Learning disability patients

Nervous System Parkinsonism was present in 46% of 150 elderly patients being treated with haloperidol and xmrelated to plasma concentrations or duration of use [151 ]. Two cases of neuroleptic-induced catatonia following the administration of intravenous haloperidol are described both patients recovered following discontinuation of haloperidol [152 ]. A case of neuroleptic malignant syndrome in a 48-year-old male is reported with index exposure to intravenous haloperidol that resolved on discontinuation [153 ]. Obsessive-compulsive symptoms are associated with a number of SGAs particularly clozapine however a case report describes the development of obsessive-compulsive symptoms in a learning disability patient treated with haloperidol [154 ]. 

CMV, a virus of the herpes family, isa common viral infection. Healthy individuals may beoome infected yet have no symptoms. However, immunocompromised patients (such as those with HIV or cancer) may have the infection. Symptoms include malaise, fever, pneumonia, and super infection. Infants may acquire the virus from the mother while in the uterus, resulting in learning disabilities and mental retardation. CM V can infect the eye, causing retinitis. Symptoms of CMV retinitis are blurred vision and decreased visual acuity. Visual impairment is irreversible and can lead to blindness if untreated. 

ADHD is rarely encountered without comorbid conditions and often is underdiagnosed. Between 40% and 75% of patients with ADHD will have one or more comorbidities (e.g., learning disabilities, oppositional defiant conduct, anxiety, or depressive disorders).10 It is important to identify other coexisting conditions in patients with ADHD to assist in initial and ongoing selection of treatment. 

The clinical utility of dietary restriction of phenylalanine (200-500 mg/day of phenylalanine) is clear. Well-controlled patients have normal intelligence, although there may be an increased risk of perceptual-learning disabilities, emotional problems and subtle motor difficulties [23]. Diet therapy must probably be maintained throughout adolescence and perhaps indefinitely. Performance may deteriorate after the diet is discontinued. 

According to the UK National Initiative for the Care of the Elderly only specialists in the care of people with dementia (that is, psychiatrists including those specialising in learning disability, neurologists, and physicians specialising in the care of the elderly) should initiate treatment. Carers views on the patient s condition at baseline should be sought. 

Affected (heterozygote) females have a milder presentation, which probably depends on the lionisation pattern. Some carriers are without symptoms, whereas others have learning disabilities to various extents [9]. Biochemical diagnosis of affected male patients is possible by analysis of Cr excretion in urine. 

Davies SJ, Cooke LB, Moore AG, Potokar J. Discontinuation of thioridazine in patients with learning disabilities balancing cardiovascular toxicity with adverse consequences of changing drugs. BMJ 2002 324(7352) 1519-21. 

Mula M, Trimble MR, Sander JW. Psychiatric adverse events in patients with epilepsy and learning disabilities taking levetiracetam. Seizure 2004 13(l) 55-7. 

Epilepsy is a common co-morbid illness in patients who have both psychiatric illness and learning disabilities. The necessary combination of the anti-epilepsy drug carbamazepine, a CYP 3A4 enzyme inducer, with a CYP 3A4 inhibiting SSRI antidepressant then calls for particularly careful increment in drug doses supported by monitoring of plasma carbamazepine concentration. 

One of your patients, with a learning disability, is due to have a minor operation. She has never had an operation before, is feeling quite nervous about the prospect and has many concerns she would like to discuss with you. 

Complete deficiency of HGPRT results in gout-related arthritis, dramatic malfunction of the nervous system, behavioral disorders, learning disability, and hostile or aggressive behavior, often self directed. In the most extreme cases, patients nibble at their fingertips or, if restrained, their lips, causing severe self-mutilation. 

One patient who consumed 300-800 pg Mo per day for about 19 days developed an acute psychosis with visual and auditory hallucinations, and a series of petit mal seizures with one life-threatening grand mal attack. At one year after the molybdenum poisoning, this patient was diagnosed as having toxic encephalopathy with executive deficiencies, learning disability, major depression, and post-traumatic stress disorder (Momcilovic 1999). 

When one pair of chromosomes does not divide, the resulting cells have 24 chromosomes and others have 22. A fertilized egg will develop into a child with Down syndrome, where the child inherits genes on 46 chromosomes 23 coming from the mother and 23 from the father. The extra chromosome causes physical and cognitive abnormalities, ranging from mild-to-severe learning disabilities. The symptoms are similar to those of patients with Alzheimer s disease. 

It may be that these variable responses are directly related to the variability of massage techniques, of which there are over 200. Massage can be given over the whole body or limited to the face, neck, or just hands, feet, legs—depending on the patient and his or her condition or illness, for example, patients with learning disabilities, and many psychiatric patients are often only able to have limited body contact for a short time. 

Vision therapy and behavioral optometry use nonsurgical methods to treat common visual problems such as strabismus, double vision, convergence insufficiency, and some learning disabilities. These methods are best described as physical therapy for the eyes and brain. Under the direction of an optometrist, the patient performs a series of exercises, some incorporating the use of specialized equipment such as patches, computer software, prisms, and optical filters. In ophthalmic and medical circles, controversy surrounds certain vision therapy practices because of doubts concerning their efficacy. 

Varied focus, e.g. Black and Minority Ethnic patients, learning disabilities... 

Ulhaq 1, Abba-Aji A. Haloperidol induced obsessive compulsive symptom (OCS) in a patient with learning disability and bipolar affective disorder. BMJ Case Rep 2012 2012. 

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