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PBBSC SY MENTAL HEALTH NURSING UNIT 6

  • Management of mental sub-normality

Management of Mental Sub-Normality

Definition:

Mental sub-normality (also referred to as intellectual disability) is a developmental condition characterized by significant limitations in intellectual functioning (IQ below 70) and adaptive behavior (e.g., daily living skills, communication, and social skills), with onset before the age of 18.

Goals of Management:

  1. Enhance adaptive functioning.
  2. Promote independence in daily life.
  3. Prevent secondary complications (e.g., behavioral problems).
  4. Integrate individuals into society and improve their quality of life.

Levels of Mental Sub-Normality:

CategoryIQ RangeCharacteristics
Mild50–69Can achieve basic academic skills, may live independently.
Moderate35–49Limited academic ability, needs supervised living.
Severe20–34Little communication ability, requires assistance in daily care.
ProfoundBelow 20Dependent on caregivers for all activities.

Management Approach

1. Multidisciplinary Team Approach

  • A team consisting of psychiatrists, psychologists, nurses, speech and occupational therapists, special educators, and social workers is essential.

2. Medical Management

  1. Treatment of Associated Conditions:
    • Epilepsy: Use anticonvulsants (e.g., carbamazepine, valproate).
    • Sensory Impairments: Manage hearing or visual deficits (e.g., hearing aids, glasses).
    • Behavioral Problems: Address aggression, hyperactivity, or self-harm with:
      • Behavioral therapy.
      • Medications such as antipsychotics (e.g., risperidone) or mood stabilizers (e.g., lithium).
  2. Nutritional Support:
    • Address malnutrition or obesity, which may complicate care.
  3. Preventive Measures:
    • Vaccination and routine health checks to prevent infections.
    • Genetic counseling for families at risk of recurrence.

3. Educational and Developmental Support

  1. Special Education Programs:
    • Tailored curriculum focusing on basic literacy, numeracy, and life skills.
    • Use individualized education plans (IEPs).
  2. Speech and Language Therapy:
    • Improve communication skills for non-verbal or minimally verbal individuals.
  3. Occupational Therapy:
    • Enhance fine motor skills and daily living abilities.
  4. Behavioral Training:
    • Use Applied Behavior Analysis (ABA) to reinforce desirable behaviors.
    • Address maladaptive behaviors with consistent, structured interventions.
  5. Social Skills Training:
    • Focus on interpersonal communication, cooperation, and self-control.

4. Psychological and Emotional Support

  1. Counseling for Families:
    • Educate families about the condition, prognosis, and management.
    • Address caregiver stress and burnout.
  2. Support Groups:
    • Connect families with peer networks for emotional and practical support.
  3. Psychotherapy for Individuals:
    • Use age-appropriate techniques (e.g., play therapy) to address emotional issues.

5. Vocational Training

  • For individuals with mild to moderate disability:
    • Provide job-oriented training (e.g., tailoring, gardening, simple assembly tasks).
    • Assist with supported employment opportunities.

6. Community Integration

  1. Daycare and Respite Services:
    • Offer structured activities during the day to provide relief to caregivers.
  2. Residential Care Facilities:
    • For those requiring 24-hour supervision or specialized care.
  3. Recreational Activities:
    • Encourage participation in sports, arts, or hobbies to boost self-esteem.

Role of Nurses in Managing Mental Sub-Normality

  1. Assessment:
    • Evaluate developmental milestones, adaptive functioning, and associated conditions.
    • Identify the individual’s strengths and weaknesses.
  2. Support for Families:
    • Provide information about available services and resources.
    • Teach caregivers effective ways to manage behaviors and support development.
  3. Health Promotion:
    • Monitor nutrition, hygiene, and vaccination status.
    • Provide guidance on maintaining physical health (e.g., exercise, dental care).
  4. Behavioral Management:
    • Assist in implementing behavioral interventions designed by specialists.
    • Use positive reinforcement to encourage desired behaviors.
  5. Advocacy:
    • Advocate for inclusive policies in schools and workplaces.
    • Facilitate access to government benefits and disability support programs.

