4. Psychiatric Conditions Flashcards
What legislation is in place to protect those with mental health conditions ?
Mental Health Act Scotland 2003.
What does Mental Health Act Scotland 2003 allow ?
Allows compulsory detainment for treatment of mental health problem/psychiatric disorders (with no provision for compulsory treatment of physical problems).
What are the 3 types of legal detainment included in Mental Health Act Scotland 2003 ? And for how long will patient remain in detention ?
Emergency detention for 72 hours.
Short term detention for 28 days.
Compulsory treatment order for 6 months.
What are the 4 principles of the Mental Health Act Scotland 2003 ?
- Person has mental disorder.
- Medical treatment available which could stop progression of condition or treat some of their symptoms.
- If treatment not provides, significant risk to person or others.
- Ability to make decisions about medical treatment is significantly impaired.
Why is detainment for personality disorders inappropriate ?
No effective treatment available for condition.
What is the difference between neurosis and psychosis ?
Neurosis - contact retained with reality.
Psychosis - contact lost with reality.
What are two types of neuroses relevant to dentistry ?
Anxiety states and phobias.
What are the 5 subtypes of neuroses ?
Anxiety, phobic, obsessional, hypochondriacal, depressive.
What are the 3 subtypes of anxiety disorders ?
Generalised anxiety disorder.
Phobic anxiety.
Panic disorder.
What is the definition of somatoform disorders ?
Manifestation of condition which does not appear medically or pathologically.
What are management strategies for anxiety disorders ?
Psycho-education.
Anxiety management strategies.
Cognitive behavioural therapy.
Prescribed medication - benzodiazepines, antidepressants.
What are 4 types of benzodiazepines ?
Diazepam.
Midazolam.
Temazepam.
Lorazepam.
What are 3 types of antidepressant medication ?
Tricyclic antidepressants.
Mirtazepine.
SSRI.
What is an example of tricyclic antidepressant ? And how does it work ?
Amitriptyline.
Block the re-uptake of serotonin and norepinephrine in presynaptic terminals, which leads to increased concentration of these neurotransmitters in the synaptic cleft.
How does mirtazepine work ?
Increases serotonin and noradrenaline in brain.
What is examples of selective serotonin re-uptake inhibitors (SSRIs) ?
Fluoxetine.
Sertraline.
Citalopram.
What are 3 dental aspects of anxiety neurosis ?
TMD and parafunction.
Oral dysaesthesias - dry, burning mouth or facial pain.
Denture intolerance.
Define cyclothymia.
Normal mood swings.
List common symptoms of depression.
Low mood.
Reduced interest and motivation.
Lethargy and tiredness.
Sleep disturbance.
Appetite disturbance.
Poor concentration.
Loss of confidence and self-esteem.
Recurrent thoughts of death and suicide.
Unreasonable self-reproach and guilt.
Forms of anxiety.
List symptoms of hypomania and mania.
Increased productivity and feeling of wellbeing.
Reduced need of sleep.
Gradual reduction in social and occupational functioning.
Increase in reckless behaviour - drugs, driving fast.
Followed by period of depression.
Define bipolar type 1.
Mania to depression.
Define bipolar type 2.
Cyclothymia to hypomania.
How long usually is drug treatment for mood disorders sustained for ?
> 2 years (before, increased risk of relapse).
What are drugs used in acute phase of mood disorders ?
SSRIs.
Venalfaxine and mirtazepine - second line.
Tricyclic antidepressants.
MAOI - used when poorly controlled.
What are mood stabilising drugs ?
Lithium.
Carbamazepine.
Valproate.
Lamotrigine.
What are dental side effects of tricyclic antidepressants ?
Dry mouth.
Sedation.
Weight gain.
What are dental side effects of SSRIs ?
Sedation.
Dry mouth.
Nausea and GI problems i.e. reflux.
Effects are less common compared with TCA.
What drugs should be avoided in patients taking lithium ?
NSAIDs and metronidazole.
Define schizophrenia.
Fundamental and characteristic distortions of thinking and perception due to multifactorial abnormality of dopaminergic neurotransmission causing cumulative, chronic deficits in motivational, affective and social domains.
Delusions can be auditory and visual.
What are 3 drugs given to patients with schizophrenia ?
Oral or depot IM injection i.e. prochlorperazine.
Dopamine antagonist drugs - un-selective dopamine blockers, more likely to cause extrapyramidal effects.
Atypical antipsychotic drugs/injections - preferred due to less likely to cause extrapyramidal side effects.
What are the 4 extrapyramidal side effects of antipsychotic drugs ?
Akathisia - restlessness.
Dystonia - involuntary contraction of muscles.
Parkinsonism - tremor, slower thought, slower movement, aphasia.
Tardive dyskinesia - uncontrollable facial movements.
What two drugs should be given to treat extrapyramidal symptoms from dopamine antagonist drugs ?
Beta blocker - propranolol, metropolol.
Antichlorinergics (reduces effect of acetylcholine) - procyclidine.
What is the consequence of dopamine antagonist drugs ?
Lead to relative acetylcholine excess resulting in extrapyramidal side effects.
What are dental signs of anorexia nervosa ?
Dry mouth.
Ulcers.
Infections.
Bleeding tendency.
