精神发育迟滞PPT课件.ppt
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1、精神发育迟滞(Mental Retardation,MR)定 义 精神发育迟滞是指个体在发育阶段(通常在18岁以前),由于先天的或后天的,生物学方面的或社会、心理方面的不利因素,使精神发育受阻或停滞,造成智力明显低于平均水平及社会适应困难。DefinitionsMental retardation are manifested by behaviors that deviate from norms for the particular sociocultural group and age.Have subnormal intellectual functioning and commens
2、urate deficits in adaptive functioning including capacities for social and personal sufficiency and independence.患 病 率一般人群中,MR患病率1%3%WHO(1985):轻度MR3%,重度34中国8省市014岁儿童(1988):1.2%;农村城市,男女湖南416岁儿童(1990):2.22%病 因遗传性异常:常染色体隐性遗传:如遗传代谢性疾病:苯丙酮尿症。常染色体显性遗传:结节性硬化症,神经纤维瘤病等。染色体畸变(结构和数目的改变)常染色体畸变:如Down Syndrome 性染
3、色体畸变:Klinefelter综合征,Turner综合征先天性颅脑畸形。母孕期有害因素的影响:感染:如风疹病毒等药物与毒性物质放射线照射母体健康情况母亲情绪因素围产期不利因素:早产、难产、产伤、窒 息、颅内出血等出生后不良因素:中枢神经系统感染、外 伤、缺氧、内分泌代谢 疾病、婴幼儿期严重营 养不良、缺乏文 化教育 机会 Mental Retardation Causes Estimated Cause Examples Frequency(%)Prenatal Genetic disorders 4.8 Chromosomal aberrations Down syndrome Singl
4、e-gene mutations Tuberous sclerosis,phenylketonuria and other metabolic disorders,fragile X syndrome Multifactorial Familial mental retardation Malformation syndromes Prader-Willi,Williams,and Angelman due to microdeletions syndromesMental Retardation CausesCongenital malformations 7.7 Malformations
5、 of the central Neural tube defects nervous system Multiple malformation Cornelia de Lange syndrome syndromes Estimated Cause Examples Frequency(%)Mental Retardation Causes Estimated Cause Examples Frequency(%)Exposure 5.3 Maternal infectionsCongenital rubella,HIV Teratogens Fetal alcohol syndrome T
6、oxemia,placentalPrematurity insufficiency Other Radiation,traumaMental Retardation Causes Estimated Cause Examples Frequency(%)Perinatal 2.0 Infections Meningitis Delivery problems Asphyxia Other HyperbilirubinemiaPostnatal 3.2 Infections Encephalitis Toxins Lead poisoning Other postnatal causes Tra
7、umas,brain tumors Psychosocial problems Poverty,psychotic illnessUnknown 30.0分级 按IQ水平分:轻度:5069;中度:3549;重度:2034;极重度:IQ20。轻度MR(7580%):IQ5069。语言功能较好,抽象思维、综合分析能力 较差;勉强小学毕业。日 常生活自理,可学会一技 之长。中度(12%左右):IQ3549。语言发育较差词 汇贫乏,不能完整表达思;数的概念模糊,不能计和 点数;学习能力低下。学 会简单的生活和工作技能,常需要别人帮助。常有体 异常。重度(78%):IQ2034。只能学会一些简单的 语言
8、有的不会说话;经过训练,能学会自己吃饭及基本卫生习惯,只能在监护下生活,不能进行生 产劳动。从小可发现躯体及神经 系统异常。极重度(12%):IQ20以下。无语言能力;对 周围环境及亲人不认识,仅 有原始情绪反应,以哭闹尖 叫表需求食物或不乐意;全 部生活需要人照料,出生时 即有明显的躯体畸形及神经 系统异常。诊 断 标 准智力明显低于同龄人的平均水平,在个别性智力测验时智商(IQ)低于人群均值2.0标准差,在70以下社会适应能力不足起病于18岁以前DSM-IV Diagnostic Criteria A.Significantly subaverage intellectual funct
9、ioning:an IQ of approximately 70 or below on an individually administered IQ test(for infants,a clinical judgment of significantly subaverage intellectual functioning).B.Concurrent deficits or impairments in present adaptive functioning(i.e.,the persons effectiveness in meeting the standards expecte
10、d for his or her age by his or her cultural group)in at least two of the following areas:communication,self-care,home living,social/interpersonal skills,use of community resources,self-direction,functional academic skills,work,leisure,health and safety.C.The onset is before age 18 years.Code based o
11、n degree of severity reflecting level of intellectual impairment:Mild mental retardation:IQ level 50.5 to approximately 70 Moderate retardation:IQ level 35.0 to 50.5 Severe mental retardation:IQ level 20.5 to 35.0 Profound mental retardation:IQ level below 20 or 25 Mental retardation,severity unspec
12、ified:when there is a strong presumption of mental retardation but the persons intelligence is untestable by standard testsCASEFred was the product of an uncomplicated pregnancy and delivery.Developmental milestones were remarkable for walking at 17 months of age,but slowness to talk and stammering,
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