Challenges in Management

  • Stigma and Discrimination: Educate the community to reduce prejudice.
  • Caregiver Burden: Provide emotional and practical support to families.
  • Financial Constraints: Advocate for subsidized services and financial assistance.

Outcomes of Effective Management

  1. Improved independence in daily living skills.
  2. Enhanced communication and social interactions.
  3. Reduced behavioral problems.
  4. Better quality of life for individuals and families.
  • Classification of mental sub-normality

Classification of Mental Sub-Normality (Intellectual Disability)

Mental sub-normality, also known as intellectual disability, is classified based on the severity of intellectual impairment and limitations in adaptive functioning. The classification primarily uses IQ scores and considers deficits in conceptual, social, and practical skills.

Classification Based on IQ Levels (DSM-5 and ICD-11)

CategoryIQ RangeDescription
Mild50–69– Slower development in academic and social skills.
– Can achieve basic education up to a 6th-grade level.
– May live independently with minimal support.
Moderate35–49– Delayed speech and motor skills.
– Limited academic skills, usually up to a 2nd-grade level.
– Requires supervision for daily activities.
Severe20–34– Marked impairments in communication and motor skills.
– Little to no academic achievement.
– Requires assistance in most daily living activities.
ProfoundBelow 20– Severe developmental delays across all domains.
– Non-verbal or minimal communication.
– Fully dependent on caregivers for all aspects of life.

Alternative Classifications

1. Based on Developmental Impact:

  • Congenital Intellectual Disability:
    • Present from birth or early infancy.
    • Causes: Genetic syndromes (e.g., Down syndrome), birth injuries, prenatal infections.
  • Acquired Intellectual Disability:
    • Occurs after birth due to trauma, infections, or environmental factors (e.g., lead poisoning, traumatic brain injury).

2. Based on Levels of Adaptive Functioning (DSM-5):

A. Conceptual Domain:

  • Mild: Difficulty with academic skills like reading, writing, and mathematics.
  • Moderate: Limited understanding of time, money, and basic academic skills.
  • Severe: Minimal conceptual understanding; relies on caretakers for problem-solving.
  • Profound: Very limited understanding; focuses on basic physical and sensory needs.

B. Social Domain:

  • Mild: Immature social interactions, difficulty understanding social cues.
  • Moderate: Limited social communication; relationships mostly with family or close caregivers.
  • Severe: Basic interaction using simple speech or gestures.
  • Profound: Non-verbal communication or limited use of facial expressions and gestures.

C. Practical Domain:

  • Mild: Can live independently with occasional support.
  • Moderate: Requires support for self-care and employment.
  • Severe: Requires ongoing assistance for daily living activities.
  • Profound: Completely dependent on caregivers for all physical needs.

ICD-11 Classification of Intellectual Disability:

The ICD-11 emphasizes limitations in both intellectual functioning and adaptive behavior, similar to the DSM-5, and categorizes intellectual disability into the following levels:

  1. Mild intellectual disability.
  2. Moderate intellectual disability.
  3. Severe intellectual disability.
  4. Profound intellectual disability.

It also includes:

  • Unspecified Intellectual Disability: When severity cannot be reliably determined (e.g., in infants or those with multiple disabilities).

Etiological Classification:

CauseExamples
Genetic FactorsDown syndrome, Fragile X syndrome, phenylketonuria (PKU).
Prenatal CausesFetal alcohol syndrome, maternal infections (e.g., rubella, toxoplasmosis).
Perinatal CausesBirth trauma, asphyxia, preterm birth complications.
Postnatal CausesInfections (e.g., meningitis), head injuries, severe malnutrition.
Environmental FactorsNeglect, lack of stimulation during early childhood, exposure to toxins (e.g., lead poisoning).

