2. Understanding Mental Health Pt. I Flashcards
Why is an Understanding of Mental Health Issues Important?
•Prevalence
•Associated with behaviors or other conditions that impact dental health
• Substance use
• Poor diet
• Neglect of hygiene procedures
• Healthcare utilization (access, avoidance)
•Reduced Compliance with Dental or Medical Procedures •Psychotropic Medications may Interact with Dental Procedures
Why is this important?
• Mental health issues are very common. Maybe 1 in 5 meet the criteria for anxiety
disorder; dental situations can rise anxiety for patients.
• This is not only impt as a practitioner, but as a citizen, a coworker, a family member, etc.
• Often co-exist with ____, poor diet, neglect of hygiene procedures,
healthcare utilization.
• Might be harder for someone to take care of their teeth or to come in to their 6 months check up if their lack of mental health prevents them from keeping a job.
• Reduced ____ – behavioral consequences of mental health issues
• Complications with ____
substance abuse
compliance
medications
Clinical vs. “Sub-clinical” Presentations
Deviance
Distress
Dysfunction
Danger
____
____
Context/Situational ____
• The way mental health disorders are diagnosed is through: DSM (Diagnostic and Statistical Manual).
• The DSM like most medial classification puts you in category– you have this disorder or you don’t.
• The reality of these disorders is that it exists on a ____: anywhere from low to extreme.
• For ex: you may have dental anxiety, but there is a certain point where when you pass, its not normal– this is a clinical manifestation of anxiety, depression, etc.
• How do we make that determination?
• Is it really unusual? – ____: it’s not unusual for someone to be apprehensive about the dentist, but it is very unusual for someone to never brush their teeth or visit the dentist.
• Does the behavior cause suffering to the person? – ____: There are some mental health episodes like manic episodes where the pt feels good.
• Is the behavior ____? Causing impairment in significant areas of the person’s life like work, school, relationships, etc.
• Is it a ____ to themselves or others?
• Things are considered a clinical problem or warrant a diagnosis if there is significant ____ or
____. (main 2)
• But it is impt to recognize that we feel these things as part of our daily living: obsessive compulsive
behavior or intrusive thoughts.
frequency
duration
variation
spectrum deviance distress dysfunctional danger
distress
dysfunction
Levels of Analysis: Depression
Structural/institutional Social/interpersonal Behavioral • (e.g., decrease in \_\_\_\_ activities, hygiene, or \_\_\_\_ interaction) Mental/cognitive • (e.g., patterns of \_\_\_\_ thinking, information processing, thoughts of \_\_\_\_) Neurological/physiological Neurochemical Molecular
Take a look at the other examples!
pleasurable
social
dysfunctional
suicide
Overview of Anxiety Disorders (DSM-5)
Anxiety Disorders \_\_\_\_** Social Anxiety Disorder (Social Phobia) \_\_\_\_** Generalized Anxiety Disorder (GAD)
Obsessive-Compulsive and Related Disorders
Obsessive Compulsive Disorder (OCD)
Body Dysmorphic Disorder
Hoarding
Trauma and Stressor-Related Disorders
Post-Traumatic Stress Disorder (PTSD)
- What is anxiety? Anxiety is a response to a ____.
- Different anxiety disorders have central feature of anxiety but differ in their specific trigger.
- Specific phobia: ex- spiders, dentists, etc.
- Social anxiety disorder: social interaction in which you are likely to be ____, embarrassed, or scrutinized.
- Panic disorder: what’s the threat? The ____ is of having a panic attack.
- Generalized anxiety disorder (GAD): pervasive sense of ____.
• Obsessive-compulsive disorders:
• The threat in obsessive compulsive disorder (OCD) is an ____, the thought or
concern of having that thought is having the source of that anxiety.
• For example: Touching the pole will contaminate me b/c everyone’s hands have been on
that pole. So I must go wash my hands. Intrusive thought: contamination.
• Body dysmorphic disorder: I am physically distorted/disfigured/unattractive in some way.
Even tho person has no visible significant deformity.
• Hoarding: people have a problem discarding items.
• PTSD: the threat is that the person has experienced a traumatic situation and anything that reminds them of that situation (i.e. loud noises, ppl who resemble attackers) may trigger anxiety, causing person to relive that threat over again.
These two are most encountered in dental practice.
specific phobia panic-disorder (and agoraphobia) threat evaluated fear worry
intrusive thought
Implications of Anxiety for Dental Practice
Prevalence – approximately ____% of the population has dental anxiety
Factors During the Dental Visit
• Panic
• Experience of pain
Factors Outside of the Dental Visit
• Avoidance
• Adherence
• About 15% of the population has dental anxiety. To the point where they’re avoiding the dentist to some extent.
