2mental retardation
TRANSCRIPT
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MentalMental
Retardation(MR)Retardation(MR)
Department of psychology
The first affiliated hospital of ZZU
Huirong guo
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TerminologyTerminology
In ICD-10 and DSM- the term mental
retardation denotes intellectual impairment
starting early in life (as distinct fromdementia !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%
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TerminologyTerminology
<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 !hocan 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 $eha"ior
taing into account the person's age'
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TerminologyTerminology
Su$groups of mental retardation are
recognied according to the degree of
impairment* mild (I+ ,0-0)
moderate (I+ .,-/)
se"ere (I+ 0-./)
and profound (I+ $elo! 0)%
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2pidemiology2pidemiology &mong the population aged 1,-1the pre"alence
of moderate and se"ere mental retardation isa$out .%0 to /%0 per thousand
The pre"alence of mental disorder among thementally retarded increase !ith the se"erity ofthe retardation
&mong people !ith mild mental retardation the
pre"alence of mental disorder is similar to thatamong people of normal intelligence $ut amongpeople !ith se"ere retardation it is greater
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Clinical features of MRClinical features of MR
the characteristic feature is lo! performance
of all inds of intellectual functioning
including learning short-term memory theuse of concepts and pro$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
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Types of retardationTypes 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$ices
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Types of retardationTypes of retardation
Moderate
IQ %5-&'
() per cent of all retarded
!ost can manage some independent acti$ities
*e+uire special education, occupation, and
super$ision
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Types of retardationTypes of retardation
Se"ere
IQ )0-%&
7 per cent of all retarded
pecific causes usual
ocial sills se$erely limited
*e+uire close super$ision and much practicalhelp
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Types of retardationTypes of retardation
4rofound
IQ .elo# )0
( per cent of all retarded
pecific causes usual
/ery se$erely disa.led
hysical pro.lems usual
/ery poor self-care
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4hysical disorders4hysical disorders
&mong the se"erely and profoundly retarded
most ha"e physical pro$lems such as sensory
or motor disa$ilities or epilepsy% Disorders ofhearing or "ision are important additional
o$stacles% Motor disa$ilities are fre5uent
including spasticity ata3ia and athetosis
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4sychiatric disorder4sychiatric disorder
&ll inds of psychiatric disorder can occur in
the mentally retarded%
Diagnosis is often difficult $ecause symptomsmay $e modified $y lo! intelligence
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4sychiatric disorder4sychiatric disorder
Schiophrenia
&ffecti"e disorder
&d6ustment disorder and neurosis
4ersonality disorder
#rganic psychiatric disorder
#"eracti"ity and autistic $eha"ior Se3ual pro$lems
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2ffects on the family2ffects on the family
They often e3perience prolonged depression!ith guilt shame or anger
& fe! parents re6ect the child !hile others$ecome o"erin"ol"ed in caring for the child to
the detriment of their other children Most parents e"entually achie"e a satisfactory
ad6ustment although they are still tempted too"erindulge the child
9o!e"er !ell they ad6ust psychologicallyparents are faced !ith the prospect of prolongedhard !or and social pro$lems% If the child alsohas a physical handicap these pro$lems areincreased%
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&etiology&etiology
Mild mental retardation is usually due to acom$ination of genetic and ad"erseen"ironment factors
Se"ere mental retardation is usually due topathological conditions of !hich most can $ediagnosed in life and a$out t!o thirds $efore$irth%
:oth mild and se"ere retardation are morecommon in the lo!er social classes possi$ly$ecause of less effecti"e pre"enti"e measures
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&etiology&etiology
;eneral causes
much mild mental retardation represents the
lo!er end of the normal distur$ance ofintelligence !hich is mainly determined $y
polygenic inheritance% Specific genetic
a$normalities are responsi$le for many of the
meta$olic and other disorders that causesse"ere retardation% Some of these causes are
discussed further $elo!
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&etiology&etiology
Social factors* lo! I+ is associated !ith lo!ersocial class po"erty poor housing and anunsta$le family en"ironment
&ntenatal damage may $e caused $y intra-uterine infection or to3ic su$stances%
4erinatal damage* the causes include $irth
in6ury ernicterus and intra"entricularhemorrhage% Clinically recognia$le $rainin6uries at $irth account for a$out 10 per centof mental retardation%
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&etiology&etiology
4ost-natal damage* may $e due to in6ury
infections and lead into3ication
Malnutrition is a common cause inde"eloping countries though much less
common in de"eloped countries
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Specific causesSpecific causes
;enetic causes
dominant conditions* neurofi$romatosis and
tu$erose sclerosis are e3amples of these rareconditions
recessi"e conditions* this is the largest group
of specific disorders and includes most of the
inherited meta$olic conditions such as
phenyletonuria homocystinuria and
galactosaemia
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Specific causesSpecific 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
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2tiology of $eha"ior pro$lems2tiology of $eha"ior pro$lems
and psychiatric disorderand psychiatric disorder
genetic organic psychological and social
The genetic causes of psychiatric disorderamongst 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%
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2tiology of $eha"ior pro$lems2tiology of $eha"ior pro$lems
and psychiatric disorderand psychiatric disorder #rganic $rain pathology is a common cause
of $eha"ior pro$lems in the most se"eralretarded people% There is a particularly closeassociation $et!een epilepsy and $eha"iordisorder especially hyperinetic $eha"ior
4sychological causes account for some of the$eha"ioral pro$lems of mentally retardedpeople% These causes include frustrationassociated !ith communication difficultyina$ility to ac5uire social sills andeducational failure%
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2tiology of $eha"ior pro$lems2tiology of $eha"ior pro$lems
and psychiatric disorderand psychiatric disorder Social factors such as family tensions or
$erea"ement are important causes of
$eha"ior pro$lems in mentally retardedpeople 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!aland self-stimulation
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&ssessment&ssessment
Se"ere mental retardation can usually
diagnosed in infancy as it is often associated
!ith physical a$normalities or delayed motorde"elopment%
The diagnosis of less se"ere mental
retardation is more difficult $ecause it is
$ased on delays in psychological de"elopment
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&ssessment&ssessment
9istory taing
4hysical e3amination
:eha"ioral assessment
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&ssessment&ssessment
De"elopmental testing
#"erall assessment
Ser"ices for the mentally retarded
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Ser"ices for mentally retardedSer"ices for mentally retarded
4re"ention
;enetic counseling
2arly detection &nte-natal screening
&nte-natal o$stetric care
4ost-natal screening &ssessment and periodic reassessment
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Ser"ices for mentally retardedSer"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
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Treatment of psychiatric disorderin the mentally retarded
similar to that of the same disorder in apatient of normal intelligence
4articular care is needed
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Than you
ee you ne1t time
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Than you
ee you ne1t time