Comparison of Levels

FeatureMildModerateSevereProfound
IQ Range50–6935–4920–34Below 20
CommunicationBasic skills, immatureLimited, simple phrasesMinimal, single wordsNon-verbal
EducationUp to 6th-grade levelUp to 2nd-grade levelLimited to basic tasksNone
Social SkillsNeeds occasional supportLimited social networksBasic interaction gesturesMinimal interaction
IndependenceSemi-independentRequires supervisionNeeds assistanceFully dependent
  • Etiological factors

Etiological Factors of Mental Sub-Normality (Intellectual Disability)

The development of mental sub-normality or intellectual disability is influenced by a variety of factors, which may occur at different stages of life (prenatal, perinatal, or postnatal). These factors can be broadly categorized into biological, environmental, and psychosocial causes.

1. Biological Factors

A. Genetic Factors:

  1. Chromosomal Abnormalities:
    • Down Syndrome: Trisomy 21; the most common chromosomal cause of intellectual disability.
    • Fragile X Syndrome: Affects the FMR1 gene, causing intellectual and behavioral challenges.
    • Turner Syndrome: Affects females with partial or missing X chromosome.
  2. Single-Gene Disorders:
    • Phenylketonuria (PKU): Inability to metabolize phenylalanine, leading to brain damage.
    • Tay-Sachs Disease: Affects lipid metabolism, causing progressive neurological deterioration.
  3. Polygenic Inheritance:
    • Interaction of multiple genes leading to intellectual disability.

B. Prenatal Factors:

  1. Maternal Infections:
    • TORCH Infections:
      • Toxoplasmosis.
      • Other infections (e.g., syphilis).
      • Rubella.
      • Cytomegalovirus.
      • Herpes simplex virus.
    • These infections can damage the developing fetal brain.
  2. Substance Use During Pregnancy:
    • Fetal Alcohol Syndrome (FAS): Caused by maternal alcohol consumption during pregnancy.
    • Exposure to drugs (e.g., opioids, cocaine) can lead to developmental delays.
  3. Maternal Health Conditions:
    • Malnutrition, anemia, or chronic illnesses (e.g., diabetes, hypertension).
    • Hypothyroidism during pregnancy.
  4. Exposure to Toxins:
    • Lead, mercury, and radiation exposure can harm fetal brain development.

C. Perinatal Factors:

  1. Birth Complications:
    • Hypoxia (oxygen deprivation): During prolonged labor or umbilical cord issues.
    • Birth Trauma: Mechanical injury to the infant’s brain during delivery.
  2. Premature Birth and Low Birth Weight:
    • Increased risk of developmental and cognitive impairments.
  3. Neonatal Infections:
    • Meningitis, encephalitis, or sepsis during the neonatal period.

D. Postnatal Factors:

  1. Infections:
    • Central Nervous System Infections:
      • Meningitis, encephalitis, or untreated middle ear infections leading to brain damage.
  2. Trauma:
    • Head injuries from accidents, falls, or abuse.
  3. Nutritional Deficiencies:
    • Severe malnutrition or deficiencies in iodine (leading to cretinism) and iron.
  4. Seizure Disorders:
    • Uncontrolled epilepsy causing repeated brain injury.

2. Environmental Factors

  1. Deprivation of Stimulation:
    • Lack of emotional, sensory, or intellectual stimulation during critical developmental periods.
  2. Neglect and Abuse:
    • Physical, emotional, or sexual abuse during early childhood can lead to developmental delays.
  3. Toxic Exposure:
    • Exposure to environmental toxins like lead, pesticides, or industrial chemicals during early childhood.
  4. Socioeconomic Factors:
    • Poverty, inadequate healthcare, and poor access to education increase the risk of intellectual disability.

