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bds3 bams > Depression, Psychosis and Personality Disorders > Flashcards

Depression, Psychosis and Personality Disorders Flashcards

1
Q

What are mood disorders also known as?

A
  • Affective disorders
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2
Q

How may mood disorders present to the dentist?

A
  • Very rare
  • Oral effects (in somatiform disorders)
  • Dysesthesias
  • Facial pain
  • Patients general demeanour
  • Need to consider whether it is appropriate to treat someone in their depression phase as can they consent efficiently
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3
Q

How on the spectrum is termed normal mood?

A
  • Termed Cyclothymia
  • Range from Elation, normal to Dysthmia
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4
Q

How can people with depressive disorder present with on the spectrum?

A
  • Mild depression all the way to sever depression with psychosis (extreme)
  • If patient flutters between normal and depressive this is termed Recurrent depressive disorder
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5
Q

How does Bipolar affective disorder present on the spectrum?

A
  • Ranges all the way along the spectrum
  • Can present with Mania with psychosis - normal - sever depression with psychosis
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6
Q

What are the names of the changes in mood on the spectrum?

A
  • Normal mood swings
  • Cyclothymic temperament
  • Cyclothymic disorder
  • Bipolar type II disorder
  • Monopolar mania
  • Bipolar type 1 disorder
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7
Q

How common are mood disorders?

A
  • Female: Male 2-3:1
  • Unipolar has 6% prevalence
  • Bipolar has life prevalence of 1.2%
  • Post natal depression occurs 0.5/1000 in one month (if has it with one baby more likely to have with another)
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8
Q

What are the common types of depressive mood disorders?

A
  • Major depressive disorder
  • Persistent depressive disorder
  • Bipolar depression
  • Postpartum depression
  • Premenstrual dysphoric disorder
  • Seasonal affective disorder
  • Atypical depression
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9
Q

What are the common symptoms of depression?

A
  • Low mood
  • Reduces interest and motivation
  • Lethargy and tiredness
  • Sleep disturbance
  • Appetite disturbance
  • Poor concentration
  • Loss of confidence and self esteem
  • Recurrent thoughts of death and suicide (ask whether they have to detect the ones who are acc considering it)
  • Unreasonable self-reproach and guilt
  • Any form of anxiety
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10
Q

How is bipolar classified?

A
  • Bipolar type 1 (mania)
  • Bipolar type 2 (Cyclothymia into hypomania)
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11
Q

What are the mania and hypomania symptoms?

A
  • Increased productivity and feeling of wellbeing
  • Reduced need for sleep
  • Gradual reduction in social functioning and occupational functioning
  • Increase in reckless behaviour
  • Followed by depressive episode
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12
Q

What are the symptoms of a Euphoric patient?

A
  • Upbeat
  • More talkative
  • Inflated self -esteem
  • Felt everything possible
  • Rapid speech
  • Restlessness
  • Reckless behaviour
  • Excessive energy
  • Decreased sleep
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13
Q

What are the symptoms of a Dysphoric patient?

A
  • Irritable
  • Agitated
  • Aggressive energy
  • Restlessness
  • Rage
  • Rapid speech
  • Reckless behaviour
  • Excessive energy
  • Decreased sleep
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14
Q

What are the treatments of mood disorders?

A
  • Combo is best option
    Psychological
  • Cognitive therapy
  • Interpersonal psychotherapies

Drug treatment
- Usually 2 years treatment or relapse occurs
- Antidepressant
- Mood stabilising

Physical
- Exercise
- Phototherapy for seasonal affect disorder
- ECT (mostly post natal depression)

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15
Q

What are some acute phase antidepressants drugs?

A
  • Selective serotonin reuptake inhibitor (SSRI)
  • Venlafaxine /Mirtazapine
  • Tricyclic antidepressants (TCA) (improve anxiety)
  • Monoamine oxidase inhibitor (MAOI)
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16
Q

What are some negatives of SSRI?

