mental subnormality
TRANSCRIPT
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BY ARUN. MKVM COLLEGE
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Introduction
Mental retardation is a state of developmental deficit that begins in childhood and result in significant limitation of intellect and poor adaptation to the demands of every day life. Several terms such as mental handicap, mental deficiency, mental subnormality and so on have been used to denote this condition.
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Definition “Mental retardation is defined by deficits in general intellectual functioning and adaptive functioning (APA, 2000).
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General intellectual functioning is
measured by an individual’s performance on intelligence quotient (IQ) tests.
Adaptive functioning refers to the person’s ability to adapt to the requirements of daily living and the expectations of his or her age and cultural group.
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Meaning Mental retardation is not a disease
but a condition in which the intellectual faculties are never manifested or have never been developed sufficiently to enable the retarded person to acquire such an amount of knowledge as persons of his own age and placed in similar circumstance with him-self are capable of receiving.
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Epidemiology About 20 million people with mild an d 4
million with moderate and severe mentally retarded .
Highest incidence in school age children with peak at ages 10 to 12.
Twice as common, in boys and girls.
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Classification of mental retardation Four types of mental retardation depending on IQ
and adaptive behavior. (Ability to Perform Self-Care Activities Cognitive/Educational Capabilities Social/ Communication Capabilities Psychomotor Capabilities)
Mild Mental Retardation.Moderate Mental Retardation.Severe Mental Retardation.Profound Mental Retardation.
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Mild Mental Retardation: (IQ 50 to 70). Constitutes about 85% of the total
mentally retarded.Motor and sensory deficits are slight.Usually develop normal language abilities
and social behavior.Can achieve academic level up to 6-8th
standard. Usually belong to low socioeconomic,
class.
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Moderate Mental Retardation: (IQ 35 to 50) about 10% of all the mentally retarded
come under this category.earlier called as “trainable”.They can be trained to speak and support
themselves by performing semiskilled or unskilled work under supervision.
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Severe Mental Retardation: (IQ 20-35) account for about 7% of the mentally
retarded.In the preschool years, their development
is usually greatly slowed.They are called the “dependant”.As adults, they can undertake simple
tasks and engage in limited activities.
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Profound Mental Retardation: (IQ below 20) Less than 1% mentally retarded.Very few of them learn to care themselves
completely.Some eventually achieve some simple
speech and social behavior.
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Etiological ImplicationsFive major predisposing factors have been
identified:1. Hereditary factors2. Early alterations in embryonic development3. Pregnancy and prenatal factors4. General medical conditions acquired in
infancy orchildhood5. Environmental influences and other mental
disorders.
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Hereditary FactorsHereditary factors are implicated as the
cause in approximately 5 percent of the cases.
These factors include inborn errors of metabolism, such as Tay-Sachs disease, phenylketonuria, and hyperglycinemia.
Also included are chromosomal disorders, such as Down syndrome and Klinefelter’s syndrome, and single-gene abnormalities, such as tuberous sclerosis and neurofibromatosis.
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Early Alterations in Embryonic Development
Prenatal factors that result in early alterations in embryonic development account for approximately 30 percent of mental retardation cases.
Damages may occur in response to toxicity associated with maternal ingestion of alcohol or other drugs.
Maternal illnessesand infections during pregnancy (e.g., rubella, cytomegalovirus)
Complications of pregnancy (e.g., toxemia, uncontrolled diabetes) also can result in congenital mental retardation
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Pregnancy and Perinatal FactorsApproximately 10 percent of cases of mental
retardation are the result of factors that occur during pregnancy (e.g., fetal malnutrition, viral and other infections, and prematurity) or during the birth process.
Examples of the latter include trauma to the head incurred duringthe process of birth, placenta previa or premature separation of the placenta, and prolapse of the umbilical cord.
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General Medical Conditions Acquired in Infancy or Childhood
General medical conditions acquired during infancy or childhood account for approximately 5 percent of cases
They include infections, such as meningitis and encephalitis; poisonings, such as from insecticides,
medications, and lead; physical trauma, such as head injuries,
asphyxiation, and hyperpyrexia
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Environmental Influences and Other Mental Disorders
Between 15 and 20 percent of cases of mental retardation are attributed to deprivation of nurturance and social, linguistic, and other stimulation, and to severe mental disorders, such as autistic disorder
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Disorders Frequent Among Mentally RetardedA.. Physical Disorders
Sensory Disorders (about 20%) Motor Disorders
Psychiatric Disorders (all varieties)SchizophreniaMood DisordersNeurosispersonality Disorders Organic Psychiatric DisordersAutism and Over activity syndromes Behavior
DisordersSexual Problems
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Causes of M.RPrenatal causes
InfectionsPhysical DamageIntoxicationsPlacental dysfunctionEndocrine disorders
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Intranatal causesBirth asphyxiaProlonged or difficult birthPrematurityKernicterusInstrumental delivery
Postnatal DamageInjuryInfectionIntoxication
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Genetic causesChromosomal Abnormalities
Down’s syndromeKlinefelter’s syndromeFragile – X – syndromeTrisomy – 21Turner’s syndrome
Metabolic DisordersAmino acidsLipids CarbohydratesPurines-Lesch-NyansyndromeUrea cycleMucopolysaccharidesMiscellaneous
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Gross Disease of Brain Tuberous sclerosis Neurofibromatosis Epilepsy
Cranial Malformations Hydrocephaly Microcephaly
Sociocultural Causes Deprivation of sociocultural stimulation
Psychiatric Conditions Autistic disorder Rett's syndrome Childhood-onset schizophrenia Asperger's syndrome
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Clinical PictureMouth - small mouth and teeth, furrowed
tongue (longitudinal cracks and grooves over the tounge), high arched palate.