3. Psychosocial Factors

  1. Adverse Childhood Experiences (ACEs):
    • Early-life stress, family conflict, or instability can negatively affect cognitive and emotional development.
  2. Parenting Styles:
    • Overprotective or neglectful parenting can hinder the development of adaptive behaviors.
  3. Cultural and Linguistic Barriers:
    • Limited access to culturally appropriate educational and healthcare resources.

4. Multifactorial Causes

  • Often, intellectual disability arises from a combination of genetic and environmental factors.
  • Example:
    • A child born with a mild genetic predisposition to intellectual challenges may experience worsening due to malnutrition or lack of stimulation.

Classification Based on Etiology

CategoryExamples
Genetic CausesDown syndrome, Fragile X syndrome, PKU, Turner syndrome.
Prenatal CausesFetal alcohol syndrome, TORCH infections, maternal malnutrition, exposure to toxins.
Perinatal CausesBirth asphyxia, low birth weight, neonatal jaundice (kernicterus).
Postnatal CausesHead injuries, infections (e.g., meningitis), severe malnutrition, seizure disorders.
Environmental CausesDeprivation, neglect, lead poisoning, lack of healthcare access.

Preventive Strategies

  1. Genetic Counseling:
    • Screening families with a history of genetic disorders.
    • Prenatal genetic testing (e.g., amniocentesis).
  2. Maternal Health:
    • Promoting proper prenatal care, balanced nutrition, and infection prevention.
    • Avoiding alcohol, smoking, and drugs during pregnancy.
  3. Neonatal Care:
    • Early detection and treatment of neonatal infections or jaundice.
    • Ensuring safe delivery practices to reduce birth trauma.
  4. Childhood Care:
    • Preventing malnutrition through proper diet and supplementation.
    • Vaccination to protect against infections like meningitis or measles.
  5. Environmental Interventions:
    • Reducing exposure to toxins (e.g., lead-safe paints, clean drinking water).
    • Providing enriching environments for early childhood development.
  • psychopathology,

Psychopathology

Definition:

Psychopathology is the study of mental disorders, including their symptoms, causes, and treatment. It explores the abnormalities in behavior, thought processes, and emotions that deviate from typical functioning, leading to distress or impairment in daily life.

Scope of Psychopathology:

  1. Descriptive Psychopathology:
    • Focuses on observing and describing mental symptoms and behaviors.
  2. Dynamic Psychopathology:
    • Examines underlying psychological mechanisms and unconscious processes (e.g., psychoanalytic theory).
  3. Developmental Psychopathology:
    • Studies mental disorders across the lifespan, considering genetic, biological, and environmental influences.

Major Areas of Study in Psychopathology:

  1. Mood Disorders:
    • Depression, bipolar disorder.
  2. Anxiety Disorders:
    • Generalized anxiety disorder, panic disorder, phobias.
  3. Psychotic Disorders:
    • Schizophrenia, delusional disorder.
  4. Personality Disorders:
    • Borderline personality disorder, antisocial personality disorder.
  5. Neurodevelopmental Disorders:
    • Autism spectrum disorder, ADHD.
  6. Substance Use Disorders:
    • Addiction to alcohol, drugs, or other substances.
  7. Somatic Symptom and Related Disorders:
    • Somatic symptom disorder, conversion disorder.
  8. Trauma and Stress-Related Disorders:
    • PTSD, adjustment disorder.

Etiology of Psychopathology

1. Biological Factors:

  • Genetics: Inherited predisposition to disorders (e.g., schizophrenia, bipolar disorder).
  • Neurotransmitter Imbalances: Dysregulation of serotonin, dopamine, GABA.
  • Structural Brain Abnormalities: Changes in brain regions like the prefrontal cortex, amygdala.
  • Medical Conditions: Thyroid dysfunction, infections, or trauma.

2. Psychological Factors:

  • Early Childhood Experiences: Neglect, trauma, or attachment issues.
  • Cognitive Distortions: Negative thought patterns contributing to depression or anxiety.
  • Personality Traits: Perfectionism, impulsivity.