• A lot of things in the dental environment might trigger panic and elicit an intense anxiety response.
• Anxiety can exacerbate the perception of pain and make it feel ____.
• Understanding anxiety is going to help you see if patients are ____ coming to you and if they are
____ to their treatment plan.
15
worse
avoiding
adhering
The Nature of Fear and Panic
Primary Function is to \_\_\_\_ the organism A response to danger or threat ◦ \_\_\_\_ Alarm ◦ \_\_\_\_ Alarm ◦ \_\_\_\_ Alarm
• Anxiety is sort of this threat response; worrying is about the future, and panic is about the present.
• When people have anxiety attacks, it’s extremely ____ and is a response to threat or
danger.
• Although it feels unpleasant, anxiety is good because it is your body trying to protect you…
• How does feeling sick to your stomach help you (common symptom of panic)? How would this feeling of nausea help you in dangerous situations?
• It doesn’t help you directly. Nausea is a byproduct of your blood rushing to your big ____ and away from digestion.
- However, there could be a False alarm (no true burglar just some wind), but your body has the same reactions to these perceived threats. Doesn’t matter if its real or not.
- Learned alarm: in Panic Disorders, you start to have these ____ alarm and have this panicked response in presence of a specific stimuli.
- For ex: a specific song was playing while your house was burning down, and every time I hear this song, it triggers this response.
true
false
learned
distressing
muscles
conditioned
Panic Attacks
•____ Nervous System
•Symptoms
•Can occur in a range of ____ disorders**
• The fight or flight response is a function of the ANS.
• ANS: sympathetic division goal is to prepare you for action; initiates an alarm response with the
symptoms we talked about previously.
• The parasympathetic system goal is to rest and digest, to bring you back to normal. Your body will do that automatically. But it doesn’t feel that way.
• A panic attack can occur in a wide range of anxiety disorders(so not only in ____ disorders but
also in): ____, specific phobia disorders, outside of anxiety disorders, etc.
autonomic
anxiety
panic
OCD
DSM-5 Diagnosis: Panic Disorder
____ unexpected panic attacks
At least one attack followed by ≥ one month of
Persistent ____ or worry about additional attacks or consequences
Significant ____ change in behavior
Not due to ____ effects of substance
Rule out other mental disorders (What is the nature of the avoidance?)
What is panic disorder?
• Recurrent unexpected panic attacks. Someone who has had a series of false alarms, and is really worried about having another one.
• For ex: you might be driving on the Schuylkill road and have a full blown panic attack with the
heart racing, chest tightening, heaving, might feel like you’re having a heart attack. Pull over. You might get checked out in the ER. Next time you’re driving the same road and you’re thinking about that last time and you having another panic attack, that worry might elicit that panic response, and you have now formed a learned response. Your presence on the Schuylkill Road might trigger another panic attack. A person with panic disorder lives in persistent fear of having another panic attack. Panic disorder is a fear of the symptoms of a panic attack.
• Panic disorder is not due to other substance or from other ____ disorders.
recurrent concern maladaptive physiological mental
Clinical Features of Panic Disorder
•____ alarms and Learned Alarms
•Why are these symptoms occurring?**
•Appraisals and Misappraisals (search for ____)
•Fear of symptoms (____ sensitivity)
•Conditions that may induce autonomic arousal?
•Specific aspects of dental context?
- The real key is that people with panic disorder misinterpret why their symptoms are occurring.
- ____: The fact that my heart is beating fast must mean there is something wrong with me. I’m going to lose control. There must be a medical reason why I’m feeling this way.
- Anxiety sensitivity – fear of fear
- What other conditions that cause autonomic arousal?
- ____! So sometimes, exercise can cause a panic attack.
- Drugs.
- Caffeine – tea, coffee.
- In a dental setting – ____, about to get injected by a needle.
false
danger
anxiety
misappraisal
exercise
epinephrine
DSM-5 Diagnosis: Specific Phobia
A. Marked fear or anxiety about specific object or situation
B. Phobic object or situation almost always provokes ____ fear or
anxiety
C. Phobic object or situation actively avoided or endured with intense distress
D. Fear or anxiety is out of proportion to actual danger
E. Fear or anxiety is ____ (typically > ____ mos.)
F. Causes clinically significant ____ or impairment
G. Not ____ explained by other conditions (e.g., other anxiety disorder)
- Specific phobia is a fear of a specific object or situation (ie snakes, heights, closed spaces, etc).
