4. Psychiatric Conditions

Question 1

What legislation is in place to protect those with mental health conditions ?

Answer 1

Mental Health Act Scotland 2003.

Question 2

What does Mental Health Act Scotland 2003 allow ?

Answer 2

Allows compulsory detainment for treatment of mental health problem/psychiatric disorders (with no provision for compulsory treatment of physical problems).

Question 3

What are the 3 types of legal detainment included in Mental Health Act Scotland 2003 ? And for how long will patient remain in detention ?

Answer 3

Emergency detention for 72 hours.
Short term detention for 28 days.
Compulsory treatment order for 6 months.

Question 4

What are the 4 principles of the Mental Health Act Scotland 2003 ?

Answer 4

• 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.

Question 5

Why is detainment for personality disorders inappropriate ?

Answer 5

No effective treatment available for condition.

Question 6

What is the difference between neurosis and psychosis ?

Answer 6

Neurosis - contact retained with reality.
Psychosis - contact lost with reality.

Question 7

What are two types of neuroses relevant to dentistry ?

Answer 7

Anxiety states and phobias.

Question 8

What are the 5 subtypes of neuroses ?

Answer 8

Anxiety, phobic, obsessional, hypochondriacal, depressive.

Question 9

What are the 3 subtypes of anxiety disorders ?

Answer 9

Generalised anxiety disorder.
Phobic anxiety.
Panic disorder.

Question 10

What is the definition of somatoform disorders ?

Answer 10

Manifestation of condition which does not appear medically or pathologically.

Question 11

What are management strategies for anxiety disorders ?

Answer 11

Psycho-education.
Anxiety management strategies.
Cognitive behavioural therapy.
Prescribed medication - benzodiazepines, antidepressants.

Question 12

What are 4 types of benzodiazepines ?

Answer 12

Diazepam.
Midazolam.
Temazepam.
Lorazepam.

Question 13

What are 3 types of antidepressant medication ?

Answer 13

Tricyclic antidepressants.
Mirtazepine.
SSRI.

Question 14

What is an example of tricyclic antidepressant ? And how does it work ?

Answer 14

Amitriptyline.
Block the re-uptake of serotonin and norepinephrine in presynaptic terminals, which leads to increased concentration of these neurotransmitters in the synaptic cleft.

Question 15

How does mirtazepine work ?

Answer 15

Increases serotonin and noradrenaline in brain.

Question 16

What is examples of selective serotonin re-uptake inhibitors (SSRIs) ?

Answer 16

Fluoxetine.
Sertraline.
Citalopram.

Question 17

What are 3 dental aspects of anxiety neurosis ?

Answer 17

TMD and parafunction.
Oral dysaesthesias - dry, burning mouth or facial pain.
Denture intolerance.

Question 18

Define cyclothymia.

Answer 18

Normal mood swings.

Question 19

List common symptoms of depression.

Answer 19

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.

Question 20

List symptoms of hypomania and mania.

Answer 20

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.

Question 21

Define bipolar type 1.

Answer 21

Mania to depression.

Question 22

Define bipolar type 2.

Answer 22

Cyclothymia to hypomania.

Question 23

How long usually is drug treatment for mood disorders sustained for ?

Answer 23

> 2 years (before, increased risk of relapse).

Question 24

What are drugs used in acute phase of mood disorders ?

Answer 24

SSRIs.
Venalfaxine and mirtazepine - second line.
Tricyclic antidepressants.
MAOI - used when poorly controlled.

Question 25

What are mood stabilising drugs ?

Answer 25

Lithium.
Carbamazepine.
Valproate.
Lamotrigine.

Question 26

What are dental side effects of tricyclic antidepressants ?

Answer 26

Dry mouth.
Sedation.
Weight gain.

Question 27

What are dental side effects of SSRIs ?

Answer 27

Sedation.
Dry mouth.
Nausea and GI problems i.e. reflux.
Effects are less common compared with TCA.

Question 28

What drugs should be avoided in patients taking lithium ?

Answer 28

NSAIDs and metronidazole.

Question 29

Define schizophrenia.

Answer 29

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.

Question 30

What are 3 drugs given to patients with schizophrenia ?

Answer 30

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.

Question 31

What are the 4 extrapyramidal side effects of antipsychotic drugs ?

Answer 31

Akathisia - restlessness.
Dystonia - involuntary contraction of muscles.
Parkinsonism - tremor, slower thought, slower movement, aphasia.
Tardive dyskinesia - uncontrollable facial movements.

Question 32

What two drugs should be given to treat extrapyramidal symptoms from dopamine antagonist drugs ?

Answer 32

Beta blocker - propranolol, metropolol.
Antichlorinergics (reduces effect of acetylcholine) - procyclidine.

Question 33

What is the consequence of dopamine antagonist drugs ?

Answer 33

Lead to relative acetylcholine excess resulting in extrapyramidal side effects.

Question 34

What are dental signs of anorexia nervosa ?

Answer 34

Dry mouth.
Ulcers.
Infections.
Bleeding tendency.