3. Social and Environmental Factors:

  • Family Dynamics: Dysfunctional relationships, abuse.
  • Socioeconomic Stressors: Poverty, unemployment.
  • Cultural Norms: Stigma or acceptance of mental health issues.

4. Interactional Models:

  • Diathesis-Stress Model: Genetic vulnerability combined with environmental stress leads to disorders.
  • Biopsychosocial Model: Integrates biological, psychological, and social influences.

Symptoms and Manifestations of Psychopathology

1. Cognitive Symptoms:

  • Delusions: False beliefs not based on reality (e.g., paranoia).
  • Hallucinations: Perceptual disturbances (e.g., hearing voices).
  • Disorganized Thinking: Difficulty organizing thoughts or speech.

2. Emotional Symptoms:

  • Persistent sadness or euphoria.
  • Irritability or extreme mood swings.

3. Behavioral Symptoms:

  • Aggression, withdrawal, repetitive actions (e.g., compulsions).
  • Inappropriate social behaviors.

4. Physiological Symptoms:

  • Changes in sleep, appetite, or physical sensations without medical causes.
  • Autonomic symptoms (e.g., palpitations, sweating in anxiety).

Diagnostic Criteria in Psychopathology

DSM-5 and ICD-11 Systems:

  1. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders):
    • Used primarily in the United States.
    • Provides diagnostic criteria based on clusters of symptoms and their duration.
  2. ICD-11 (International Classification of Diseases):
    • A globally recognized system by the World Health Organization.
    • Broader classification, often used in public health contexts.

Theories of Psychopathology

1. Biological Theories:

  • Emphasize the role of genetics, brain structure, and neurochemistry.
  • Example: Dopamine hypothesis in schizophrenia.

2. Psychodynamic Theories:

  • Originating from Freud’s work.
  • Focus on unconscious conflicts, early experiences, and defense mechanisms.

3. Cognitive-Behavioral Theories:

  • Disorders arise from maladaptive thought patterns and learned behaviors.
  • Example: Negative triad in depression (self, world, future).

4. Humanistic Theories:

  • Focus on self-actualization and personal growth.
  • Disorders arise from unmet needs or lack of self-awareness.

5. Sociocultural Theories:

  • Highlight the role of cultural norms, stigma, and societal pressures.
  • Example: Impact of poverty or discrimination.

Treatment Approaches in Psychopathology

1. Pharmacological Treatment:

  • Antidepressants: SSRIs (e.g., fluoxetine) for depression and anxiety.
  • Antipsychotics: Risperidone, haloperidol for schizophrenia.
  • Mood Stabilizers: Lithium, valproate for bipolar disorder.
  • Anxiolytics: Benzodiazepines (e.g., lorazepam) for anxiety.

2. Psychotherapy:

  • Cognitive Behavioral Therapy (CBT): Effective for anxiety, depression.
  • Psychoanalysis: Addresses unconscious conflicts.
  • Dialectical Behavior Therapy (DBT): For borderline personality disorder.

3. Social and Environmental Interventions:

  • Family Therapy: Addresses family dynamics contributing to the disorder.
  • Social Skills Training: Enhances interpersonal relationships.
  • Vocational Rehabilitation: Helps individuals regain independence.

4. Lifestyle Interventions:

  • Regular physical activity and balanced nutrition.
  • Mindfulness practices to reduce stress.

