Vignette Number LD 01
Speciality:
Learning Disabilities
Date:
10 October 2001
Vignette:
A 40-year old patient with Down's syndrome had been living in a
residential home. Staff report a gradual deterioration in self care
and his ability to engage in everyday activities. He has become
irritable when interacting with peers. Relatives visit
regularly.
How would you go about assessing and managing this patient?
Suggested Probes:
- What investigations might be necessary?
- What difficulties might there be in mental state
examination?
- What environmental factors might be important?
- Need for comprehensive history to be taken from carers and
family.
- Physical examination to rule out concurrent infections.
- Demonstrate awareness of affective/psychotic/organic aetiology
including epilepsy, hypothyroidism, dementia in this group of
patients.
- Highlight difficulty in mental state examination/presentation
of illnesses and relevance of environmental factors.
- Need to convene case conference and consider management of
underlying cause of deterioration.