Dentistry and Mental Health Flashcards
Medical model of psychiatry
Impairment is located within the individual
Requires a doctors diagnosis
Pt should then undergo the medical treatment prescribed
Failure to do so in mental illness may be seen as lack of insight, further confirming diagnosis
Social model of mental health
The issue is located within society not the individual
Industrialisation
Workhouses
Behaviour that can no longer be accommodated within society is institutionalised
‘Bedlam’
Hospital of St Mary of Bethlehem London
Monks originally ‘cared’ for the poor and marginalised, paupers
Management was corrective and harsh
Observation of Institutionalized subjects led to characteristics being described as diagnoses
The specialty of psychiatry developed and institutions became therapeutic rather than custodial
Social constructionism (cultural differences)
Psychiatry and psychopharmacology: conditions
Anxiety (neurotic) disorders Phobic disorders Affective Disorders e.g. depression Psychotic Disorders Eating disorders Alcohol and substance misuse Personality Disorders Dementia
Psychiatry and psychopharmacology: drugs
Antidepressants
Hypnotic/ anxiolytic
Antipsychotic
Mood stabilizers
Hearing voices
Very Common and not always negative
Used in diagnosis of mental health problems
Psychotropic drugs prescribed for treatment have many side effects (e.g. dry mouth)
The Hearing Voices Network describe these as ‘effects’ not ‘side effects’, they may include
-tremor
-psychosis, mania, delusions
-insomnia
Failure to take medication is seen as part of illness
Why am I mad?
Genetic - less than 10% Growing up in a city Repeatedly moving schools Migrant populations Trauma
Trauma theory
Supports the concept that trauma, particularly in childhood, may result in mental ill health, including hearing voices
Trauma
Sigmund Freud – developed the idea that relationship problems (especially with the mother) can create mental ill health
Trauma Theory
Dental phobia may be associated with this
Vulnerability
Truth trust consent
Bob Johnson ‘Hand of human kindness’
-many murderers have suffered trauma as children
John Ballat ‘Intelligent Kindness’
Communication
Truth
Calm
Direct
-minimise small talk
-music
-humour
Clear medical history
-mental health diagnosis
-medication
-self harm history
-use of non prescribed drugs ('street' drugs/ cannabis)
-smoking
-alcohol
-liver problems
-hospital admissions
Past dental history
Honesty: hope
Treatment Plan
-factual
-clear
-achievable
-self esteemTrust
Reliable Consistent Flexible Vulnerability Mental health worker/ NOK Risk assessment
Consent
Assessment of capacity -understand the information -retain the information -weigh it in the balance -communicate the decision Fluctuating capacity Defer non urgent treatment Best interests
Factors influencing care
Anxiety/ phobia Poor motivation Chaotic lifestyle Dry mouth/ drooling Movement disorder Alcohol Drug use Smoking Self harm Paranoia Violence/ aggression TSL
Accessing care
Poor attendance patterns due to:
- chaotic lifestyles
- lack of motivation
- anxiety/ phobia
- agoraphobia
- paranoia
Consider:
- Appointment timings
- Involve a third person if possible
- Reminders (e.g. text)
- Empathy (all members of the team)