A
  • Give anxiety which is not great for depressive episode
  • Often feel like they have to rely on drug and can’t stop
  • Combine with tricyclic to reduce anxiety
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17
Q

What are some mood stabilising drugs?

A
  • Lithium
  • Carbamazepine
  • Sodium Valproate
  • Lamotrigine
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18
Q

Why is the patient taking an antidepressant?

A
  • Not always used to treat depression so need to ask patient
  • Treat depression
  • Treat anxiety disorder including OCD and panic attacks
  • Pain relief
  • Help psychological treatments
  • Promote learning of new behaviours
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19
Q

What are the Tricyclic antidepressants names?

A

Original
- Amitriptyline, Nortriptyline, Dosulepin
New
- Imipramine, Doxepin

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20
Q

What are some side effects of Tricyclic antidepressants?

A
  • Dry mouth
  • Sedation (so take at night)
  • Weight gain (reduction in feeling full)
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21
Q

What patients do you need to be cautious with when prescribing Tricyclic antidepressants?

A
  • Glaucoma and Prostatism
  • Cause rise in eye pressure and blockage of urine output
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22
Q

What are SSRIs?

A
  • Popular brand is Prozac
    Other inc
  • Fluoxetine, paroxetine, fluvoxamine
  • Citalopram, Setraline
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23
Q

What are the side effects of SSRI’s?

A
  • Acute anxiety disorders
  • Sedation
  • Dry mouth
  • Gastrointestinal upset
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24
Q

What are Monoamine oxidase inhibitors?

A
  • MAOI
  • Phenelzine
  • Isocarboxazid
  • Selegeline
25
Q

What are the interactions of MAOIs?

A

Indirect acting sympathomimetic amines e.g. ephedrine
- Has enhanced vasoconstrictor effect
- Cold and cough remedies

Foodstuffs
- Tyramine containing products like alcohol/low alcohol, bovril/oxo/marmite, cheese, herring, beans
- Patients can’t be given these drugs unless they understand the threat to their life if eating these

26
Q

What are some other drugs that can be used as antidepressants but not usually started by a GP but a Psychiatrist?

A
  • Venlafaxine
  • Mirtazapine
  • Nefazadone
  • Reboxetine
27
Q

What should you avoid if prescribing Lithium?

A
  • NSAIDs
  • Metronidazole
28
Q

What antipsychotic medicines can be given to treat episodes of mania?

A
  • Aripiprazole
  • Olanzapine
  • Quetiapine
  • Risperidone
29
Q

What are the direct drug effects of antidepressants in dentistry?

A
  • Dry mouth which can ultimately cause caries
  • Sedation
  • Facial dyskinesias (uncontrollable facial twitches)
30
Q

What are Psychoses?

A
  • Perceptual abnormalities
  • Can be manic depression
  • Schizophrenia
  • Korsakoff’s Psychosis (alcohol induced brain degeneration)
  • Difficult to treat in dentistry during acute episodes
31
Q

What are the drug effects of Psychoses meds?

A
  • Dry mouth
  • Drug interactions
  • Dyskinesia (tonic or dystonia)
32
Q

What is Schizoprenia?

A
  • Thought disorder
  • Fundamental and characteristic distortions of thinking and perception
  • Various types of delusion (sometimes bizarre)
  • Auditory hallucinations which are often threatening and derogatory
33
Q

What does Schizophrenia include?

A
  • Relapsing and remitting periods of acute psychosis
  • Cumulative, chronic deficits in motivational, affective and social domains
34
Q

Why does Schizophrenia occur?

A

Genetic susceptibility - multigene
Environmental - potential risk factors
Drug abuse - Cocaine, amphetamine, ectasy, opiate
- Prevalence is 1-2%

35
Q

How is Schizophrenia managed?

