11 - Depression, psychoses and personality disorders Flashcards
What is cyclothymia?
- normal mood spectrum
- elation, normal mood and dysthymia
What is depressive disorder?
- unipolar disorder
- mild depression, moderate depression, severe depression, severe depression with psychosis
What is recurrent depressive disorder?
Normal mood, dysthymia, mild depression, moderate depression, severe depression, severe depression with psychosis
What is bipolar affective disorder?
Ranges from mania with psychosis to severe depression with psychosis
What is bipolar type I?
Experiences full range of emotions at their extremes
What is bipolar type II?
Experiences severe depression ± psychosis to hypomania
Give examples of depressive mood disorders.
- major depressive disorder
- persistent depressive disorder
- bipolar depression
- postpartum depression
- premenstrual dysphoric disorder
- seasonal affective disorder
- atypical depression
What are common symptoms of depression?
- low mood
- reduced motivation/interest
- lethargy
- sleep disturbance
- appetite disturbance
- poor concentration
- loss of confidence
- suicidal thoughts
- unreasonable guilt
- anxiety
What are common signs of mania and hypomania?
- increased productivity and feeling of wellbeing
- reduced need for sleep
- gradual reduction in social functioning and occupational functioning
- increase in reckless behaviour
- commonly followed by period of depression
What are the different treatment options for mood disorders?
- psychological
- drug therapy
- physical
Give examples of psychological treatment of mood disorders.
- CBT
- interpersonal pscyhotherapies
Describe the drug therapy regime for mood disorders.
- usually 2 year treatment
- antidepressant
- mood stabilising
Give examples of physical treatment of mood disorders.
- exercise
- phototherapy (SAD)
- ECT (post-partum)
What are acute phase antidepressants?
- SSRI (selective serotonin reuptake inhibitor)
- mirtazepine
- tricyclic antidepressant
- monoamine oxidase inhibitor
What are examples of mood stabilising drugs?
- lithium
- carbamazepine
- valproate
- lamotrigine
What can antidepressants be prescribed for?
- depression
- anxiety disorders
- pain relief
- aid psychological treatments
Give examples of TCAs.
- amitriptyline
- doxepin
What are side effects of TCAs?
- xerostomia
- sedation
- weight gain
Who should TCA be use with caution?
- glaucoma
- prostatism
Give examples of SSRIs.
- fluoxetine
- citalopram
- sertraline
What are side effects of SSRIs?
- acute anxiety disorders
- sedation
- xerostomia
- GI upset
Give examples of MAOIs.
- phenelzine
- selegeline
What are interactions associated with MAOIs?
- indirectly act on sympathomimetic amines which gives an enhanced vasoconstrictor effect
- interacts with some foodstuffs including alcohol, cheese and beans
What drugs are used to treat bipolar disorder?
- lithium
- carbamazepine or valproate
- aripiprazole/risperidone (antipsychotic drugs to treat mania)
What should you avoid when taking lithium?
- NSAIDs
- metronidazole
How can antidepressants affect dentistry?
- xerostomia
- caries (severe xerostomia when taking lithium)
- sedation
- facial dyskinesias (twitching)
- drug interactions
What are psychoses?
- perceptual abnormalities
- include manic depression, schizophrenia, Korsakoff’s psychosis
What is Korsakoff’s psychosis?
Alcohol induced brain degeneration
What is schizophrenia?
- thought disorder
- distortions of thinking and perception
- can have bizarre delusions that are “normal” to the patient
- can have auditory/visual hallucinations which can be threatening or derogatory
What causes schizophrenia?
- genetic
- perinatal factors can influence
- drug abuse (!!!) including cocaine, amphetamine, ecstasy, opiates and cannabis
How do you manage schizophrenia?
- CBT
- family intervention
- drug therapy
What drugs are used to treat schizophrenia?
- often IM injection due to problems with compliance
- dopamine antagonists
- atypical antipsychotics
What is an example of a dopamine antagonists?
Doperidol
What are examples of atypical antipsychotics?
- respiridone
- clozapine
What are extrapyramidal side effects that can be experienced when taking antipsychotics?
- akathisia (restlessness, tapping fingers etc)
- dystonia (involuntary contractions)
- Parkinsonism
- tardive dyskinesia (uncontrollable fiscal movements including lip smacking, do not stop when medication is stopped)
How do you treat extrapyramidal side effects?
- use atypical antipsychotics instead
- non-selective beta blockers (eg propranolol)
- anticholinergics (eg benztropine)
What is anorexia nervosa?
- altered body perception
- avoids eating
- presents in the oral cavity with ulcers, dry mouth, infections and bleeding due to malnutrition
What is bulimia?
- patient maintains a normal weight
- patient comfort eats as a reaction to stimuli (ie stress) and vomits food back up
- presents in the oral cavity with dental erosion on palatal surfaces and oesophageal strictures
What is a personality disorder?
- chronic peculiarities of character
- maladaptation to life
- often present with antisocial behaviour
