Dentistry and mental illness 2 Flashcards
2 examples of dysphoria
ethnic dysphora
gender dysphoria
physical/ oral manifestations of anorexia/ bulemia
vomiting --> tooth erosion use vinegar/ lemon to reduce hunger thickened knuckles (Russells sign) lanugo hair (baby hair) pale, cold peripheries
signs of acute scizophrenia
delusions, hallucinations, interrupted thought processes
signs of chronic scizophrenia
- slowness, apathy, lack of drive, social withdrawal
- abnormal use of language (sentences, new words)
- inability to explain abstract ideas eg proverbs
- over-inclusiveness (eg everyone out to get them)
- delusions, hallucinations (auditory, visual)
- incongruous mood, eg laugh at inappropriate times
oral effects of scizophrenia
increased DMFT
tooth brushing not a priority
more likely to be edentulous due to trauma from fights etc
4 treatment options for mental illness
- drugs
- electro convulsive therapy (electric shock to frontal lobe, now rarely used)
- psychotherapy (councelling, underlying causes)
- behaviour therapy eg CBT (desensitisation, flooding, relaxation, thought processes)
types of drugs used for mental illness
psychotropic: mental symptoms
neuroleptic: antipsychotic, major tranquilisers
- anxiolytic: minor tranquilisers
what % of population have dental phobia
3-4%
6 factors associated with oral health and access to care
- type, severity, stage of illness
- side effects of medication (xerostomia, dyskenesia/ dystonia)
- mood, motivation, self-esteem (poor compliance)
- lack of perception of OH problems
- habit/ lifestyle (diet, SES, substance abuse)
- lack of information (knowledge/ attitudes)
body dysmorphic disorder and relevance to dentistry
belief in cosmetic defect in someone of ordinary appearance –> not satisfied with surgical outcomes
associated with environmental work/ home stressors
define MUS
medically unexplained symptoms
what to ask when a pt presents with MUS 5
- somatic symptoms of anxiety/ depression (eg weight loss)
- previous history of MUS
- evidence of precipitation by stress
- family/ past psychiatric history
- evidence that symptoms respond to psychological interventions
how to treat unexplained symptoms 8
- admit uncertainty, go through test results
- ask about specific concerns
- give positive explanation of symptoms
- copy clinic letters
- stress potential for recovery, expectations
- discuss stressors
- encourage activity
- reframe and reattribute stress and symptoms
issues with managing MUS 5
- clinical duty of care v patient autonomy
- competent pts can refuse tx (assume capacity unless proven otherwise, best interest checklist)
- lasting powers of attourney (people appointed to act for individual should mental incapacity occur)
- provision of living wills/ advance decisions
- ill tx/ neglect of a person who lacks capacity –> max 5 yr prison sentence
what is included in best interests checklists (MCA sections 4) 5
- consider all relevant circumstances (decision maker is aware)
- regaining capacity: can decision be delayed until then
- permitting and encouraging participation: finding appropriate means of communication or using others to help person participate in decision-making process
- considering person’s wishes, feelings, beliefs, values (esp written statements of person when they had capacity)
- taking in to account views of other people (family, informal carers, anyone with an interest in persons welfare/ appointed to act on his/ her behalf
purpose of mental capacity act 2005 and where it covers
framework for people who may not be able to make decisions (learning difficulties/ dementia/ poor mental health –> who can make decisions and how to go about this)
covers england and wales
differences between competency and capacity
competency: ability to consent for yourself (understand/ remember info about clinical circumstances, weigh up choices, believe info applies to you)
capacity: individual (ability to understand, remember, use info to make decisions, communicate decision)
what is needed for consent
competency AND capacity
5 considerations of DCP in dealing with pts with mental health problems
- prevent/ control disease (manage symptoms, maintain oral health, comfort, function)
- environment (staff, waiting time, prep, encouragement, distraction)
- appropriate medical/ social histories (opportunities to disclose, stop masking of symptoms)
- patient control: stop signals, provide/ offer pain relief
- dentist a EDUCATOR: expectations, preconceptions, OH, diet councelling, future appointments
4 models to adapt tx for pts with mental issues
- modelling (pt learns by imitation)
- biofeedback (listening to body response and controlling, eg muscle tension, HR, blood pressure
- token economy: +ve reinforcement. tokens for good behaviour, exchanged for something meaningful
- behaviour contracts: +ve reinforcement, plan of behaviours. often used for schoolchildren
define addiction
physical and psychological dependency
associated with tolerance and withdrawal, relapse
define abuse
pathologic behaviour associated with drugs despite associated social, psychological or physical probs
define dependence
continued substance use due to physical or psychological need
tolerance/ withdrawal
define tolerance
need for increased quantities of a substance to achieve desired results