A

Psychological therapy
- CBT
- Cognitive remediation
- Family intervention

Drug therapy
- Oral or depot IM injection (issue with compliance and frequency of requirement as they may not see themselves with an illness or anything wrong)
- Dopamine antagonist drugs
- Atypical antipsychotics

36
Q

What side effects can dopamine antagonist drugs cause?

A
  • Cause extrapyramidal side effects like inability to sit still, involuntary muscle contraction, involuntary facial movements
  • Sedation
  • Dry mouth
  • Atypical antipsychotics preferred as less likely to produce these side effects
37
Q

What are some older antipsychotic drugs used?

A
  • Butyrophenones
  • Phenothiazines
  • Thioxanthenes
38
Q

What are some new atypical antipsychotics drugs?

A
  • Sulpiride
  • Respiridone
  • Clozapine
  • Quetiapine
  • Aripiprazole
  • Olanzapine
39
Q

What are some extrapyramidal side effects of antipsychotics?

A
  • Akathisia
  • Dystonia
  • Parkinsonism
  • Tardive dyskinesia (only one that doesn’t go away if medicine stopped)
40
Q

What is Dystonia?

A
  • Muscles involuntary contract and contort leading to painful positions and movement
41
Q

What is Akathisia?

A
  • Restlessness, hard to sit still or down
  • Tapping fingers, rocking, crossing and uncrossing legs
42
Q

What is Parkinsonism?

A
  • Same as Parkinson’s but caused by meds not disease
  • Tremor, slower thought process, slower movements, rigid muscles , facial stiffness
43
Q

What is tardive dyskinesia?

A
  • Uncontrollable facial movements like sucking or chewing, lip smacking, sticking tongue out
  • Does not go away if medicine stopped
44
Q

How are extrapyramidal symptoms treated?

A
  • Use atypical antipsychotic instead
  • Use beta-adrenergic blockers (Propanolol/Metropolol)
  • Anticholinergics to reduce effect of acytlycholine e.g. Benxtropine (Dry mouth)
45
Q

What is anorexia nervosa?

A
  • Altered perception of body image
  • Don’t eat
  • oral effects of malnutrition inc ulcers, dry mouth, infections, bleeding gums
46
Q

What is Bulimia?

A
  • Normal weight
  • Tend to binge/vomit
  • Use laxatives, excessive exercise, diuretics
  • Comfort eating as maybe stress reaction
  • Dental erosion and oesophageal stricture
47
Q

What is comfort eating?

A
  • Eating out of comfort of anxiety
48
Q

What are the variations of personality types?

A
  • Overachiever
  • Dramatic
  • Daydreamer
  • Worrier
  • Isolated introvert
  • Perfectionist
49
Q

What are the different personality disorders?

A
  • Borderline personality disorder
  • Antisocial personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder
  • Avoidant personality disorder
  • Dependent personality disorder
  • Schizoid personality disorder
50
Q

What is borderline personality disorder?

A
  • Instability in interpersonal relationships, self image and affects and marked impulsivity
51
Q

What is antisocial personality disorder?

A
  • Disregard for and violation of rights of others?
52
Q

What is Histrionic personality disorder?

A
  • Excessive emotionality and attention seeking
53
Q

What is narcissistic personality disorder?

A
  • Grandiosity, need for admiration, lack of empathy
54
Q

What is avoidant personality disorder?

A
  • Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
55
Q

What is dependent personality disorder?

A
  • Submissive and clinging behaviour related to excessive need to be taken of
56
Q

What is Schizoid personality disorder?

A
  • Detachment from social relationships and restricted range of emotional expression
57
Q

What are some symptoms of borderline personality disorder?

A
  • Deep fear
  • Very black or white thinking
  • Stress paranoia
  • Unstable relationships
  • Changes in self image
  • Impulsive behaviour
  • Suicidal threats
  • Excessive mood swings
  • Feelings of solitude
58
Q

What are the subtypes of borderline personality disorder?

A
  • Discouraged borderline
  • Impulsive borderline
  • Petulant borderline
  • Self-destructive borderline

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