Eyes-oblique palpebral fissures, epicanthic foldsHead – flat occiputHands – short and broad, curved with fingers,
single transverse crease (single crease extends across the palm of the hand ).
Joints – hyper extensibility or hyper flexibility, hypotonia (low muscle tone), poor Moro reflex
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Effects of Mental Retardation on the FamilyDistress, feelings of rejection. Depression, guilt, shame or angerRejection of child.Overindulgence.Social problems.Marital disharmony (in some).Burden of care for their child.Dissatisfaction about medical and social
services (even when they are normal).
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Diagnosis of mental retardationHistoryGeneral Physical ExaminationDetailed Neurological ExaminationMental Status ExaminationInvestigations
RoutineUrine examinationBlood TestChromosomal StudiesEndocrinolLiver Function testsEEGCTScan of BrainDevelopmental Assessment
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Differential DiagnosisDelayed maturationBlindness or other sensory defects.Childhood psychosis Childhood autismSevere neuroses.Systemic disorders with physical
handicap.Deprived children with insufficient
stimulation.Epilepsy.States due to the side effects of drugs
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Management of mental retardation
1. Primary Prevention2. Secondary Prevention3. Tertiary Prevention
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Primary PreventionHealth Promotion
Good antenatal care and encouraging deliveries in hospitals under proper supervision and care
Improving the socioeconomic status of the country.
Education of the public to help in early detection of mental retardation and also, to, remove various misconceptions about its causes and treatment.
Facilitating research to identify the causes, and to invent new methods of treatment.
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Cont………….Specific Protection
Good parental, natal and postnatal care the pregnant mothers at risk.
Genetic counseling to at risk patients Avoiding childbirths in late age of the motherAvoiding consanguinal marriagesAvoiding marriages of mentally retarded
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Secondary Prevention (Early Diagnosis and Treatment)
Early detection and treatment of the preventable disorders
Amniocentesis and medial termination of pregnancy on medical grounds.
Early detection of correctable disorders.Prevent them against abuse
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Tertiary Prevention
Disability LimitationTreatment of physical and psychological
problems Institutionalization of severe mentally
retarded or those with psychological problems.
Education (if educable) and training to avoid handicaps.
Physiotherapy to treat the associated deficits.
Rehabilitation
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Counseling to ParentsThe causation, prognosis of mental
retardation.To educate mothers and families in caring
for the mentally handicappedSpecial supervision for the physically
handicapped or those severely and profoundly men tally retarded.
Treatment of psychological problems in parents.
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HospitalizationIndications
Attention deficit disorders with hyperkinesis
destructive, assaultive behavior.PsychosisOrganic psychosis
Social factorsOver crowdingIncompetent parentsMentally retarded or psychotic parentsSingle parenthoodNo one to look after
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Nursing managementImpaired verbal communication related to
delayed development of milestones.Attention deficit related to mental
retardation impaired cognitive function.Self care deficit by difficulty in grooming,
nutrition, hygiene related to impaired cognitive functions.
Impaired health maintenance related to cognitive impairment
Social isolation related to impaired personal relationships
Ineffective coping related to mentally retarded child.
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Reference Dr.K.Lalitha,”MENTAL HEALTH AND PSYCHIATRIC NURSING AN INDIAN PERSPECTIVE”, 2nd edition, Bangalore: V.M.G. Book House, 2008,pg no:529-534
Dr.Kapoor.B, “ TEXTBOOK OF PSYCHIATRIC NURSING”, vol II, 1st edition,Delhi: Kumar publishing house,2006, pg
no:208-213
Sreevani R, “A Guide To Mental Health Psychiatric Nursing”, 2nd edition, Jaypee publication, New Delhi. Pg no. 104-108
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Assignment Define mental retardation.
Explain about the classification of M.R
List down the causes of M.R
List down the steps involved in the management of M.R
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Thank You