in antisocial activities.
JUVENILE
DELINQUENCY
Juvenile delinquent is a person
who is below 16 yrs of age (18
yrs, in case of girls) who indulges
in antisocial activities.

63. SOCIAL CAUSES
1.Defects in the family
2.Defects in the school
3.Child living in a crime
dominated areas
4.War and post war conditions
SOCIAL CAUSES
1.Defects in the family
2.Defects in the school
3.Child living in a crime
dominated areas
4.War and post war conditions

64. PSOYCHOLOGICAL
CAUSES
1.Personality
2.Emotional insecurity
3.Mental illness
PSOYCHOLOGICAL
CAUSES
1.Personality
2.Emotional insecurity
3.Mental illness

65. ECONOMIC CAUSES
1.Poverty - Stealing
2.Prostitution
ECONOMIC CAUSES
1.Poverty - Stealing
2.Prostitution

66. REfORMAtORY
MEASURES
1.Probation
2.Reformatory schools,
Remand homes
3.Psychological therapies (Play
therapy, finger painting &
REfORMAtORY
MEASURES
1.Probation
2.Reformatory schools,
Remand homes
3.Psychological therapies (Play
therapy, finger painting &

68. TIC DISORDER
• Abnormal involuntary movementswhich
occurs suddenly, repetitively, rapidly and is
purposeless in nature.

69. 2 Types
• Motor Tics
• Characterized by
repititive motor
movements
• Verbal Tics
• Characterized by
repititive
vocalizations.

70. Gilles de la Tourette’s syndrome
• Special type of chronic tic disorder.
• Characterized by
– Multiple motor tics & vocal tics
– Duration one year
– Onset is usually before 11 yrs of age

71. MOTOR TICS
• Simple Motor
Tics
1.Blinking
eyes
2.Grimacing
3.Shrugging of
shoulders
4.Tongue
protrusion
• Complex Motor
Tics
• Facial gestures
• Stamping,
• Jumping
• Hitting self
• Squating
• Twirling
• Echokinesis
• Copropraxia

72. VERBAL TICS
• Simple Vocal
Tics
• Coughing
• Barking
• Throat Clearing
• Sniffing
• Clicking
• Complex Vocal
Tics
• Echolalia
• Palilalia
• Coprolalia
• Mental
Coprolalia

73. TREATMENT
• Haloperidol is a drug of choice.
• In severe cases Pimozide or
Clonidine can be used as an
adjunct.