Role of Nurses in Managing Psychopathology

  1. Assessment:
    • Perform a detailed mental status examination.
    • Identify risk factors (e.g., suicidal ideation, aggression).
  2. Planning and Goal Setting:
    • Collaborate with patients to set achievable recovery goals.
    • Prioritize safety and stabilization in acute cases.
  3. Therapeutic Interventions:
    • Administer medications and monitor for side effects.
    • Provide psychoeducation about the disorder and treatment plan.
  4. Supportive Care:
    • Build a therapeutic relationship using empathy and nonjudgmental attitudes.
    • Involve family members in care plans.
  5. Crisis Management:
    • Address acute episodes (e.g., psychosis, panic attacks).
    • Prevent harm to the patient or others.
  6. Community Integration:
    • Encourage participation in support groups.
    • Facilitate access to vocational training or social services.
  • psychometric assessment,

Psychometric Assessment

Definition:

Psychometric assessment refers to the systematic measurement of an individual’s mental capabilities, behavioral tendencies, emotions, and personality traits through scientifically validated tools and techniques. It is widely used in clinical, educational, organizational, and research settings.

Purpose of Psychometric Assessment:

  1. Clinical Applications:
    • Diagnose mental health disorders (e.g., depression, anxiety, schizophrenia).
    • Assess cognitive and emotional functioning.
    • Evaluate the effectiveness of therapeutic interventions.
  2. Educational Applications:
    • Assess learning disabilities or intellectual abilities.
    • Guide academic placement or support.
  3. Organizational Applications:
    • Measure aptitude, personality traits, and job suitability.
  4. Research Applications:
    • Collect data for psychological studies or experiments.

Components of Psychometric Assessment

Psychometric assessments typically evaluate the following areas:

1. Cognitive Abilities:

  • Intelligence, memory, attention, problem-solving skills.
  • Tools: Wechsler Intelligence Scale, Raven’s Progressive Matrices.

2. Personality Traits:

  • Measures stable characteristics like introversion, extroversion, or emotional stability.
  • Tools: MMPI (Minnesota Multiphasic Personality Inventory), NEO-PI-R (Big Five Personality Traits).

3. Behavioral Patterns:

  • Evaluates observable actions and tendencies.
  • Tools: Behavioral checklists and observational scales.

4. Emotional Functioning:

  • Measures emotional regulation, mood, and emotional responses.
  • Tools: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI).

5. Neuropsychological Functioning:

  • Assesses brain functions like memory, attention, and executive functioning.
  • Tools: Montreal Cognitive Assessment (MoCA), Wisconsin Card Sorting Test (WCST).

Types of Psychometric Tests

A. Standardized Intelligence Tests:

  • Measure intellectual ability and problem-solving skills.
  • Examples:
    • Wechsler Intelligence Scales (WAIS, WISC): Commonly used for assessing IQ.
    • Stanford-Binet Intelligence Scale.

B. Personality Tests:

  • Objective Tests:
    • Fixed responses, often scored quantitatively.
    • Example: MMPI-2, 16PF.
  • Projective Tests:
    • Open-ended responses; reveal unconscious thoughts.
    • Example: Rorschach Inkblot Test, Thematic Apperception Test (TAT).

C. Achievement and Aptitude Tests:

  • Achievement Tests: Measure acquired knowledge (e.g., academic skills).
  • Aptitude Tests: Predict future performance (e.g., GRE, SAT).

D. Neuropsychological Tests:

  • Assess specific brain functions, including memory, attention, and executive skills.
  • Example: Boston Naming Test, Trail Making Test (TMT).

E. Behavioral Assessments:

  • Direct observation or self-report of behaviors.
  • Example: Conners’ Rating Scales for ADHD, Vineland Adaptive Behavior Scales.

F. Emotional and Psychopathological Assessments:

  • Diagnose emotional disorders and mental illnesses.
  • Example:
    • Beck Depression Inventory (BDI).
    • Hamilton Anxiety Rating Scale (HAM-A).

Principles of Psychometric Assessment

  1. Standardization:
    • Tests must have uniform procedures for administration and scoring.
    • Example: IQ tests are standardized to compare results against a normative population.
  2. Reliability:
    • Consistency of test results over time or across evaluators.
    • Types of reliability:
      • Test-Retest Reliability.
      • Inter-Rater Reliability.
  3. Validity:
    • Measures whether the test assesses what it claims to assess.
    • Types of validity:
      • Construct Validity: Theoretical correctness of the test.
      • Criterion Validity: Correlation with external outcomes.
  4. Norms:
    • Scores are compared against a representative sample to interpret results.
  5. Cultural Sensitivity:
    • Tests should be adapted to cultural and linguistic contexts to avoid bias.

