1 / 24

Prescribing For Young People With Learning Disability

Prescribing For Young People With Learning Disability. Food For Thought. Ethical Issues, Holistic Assessment and Clinical Practice. Food For Thought. ‘We forfeit three-quarters of ourselves to be like other people’ Arthur Schopenaur

elvin
Download Presentation

Prescribing For Young People With Learning Disability

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Prescribing For Young People With Learning Disability

  2. Food For Thought Ethical Issues, Holistic Assessment and Clinical Practice

  3. Food For Thought ‘We forfeit three-quarters of ourselves to be like other people’ Arthur Schopenaur ‘If a man does not keep pace with his companions, perhaps it is because he hears a different drummer. Let him step to the music that he hears, however measured or far away’ Henry David Thoreau

  4. Developmental Disorder • Onset during gestation, from birth or from early childhood • Deviation from the average in how the child perceives, thinks and feels • Encompasses domains of behaviour • Accompanied by distress and problems in performance

  5. Pathophysiology in MLD

  6. Emotional Instability • Conflicts with others • Inability to cope with being thwarted • Inability to consider consequences • ‘Meltdowns’ • Confusion about differentness • Inability to visualise aims and preferences • Self-injurious behaviour

  7. SWAP 200 • At the mercy of spiralling emotions • No stable image of self • Anxiety about rejection and abandonment • Need for external soothing • Elicits mirrored feelings in others • Has disregard for safety or welfare of self and others • Unawareness of others’ needs

  8. Clinical Depression • Ego Threat – sadness, failure, loss of pleasure, blame, punishment, worthless • Vegetation – sleep, fatigue, appetite, libido • Arousal – energy, agitation, irritability, concentration, focus

  9. Developmental Tasks • Capable v.Helpless • Adventurous v. Avoidant • Persistent v. Quitting • Affectionate v. Detached • Assertive v. Submissive • Volatile v. Calm

  10. Behavioural Modelling • Self Fulfilment (Maslow) • Aspirations • Norms • Scripts • Empathy • Congruence • Goals

  11. Behavioural Models • Reasoned Action (Ajzen) • Congruence (Frijda) • Dynamic Attachment (Crittenden) • Behavioural Analysis (Snyder) • Procedural Sequencing (Chaiken) • Reciprocity (Gambrill) • Mentalising (Fonagy)

  12. Primary Emotions • Anger – demeaning offence against self • Anxiety – uncertain threat against self • Sadness – experience of irrevocable loss • Happiness – progress towards a goal • Pride – achievement of a goal • Love – affection for idealised other

  13. Secondary Emotions • Relief • Frustration • Hostility • Disgust • Hurt • Embarassment

  14. ACTING OUT #1

  15. ACTING OUT #2

  16. ACTING OUT #3

  17. CAVEATS WITH SSRIs • SSRIs can cause A-V defects in first trimester of pregnancy • Impotence from SSRIs can be counteracted by Periactin • Contraceptives can be impaired by modafinil • Risperidone can induce hypomania • Fluoxetine can double blood levels of mood-stabilisers • Tryptophan can cause serotonin overload • ‘Poop-out’ on fluoxetine occurs in 20% of cases

  18. CAVEATS with NEUROLEPTICS • Haloperidol loses its anxiolytic effect in higher doses • Abilify can improve executive functioning • Abilify can cause suicidality due to akathisia • High blood sugars with olanzapine if relative has diabetes • Risperidone does not work above 6mg daily in adults • High prolactin levels stunt growth and delay puberty

  19. CAVEATS with ANTICONVULSANTS • Suicide risk can be increased with anticonvulsants • Fortnightly checks of LFTS and serum levels of Tegretol • Children and adolescents are resistant to mood-stabilising • Children with ADHD are prone to have behavioural side-effects from mood-stabilisers • Atypical antipsychotics are just as effective

  20. CASE STUDY (MLD+ASD+ADHD+BPD) • Aged 5 – ASD (aggression, agarophobic, insomnia, hyper) > risperidone 1mg nocte> global improvement ‘a new man’ • Aged 6 – regressed > olanzapine 2.5mg nocte > mum says needs dose increased > 5mg nocte > excellent improvement • Aged 9 – regressed > risperidone 2.75mg • Aged 9 – ‘high and anxious’ > risperidone 1mg > labile, insomnia • Aged 13 - > ADHD > risperidone 1.5 mg > ‘excellent progress’

  21. CASE STUDY continued • Aged 13 – BST > mood improved, less agitated, on risperidone 1.5mg + >melatonin > ‘brilliant’ > ADHD? • Aged 13 – YMRS, violent to Mum, BST continues >EEG > ADHD ‘confirmed’ > Medikinet > ‘good benefit’, ‘content’ relaxed’ • Aged 14 – Medikinet stopped due rebound effect > ‘back to normal’ • Aged 14 – ‘giddy and lively’ > atomoxetine > EMW but ‘good effect’, ‘moods improved’, ‘happier and less tearful’ • Aged 15 – giddy, echolalia, repetitive movement > BPD > valproate + risperidone + atomoxetine • Aged 15 – atomoxetine discontinued > clonidine 0.75 mg

  22. Useful Websites • http://amberlist.wordpress.com ‘Prescribing for Young People’ • http://johnalstonmd.com/docs/ADD_Bipolar_RAD.pdf ‘Juvenile Bipolar Disorder’ (John Alston, Baltimore) • http://www.familyrelationsinstitute.org/include/dmm_model.htm ‘Dynamic Maturational Model’ (Patricia Crittenden, Miami)

  23. Useful Websites #2 • http://www.merseycare.nhs.uk/Library/What_we_do/Clinical_Services/Pharmacy/LearningDisabilities-Finalv3.pdf ‘Merseyside Clinical Guidelines’

  24. Thank You For Listening

More Related