- The phobia object causes immediate fear or terror.
- Fear of the dentist has broader health consequences.
- The specific fear is out of proportion to the actual danger.
immediate persistent 6 distress better
Specific Phobia: Subtypes
•Animal
•Natural environment (e.g., heights,
storms, water)
•Blood-Injection-injury
•Situational (e.g., planes, elevators, enclosed places)
•Other (e.g., situations that may lead to choking, clowns)
Blood-Injection Injury Type • Physiological reaction may differ from other phobias • May see drop in \_\_\_\_ • Strong vasovagal response runs in \_\_\_\_ • Includes Dental Phobia...BUT
• Different types of specific phobia.
• We will focus on blood-injection-injury b/c that’s most relevant to dentists.
• Most fear responses = autonomic arousal = ____ increases, etc.
• Ppl with blood-injection-injury subtype have a different reaction:
•
They may actually see a drop in ____. There’s a history in their families of strong vasovagal response– including dental phobia.. However, research suggests (next slide)
blood pressure and heart rate
families
HR
HR
Blood-Injection Injury vs. Dental Phobia
Blood-Injection Injury Type
• Feared stimuli (blood, needles, wounds)
• Physiological reaction may differ from other phobias
• May see ____ in blood pressure and heart rate (after initial increase)
• Strong vasovagal response runs in families
Dental Phobia
•____ in BP; less likely to faint
•More concern over loss of ____ than blood or injection
•Feared stimulus; more likely to be sounds of aerator and broader treatment setting
• Research suggests they might be different things:
• People with blood-injection injury type have a fear triggered by specific injection related
stimuli– blood, needles, wounds.
• May see an initial increase briefly in BP and then a drop àfaint.
• People with dental phobia- the fear could be a wider range of things like the smell of the office, the sound of the aerator, sight of the dentist or equipments, etc.
• May see increase in BP. Fear is loss of control.
• There is a little bit of overlap, but these two fears are two ____ things.
drop
increase
control
different
Etiology of Anxiety Disorders
Triple Vulnerability Model
Generalized Biological Vulnerability
◦ Evidence for specific vs. general risk based on twin studies & family studies
◦ ____ of brain circuits related to anxiety
◦ Behavioral Inhibition System (BIS) -Triggered by signals for ____, non reward, novelty/unexpected events; brain stem to ____ and hippocampal area of limbic system to the ____ cortex
◦ Fight/Flight System – immediate alarm response; brain stem to ____ to hypothalamus to ____ matter
General Psychological Vulnerability
◦ Tendency toward seeing threats or danger as ____ and unpredictable
◦ ____ and cognitive bias (attention bias, interpretation bias)
Specific Psychological Vulnerability
◦ Specific focus of anxiety grows out of early experiences – ____ what is dangerous
hypersensitivity
punishment
septal
frontal
amygdala
central gray
uncontrollable
hypervigilance
learning
Etiology of Anxiety Disorders
What causes anxiety disorders?
• The prevailing explanation is that there are three levels of vulnerabilities to anxiety.
• 1. Generalized Biological Vulnerability- evidence that some ppl start with a level of ____ to all forms of anxiety. That your biological response to threat or stress is elevated; start off with a higher baseline. Some people have a higher response to stress.
• Behavioral inhibition system (BIS) – tendency to ____ for threat and be responsive to threat in your environment; some ppl have a higher baseline of paying ____ to threats. If all those anxiety disorders are caused by threat, if you start out with a hypersensitivity to perceive threat, you are more vulnerable to start with.
• Anxiety disorders run in families.
• 2. General Psychological Vulnerability- tendency to seeing the world as a ____ and
unpredictable. You’re more vulnerable to perceiving threats.
• Research shows that people with this vulnerability tend to ____ on the threats more than others. For ex, ppl with anxiety disorders tend to focus in first and most quickly to threatening words than other ppl w/o anxiety disorders.
First one: I’m responding ____ more readily to threats.
Second one: I’m seeing the world more ____ and more threatening and less under my control. People with these vulnerabilities are more likely to develop some form of anxiety.
vulnerability search attention dangerous focus
biologically
dangerous
Etiology of Anxiety Disorders
- Specific Psychological Vulnerability- determines what specific ____ of threat seems to be driving their anxieties.
- I’m more vulnerable to react to stress general and biological. I tend to notice threats more readily than other ppl and I had a really bad experience with the dentist -> ____ PHOBIA
- Experiences that shape what we label as dangerous. Some of us may label thoughts as dangerous while others may label being scrutinized or embarrassed as dangerous.
form
dental