Steps in Psychometric Assessment

  1. Preparation:
    • Select the appropriate test based on the purpose of the assessment (e.g., clinical, educational).
  2. Administration:
    • Ensure the test environment is conducive (quiet, comfortable).
    • Follow standardized procedures for consistent results.
  3. Scoring and Interpretation:
    • Score the test based on manuals or computerized systems.
    • Interpret results with reference to norms or benchmarks.
  4. Feedback:
    • Share findings with the individual or relevant stakeholders (e.g., parents, employers).
    • Provide actionable recommendations.
  5. Follow-Up:
    • Use results to guide interventions or monitor progress over time.

Commonly Used Psychometric Tools

DomainTool
Cognitive FunctioningWechsler Adult Intelligence Scale (WAIS), Raven’s Progressive Matrices
PersonalityMinnesota Multiphasic Personality Inventory (MMPI), Rorschach Inkblot Test
Emotional DisordersBeck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS)
Behavioral IssuesConners’ Rating Scales (ADHD), Achenbach System of Empirically Based Assessment (ASEBA)
NeuropsychologicalTrail Making Test (TMT), Wisconsin Card Sorting Test (WCST)

Advantages of Psychometric Assessments

  • Objective and evidence-based evaluation.
  • Helps in identifying strengths and weaknesses.
  • Facilitates targeted interventions.
  • Useful in tracking progress over time.

Limitations

  • Potential cultural and linguistic bias in tests.
  • Over-reliance on standardized scores without considering individual context.
  • Misinterpretation of results without proper training.
  • diagnostic criteria and management of sub-normality.

Diagnostic Criteria and Management of Mental Sub-Normality (Intellectual Disability)

Diagnostic Criteria

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) and ICD-11 (International Classification of Diseases, 11th Revision), intellectual disability (ID) is defined by deficits in both intellectual functioning and adaptive functioning, with onset during the developmental period.

1. Diagnostic Criteria (DSM-5):

A. Deficits in Intellectual Functioning:

  • Impairments in reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience.
  • Confirmed by:
    • Standardized intelligence testing (IQ < 70).
    • Clinical assessment.

B. Deficits in Adaptive Functioning:

  • Failure to meet developmental and sociocultural standards for personal independence and social responsibility.
  • Deficits in at least one of the following domains:
    1. Conceptual Domain: Academic skills, memory, problem-solving.
    2. Social Domain: Interpersonal skills, communication, empathy.
    3. Practical Domain: Daily living skills, self-care, money management.

C. Onset During Developmental Period:

  • Symptoms must appear before the age of 18.

2. Classification by Severity:

Severity LevelIntellectual FunctioningAdaptive Functioning
MildIQ 50–69: Slower development but can achieve basic skills.Can live independently with occasional support.
ModerateIQ 35–49: Limited academic ability, needs supervision.Requires assistance in most daily activities.
SevereIQ 20–34: Little communication ability.Requires extensive support for daily living.
ProfoundIQ < 20: Significant developmental delays.Fully dependent on caregivers for all aspects of life.

Assessment Tools for Diagnosis

  1. Standardized IQ Tests:
    • Wechsler Intelligence Scales (WISC, WAIS).
    • Stanford-Binet Intelligence Scale.
    • Raven’s Progressive Matrices.
  2. Adaptive Behavior Scales:
    • Vineland Adaptive Behavior Scales (VABS).
    • Adaptive Behavior Assessment System (ABAS).
  3. Medical and Genetic Tests:
    • Identify underlying causes (e.g., Down syndrome, Fragile X syndrome).
  4. Developmental History:
    • Evaluate milestones and social, academic, and communication skills.

