difference between mental disabilities and mental disorders 8
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Differences between Developmental Disorders & Mental Disorders
and What Do We Do in Cefn
Carnau ?!Dr khalid MansourPriory Cefn Carnau
Development
1- Adult Brain Abilities / Skills
3- Nurturing (Environmental Stimulation)
2- Biological Development (Maturity)
1- Child Brain Abilities / Skills
Basic Brain Abilities / Skills• Major Systems:
• Object related (physical) intelligence.• Emotional intelligence.• Social intelligence.
• Subsystems:• Temperament • Resilience• Problem Solving• Self-sufficiency• Self-stimulation• Central Coherence
Object-Related (Physical) Intelligence
• Managing objects and/or physical environment.
• Budgeting, Travelling, Cleaning, Cooking, etc.
• Usually measured by IQ.
Emotional Intelligence•Ability to appreciate and treat oneself and others as individuals:• Insight (self awareness / self observation)
• Empathy (theory of mind)
• > positive personal relationships
Social Intelligence
Ability to interact with abstract parts of society > fitting well in the wider society :
•Law, Social Norms.•Government, Police, Social Services.
•Society, Country, Nation, humanity.
Brother, friend, mate, partner: Emotional Intelligence
People in society not known personally: Social Intelligence
Basic Brain Functions: Subsystems:
• Positive Temperament vs Negative Temperament
• Resilience vs Despondence• Problem Solving vs Vulnerability• Self Sufficiency vs Dependence• Self Stimulation vs Irritability • Central Coherence vs Awkwardness
2- Maturity
3- Nurture •Family•Environment
•Neglect / Deprivation
•Abuse •Culture•Trauma
Patterns of Development
NOT Adult Brain Systems / Subsystems
X Nurturing
(Environmental Stimulation)
X Biological Development (Maturity)
Child Brain Systems / Subsystems
Normal Development Adult Functioning
illness development
illness development
illness development
Child Functioning
MaturityRegression
Consistent / Pervasive Developmental Disorders
Adult functioning
Childish Functioning
Irregular Developmental Disorders
Differences between Developmental Disorders & Mental Disorders
4- Developmental Dis. & Acquired Mental Illness
Developmental Dis. & Acquired Mental Illness
Differences:•Baseline.•Functionality •Saved parts •Potential for recovery•Speed of recovery•Rehabilitation
What do we do in Cefn Carnau
1. Assessment2. Admission3. Care4. Treatment5. Risk
management6. Discharge
Assessment
Developmental Disorders (Mental):• Two main categories:
• Specific DD (e.g. dyslexia, dyscalculia, speech disorders, etc.
• Pervasive DD (e.g. Mental Retardation (Learning Difficulties) or Autistic Spectrum Disorders)
• All frequently seen in chronic mental health services
Developmental Disorders in Cefn Caranu
•Primary Developmental Disorders > Challenging Behaviour (Secondary Mental Disorders) + High Risk (to others).
•Atypical presentations from mental illnesses without developmental disorders.
Diagnosis:• History taking (client and carers).
• Cross-sectional mental and behavioural assessment
• Observation / Monitoring • Psychometric tests • Investigations.• Formulations • Therapeutic Trials.
Clinical Assessments:• Still the main systems in use >
• Diagnostic criterial and
classifications > vague• Open to Disagreement
• Subjective / Elective
methods unavoidable. • Funding issues.• Need multiple professional
agreement
Psychometric Assessment
• Expensive, time consuming and hard
to find • Heavily dependent on client
cooperation • Relatively of limited specificity and low
sensitivity (↑ False +ve and False –ve)• Limited in scope (Not as good in
suggesting differential diagnosis)• Most services demand confirmations
via clinical assessment especially by a
doctor
Causes of Challenging Behaviour:
Higher sensitivity to: •Physical health factors. •Environmental factors.
•Abuse / Neglect •Vulnerability factors
•Communication problems
Criteria for Admission:
•A Section of MHA.•Pose significant risk to others (not to oneself).
•Similar level of functioning•Primarily problem > Developmental Disorders
•Main need > structured care > protective environment
Principles of Care:
Multi-dimensional principle:
•Physical, •Emotional,•Social.
Maturity - Regression Principle: • Based on levels
of development.• Prevention of
regression principle.
• Reaching the maximum of one’s potential.
• Individualisation of care
• Normalisation of care
Principles of Care:• The Family Principle:
•Human factor•Unconditional care •High Predictability & Consistency.
•Clear structure.•High Promotion of development
• Group work:• Multidimensional:
• Behavioural, medical, physical, psychological, social, occupational, educational
• Not easy:• Communication.• Leadership.• Internal structure.• Support system.
Principles of Care: the Multidisciplinary Team
Treatments: Traditional but Comprehensive:• Physical Medicine: GP, Neurologist, Dentist • Mental Health Medications• Behavioural • Relational • Psychotherapy• Occupational • Educational • Social work • SALT• Physiotherapy• Genetic Counselling
Treatments General:
Packages: •Syndromic•Non-syndromic.
Not as specific: •Less RCTs on medications in Developmental Disorders > More side effects.
•Other TTs similar
Treatments:• Tailored • Individualistic• Multidimensional • Strong non-chemical component
• Experimental • Slower• More expensive
Risk Management:Internal factors:• Insight: functional is enough• Coping:
• Internal: coping with weaknesses.• External: ability to use external help.
• Life-style: • Structure: learning, structured activity, work,
etc • Fulfilment: Personal choices, Hobbies,
qualifications, etc
Risk Management:External factors:• Environment:
• Physical environment: e.g. housing, travelling, finance, etc.
• Personal / practical: carers• Socio-emotional: family,
friends, relationships.• Supervision• Support• Boundaries: e.g. Sections MHA,
CTO, etc
Discharge: General Considerations
•Secure setting is not normal > exceptional setting.
•We can not continue without providing the justification.
•Discharge from secure setting is not discharge from treatment or care.
Discharge: General Considerations• high vulnerability to relapses.• Behavioural Improvement does
not always means dischargeable• None-transferable improvement
vs transferable improvement • Less vulnerability• Effective external care/ttt.• Real target > stop patients coming
back
Additional Tasks • Working with families.• Engagement of the Public.• Working with the media.• Complaints and litigations.
• Departmental and non-departmental regulatory and inspection bodies.
• HIW• NHS• Commissioners• Tribunals
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