Question 11#

An 18-year-old man with learning disability has ectopia lentis, fair hair, long thin limbs, and osteoporosis. The most likely diagnosis is:

A. Phenylketonuria

B. Homocystinuria is a metabolic disorder characterized by an increased blood and urine concentration of amino acid homocysteine. Clinical features resemble Marfan syndrome; patients have ectopia lentis, chest and spinal deformities similar to Marfan syndrome. But changes in hair colour, osteoporosis, arterial and venous thrombosis, and learning disabilities are generally absent in patients with Marfan syndrome.

Reference:

1. Gelder MG, et al., eds. Shorter Oxford Textbook of Psychiatry, 5th edn. Oxford University Press, 2006, p. 715.

Question 12#

The social approach of providing a pattern of life as ordinary as possible for the learning disabled population is called:

A. Community rehabilitation

C. In the past, learning disability has been a cause for social rejection, with prejudiced labels such as ‘degeneracy’ associated with it. The so-called degenerates were isolated from the community, leading to the establishment of large mental institutions. The principle of normalization is seen by many as a reaction to the dehumanizing policies of the past. Normalization promotes independence and autonomy while making it possible for people with learning disabilities to have an ordinary life with the same choices and opportunities as everyone else. This shifts the focus from ‘disability’ to ‘differences in ability’.

Reference:

1. Gelder MG, et al., eds. Shorter Oxford Textbook of Psychiatry 5th edn. Oxford University Press, 2006, p. 722.

Question 13#

The proportion of the learning disabled population with an IQ in the range 50–70 is:

A. 10%

D. Nearly 85% of those with learning disability have an IQ in the range 50–70 (mild learning disability). Of the rest, nearly 10% have moderate learning disability with an IQ in the range 35–50 and around 5% have an IQ in the severe/profound learning disability range (less than 35).

Reference:

1. Gelder MG, et al., eds. Shorter Oxford Textbook of Psychiatry, 5th edn. Oxford University Press, 2006, p. 708.

Question 14#

A landmark epidemiological study in child psychiatry is the Isle of Wight study in the UK.

What was the nature of the original sample first studied?

A. A sub-sample of all children aged 5–13

D. Major epidemiological work in child psychiatry started with the Isle of Wight surveys between 1964 and 1974. The Isle of Wight surveys had a two-phase design, with a systematic questionnaire screening a large sample, followed by in-depth assessments of a sub-sample selected according to the results of screening. Multiple informants were used in both phases. All 9- to 11-year-old children attending state schools on the island were included in the primary survey. A 4-year follow-up was carried out for children identified with psychiatric problems when they were approximately 14 years old.

Reference:

1. Rutter M. Isle of Wight revisited: twenty-fi ve years of child psychiatric epidemiology. Journal of the American Academy of Child and Adolescent Psychiatry 1989; 28: 633–653.

Question 15#

The point prevalence of any ICD-10 disorders in 5- to 15-year-old children is estimated to be around:

A. 1%

C. Numerous cross-sectional epidemiological surveys have confirmed that psychopathology in young people is common, with most studies estimating the prevalence to be between 10% and 20%. In a study that included more than 10 000 children, overall rates of psychiatric disorders in 5- to 15-year-old children in UK was estimated to be around 9.5%. A review of 49 surveys worldwide indicated an average point prevalence of 12.9% for psychiatric disorders in children. Emotional disturbances and behavioural disorders are equally common. Only a small proportion – between 10% and 30% – of children with a psychiatric disorder make contact with specialist mental health services.

Reference:

1. Martin A, Volkmar FR, eds. Lewis’s Child and Adolescent Psychiatry: A Comprehensive Textbook, 4th edn. Lippincott Williams and Wilkins, 2007, p.164.