Management of Mental Sub-Normality

The management of intellectual disability is a multidisciplinary approach that includes medical, educational, psychological, and social interventions.

1. Medical Management

  1. Treatment of Underlying Causes:
    • Address medical conditions like hypothyroidism, phenylketonuria (PKU), or epilepsy.
    • Treat sensory deficits (e.g., hearing aids for hearing loss, glasses for vision problems).
  2. Behavioral Issues:
    • Medications for aggression, self-harm, or hyperactivity:
      • Antipsychotics (e.g., risperidone) for aggression.
      • Mood stabilizers (e.g., lithium) for emotional dysregulation.
      • Stimulants (e.g., methylphenidate) for ADHD symptoms.
  3. Nutritional Support:
    • Address malnutrition or obesity.
    • Provide dietary management for conditions like PKU.
  4. Preventive Measures:
    • Genetic counseling for at-risk families.
    • Vaccinations and routine health screenings.

2. Educational and Developmental Interventions

  1. Special Education:
    • Individualized Education Programs (IEPs) tailored to the child’s needs.
    • Focus on basic academic skills (literacy, numeracy) and life skills.
  2. Speech and Language Therapy:
    • Improve communication skills, especially in moderate to profound cases.
  3. Occupational Therapy:
    • Enhance fine motor skills and independence in daily living tasks.
  4. Social Skills Training:
    • Teach interpersonal communication and coping strategies.
  5. Behavioral Therapy:
    • Use Applied Behavior Analysis (ABA) to reinforce positive behaviors and reduce maladaptive behaviors.

3. Psychological Support

  1. Counseling for Families:
    • Educate families about the condition, prognosis, and management.
    • Provide emotional support and strategies to manage caregiver stress.
  2. Psychotherapy for Individuals:
    • Focus on building self-esteem and managing emotional distress.
  3. Support Groups:
    • Peer networks for sharing experiences and solutions.

4. Vocational Training and Employment

  1. Job-Oriented Training:
    • Teach skills for sheltered or supported employment (e.g., gardening, crafts).
  2. Independent Living Skills:
    • Budgeting, cooking, and personal hygiene for mild cases.
  3. Workplace Support:
    • Provide adaptations and on-the-job training for supported employment.

5. Community-Based Rehabilitation

  1. Daycare Programs:
    • Structured activities to develop skills and provide respite for families.
  2. Residential Care:
    • For individuals requiring 24-hour supervision.
  3. Social Inclusion:
    • Encourage participation in recreational and community activities.

6. Relapse Prevention and Long-Term Follow-Up

  1. Regular Monitoring:
    • Assess physical and mental health periodically.
    • Address emerging behavioral or emotional issues promptly.
  2. Relapse Prevention Plans:
    • Encourage consistent routines and stable environments.
    • Prevent secondary complications like depression or social isolation.
  3. Care Transition Planning:
    • Plan for adult care services as the individual transitions out of childhood services.

Role of Nurses in Management

  1. Assessment:
    • Monitor developmental milestones and adaptive functioning.
    • Identify signs of co-occurring conditions (e.g., seizures, sensory deficits).
  2. Supportive Care:
    • Build trust and rapport with the patient and family.
    • Provide a safe and supportive environment.
  3. Education:
    • Teach caregivers about the condition and home-based interventions.
    • Guide on behavioral management strategies.
  4. Coordination of Care:
    • Act as a liaison between families and healthcare providers.
    • Facilitate access to community resources and services.
  5. Emotional Support:
    • Address caregiver stress and provide coping strategies.

Prognosis

  • Mild to Moderate ID: With appropriate education and support, individuals can achieve partial or full independence in adulthood.
  • Severe to Profound ID: Requires lifelong care and supervision, but quality of life can be enhanced through tailored interventions.

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Categorized as PBBSC SY MENTAL HEALTH NURSING, Uncategorised