Differences between Developmental Disorders & Mental Disorders

and What Do We Do in Cefn

Carnau ?!Dr khalid MansourPriory Cefn Carnau

Development

Development

1- Adult Brain Abilities / Skills

3- Nurturing (Environmental Stimulation)

2- Biological Development (Maturity)

1- Child Brain Abilities / Skills

Basic Brain Abilities / Skills• Major Systems:

• Object related (physical) intelligence.• Emotional intelligence.• Social intelligence.

• Subsystems:• Temperament • Resilience• Problem Solving• Self-sufficiency• Self-stimulation• Central Coherence

Object-Related (Physical) Intelligence

• Managing objects and/or physical environment.

• Budgeting, Travelling, Cleaning, Cooking, etc.

• Usually measured by IQ.

Emotional Intelligence•Ability to appreciate and treat oneself and others as individuals:• Insight (self awareness / self observation)

• Empathy (theory of mind)

• > positive personal relationships

Social Intelligence

Ability to interact with abstract parts of society > fitting well in the wider society :

•Law, Social Norms.•Government, Police, Social Services.

•Society, Country, Nation, humanity.

Brother, friend, mate, partner: Emotional Intelligence

People in society not known personally: Social Intelligence

Basic Brain Functions: Subsystems:

• Positive Temperament vs Negative Temperament

• Resilience vs Despondence• Problem Solving vs Vulnerability• Self Sufficiency vs Dependence• Self Stimulation vs Irritability • Central Coherence vs Awkwardness

2- Maturity

3- Nurture •Family•Environment

•Neglect / Deprivation

•Abuse •Culture•Trauma

Patterns of Development

NOT Adult Brain Systems / Subsystems

X Nurturing

(Environmental Stimulation)

X Biological Development (Maturity)

Child Brain Systems / Subsystems

Normal Development Adult Functioning

illness development

illness development

illness development

Child Functioning

MaturityRegression

Consistent / Pervasive Developmental Disorders

Adult functioning

Childish Functioning

Irregular Developmental Disorders

Differences between Developmental Disorders & Mental Disorders

4- Developmental Dis. & Acquired Mental Illness

Developmental Dis. & Acquired Mental Illness

Differences:•Baseline.•Functionality •Saved parts •Potential for recovery•Speed of recovery•Rehabilitation

What do we do in Cefn Carnau

1. Assessment2. Admission3. Care4. Treatment5. Risk

management6. Discharge

Assessment

Developmental Disorders (Mental):• Two main categories:

• Specific DD (e.g. dyslexia, dyscalculia, speech disorders, etc.

• Pervasive DD (e.g. Mental Retardation (Learning Difficulties) or Autistic Spectrum Disorders)

• All frequently seen in chronic mental health services

Developmental Disorders in Cefn Caranu

•Primary Developmental Disorders > Challenging Behaviour (Secondary Mental Disorders) + High Risk (to others).

•Atypical presentations from mental illnesses without developmental disorders.

Diagnosis:• History taking (client and carers).

• Cross-sectional mental and behavioural assessment

• Observation / Monitoring • Psychometric tests • Investigations.• Formulations • Therapeutic Trials.

Clinical Assessments:• Still the main systems in use >

• Diagnostic criterial and

classifications > vague• Open to Disagreement

• Subjective / Elective

methods unavoidable. • Funding issues.• Need multiple professional

agreement

Psychometric Assessment

• Expensive, time consuming and hard

to find • Heavily dependent on client

cooperation • Relatively of limited specificity and low

sensitivity (↑ False +ve and False –ve)• Limited in scope (Not as good in

suggesting differential diagnosis)• Most services demand confirmations

via clinical assessment especially by a

doctor

Causes of Challenging Behaviour:

Higher sensitivity to: •Physical health factors. •Environmental factors.

•Abuse / Neglect •Vulnerability factors

•Communication problems

Admission

Criteria for Admission:

•A Section of MHA.•Pose significant risk to others (not to oneself).

•Similar level of functioning•Primarily problem > Developmental Disorders

•Main need > structured care > protective environment

Management: Care

Principles of Care:

Multi-dimensional principle:

•Physical, •Emotional,•Social.

Maturity - Regression Principle: • Based on levels

of development.• Prevention of

regression principle.

• Reaching the maximum of one’s potential.

• Individualisation of care

• Normalisation of care

Principles of Care:• The Family Principle:

•Human factor•Unconditional care •High Predictability & Consistency.

•Clear structure.•High Promotion of development

• Group work:• Multidimensional:

• Behavioural, medical, physical, psychological, social, occupational, educational

• Not easy:• Communication.• Leadership.• Internal structure.• Support system.

Principles of Care: the Multidisciplinary Team

Management: Treatment

Treatments: Traditional but Comprehensive:• Physical Medicine: GP, Neurologist, Dentist • Mental Health Medications• Behavioural • Relational • Psychotherapy• Occupational • Educational • Social work • SALT• Physiotherapy• Genetic Counselling

Treatments General:

Packages: •Syndromic•Non-syndromic.

Not as specific: •Less RCTs on medications in Developmental Disorders > More side effects.

•Other TTs similar

Treatments:• Tailored • Individualistic• Multidimensional • Strong non-chemical component

• Experimental • Slower• More expensive

Risk Management

Risk Management:Internal factors:• Insight: functional is enough• Coping:

• Internal: coping with weaknesses.• External: ability to use external help.

• Life-style: • Structure: learning, structured activity, work,

etc • Fulfilment: Personal choices, Hobbies,

qualifications, etc

Risk Management:External factors:• Environment:

• Physical environment: e.g. housing, travelling, finance, etc.

• Personal / practical: carers• Socio-emotional: family,

friends, relationships.• Supervision• Support• Boundaries: e.g. Sections MHA,

CTO, etc

Discharge

Discharge: General Considerations

•Secure setting is not normal > exceptional setting.

•We can not continue without providing the justification.

•Discharge from secure setting is not discharge from treatment or care.

Discharge: General Considerations• high vulnerability to relapses.• Behavioural Improvement does

not always means dischargeable• None-transferable improvement

vs transferable improvement • Less vulnerability• Effective external care/ttt.• Real target > stop patients coming

back

Additional Tasks • Working with families.• Engagement of the Public.• Working with the media.• Complaints and litigations.

• Departmental and non-departmental regulatory and inspection bodies.

• HIW• NHS• Commissioners• Tribunals

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