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BDS3 BAMS > Depression, Psychosis and Personality Disorders > Flashcards

Depression, Psychosis and Personality Disorders Flashcards

1
Q

What are mood disorders also known as?

A
  • Affective disorders
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2
Q

How may mood disorders present to the dentist?

A
  • Very rare
  • Oral effects (in somatiform disorders)
  • Dysesthesias
  • Facial pain
  • Patients general demeanour
  • Need to consider whether it is appropriate to treat someone in their depression phase as can they consent efficiently
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3
Q

How on the spectrum is termed normal mood?

A
  • Termed Cyclothymia
  • Range from Elation, normal to Dysthmia
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4
Q

How can people with depressive disorder present with on the spectrum?

A
  • Mild depression all the way to sever depression with psychosis (extreme)
  • If patient flutters between normal and depressive this is termed Recurrent depressive disorder
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5
Q

How does Bipolar affective disorder present on the spectrum?

A
  • Ranges all the way along the spectrum
  • Can present with Mania with psychosis - normal - sever depression with psychosis
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6
Q

What are the names of the changes in mood on the spectrum?

A
  • Normal mood swings
  • Cyclothymic temperament
  • Cyclothymic disorder
  • Bipolar type II disorder
  • Monopolar mania
  • Bipolar type 1 disorder
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7
Q

How common are mood disorders?

A
  • Female: Male 2-3:1
  • Unipolar has 6% prevalence
  • Bipolar has life prevalence of 1.2%
  • Post natal depression occurs 0.5/1000 in one month (if has it with one baby more likely to have with another)
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8
Q

What are the common types of depressive mood disorders?

A
  • Major depressive disorder
  • Persistent depressive disorder
  • Bipolar depression
  • Postpartum depression
  • Premenstrual dysphoric disorder
  • Seasonal affective disorder
  • Atypical depression
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9
Q

What are the common symptoms of depression?

A
  • Low mood
  • Reduces interest and motivation
  • Lethargy and tiredness
  • Sleep disturbance
  • Appetite disturbance
  • Poor concentration
  • Loss of confidence and self esteem
  • Recurrent thoughts of death and suicide (ask whether they have to detect the ones who are acc considering it)
  • Unreasonable self-reproach and guilt
  • Any form of anxiety
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10
Q

How is bipolar classified?

A
  • Bipolar type 1 (mania)
  • Bipolar type 2 (Cyclothymia into hypomania)
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11
Q

What are the mania and hypomania symptoms?

A
  • Increased productivity and feeling of wellbeing
  • Reduced need for sleep
  • Gradual reduction in social functioning and occupational functioning
  • Increase in reckless behaviour
  • Followed by depressive episode
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12
Q

What are the symptoms of a Euphoric patient?

A
  • Upbeat
  • More talkative
  • Inflated self -esteem
  • Felt everything possible
  • Rapid speech
  • Restlessness
  • Reckless behaviour
  • Excessive energy
  • Decreased sleep
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13
Q

What are the symptoms of a Dysphoric patient?

A
  • Irritable
  • Agitated
  • Aggressive energy
  • Restlessness
  • Rage
  • Rapid speech
  • Reckless behaviour
  • Excessive energy
  • Decreased sleep
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14
Q

What are the treatments of mood disorders?

A
  • Combo is best option
    Psychological
  • Cognitive therapy
  • Interpersonal psychotherapies

Drug treatment
- Usually 2 years treatment or relapse occurs
- Antidepressant
- Mood stabilising

Physical
- Exercise
- Phototherapy for seasonal affect disorder
- ECT (mostly post natal depression)

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15
Q

What are some acute phase antidepressants drugs?

A
  • Selective serotonin reuptake inhibitor (SSRI)
  • Venlafaxine /Mirtazapine
  • Tricyclic antidepressants (TCA) (improve anxiety)
  • Monoamine oxidase inhibitor (MAOI)
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16
Q

What are some negatives of SSRI?

A
  • Give anxiety which is not great for depressive episode
  • Often feel like they have to rely on drug and can’t stop
  • Combine with tricyclic to reduce anxiety
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17
Q

What are some mood stabilising drugs?

A
  • Lithium
  • Carbamazepine
  • Sodium Valproate
  • Lamotrigine
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18
Q

Why is the patient taking an antidepressant?

A
  • Not always used to treat depression so need to ask patient
  • Treat depression
  • Treat anxiety disorder including OCD and panic attacks
  • Pain relief
  • Help psychological treatments
  • Promote learning of new behaviours
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19
Q

What are the Tricyclic antidepressants names?

A

Original
- Amitriptyline, Nortriptyline, Dosulepin
New
- Imipramine, Doxepin

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20
Q

What are some side effects of Tricyclic antidepressants?

A
  • Dry mouth
  • Sedation (so take at night)
  • Weight gain (reduction in feeling full)
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21
Q

What patients do you need to be cautious with when prescribing Tricyclic antidepressants?

A
  • Glaucoma and Prostatism
  • Cause rise in eye pressure and blockage of urine output
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22
Q

What are SSRIs?

A
  • Popular brand is Prozac
    Other inc
  • Fluoxetine, paroxetine, fluvoxamine
  • Citalopram, Setraline
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23
Q

What are the side effects of SSRI’s?

A
  • Acute anxiety disorders
  • Sedation
  • Dry mouth
  • Gastrointestinal upset
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24
Q

What are Monoamine oxidase inhibitors?

A
  • MAOI
  • Phenelzine
  • Isocarboxazid
  • Selegeline
25
What are the interactions of MAOIs?
Indirect acting sympathomimetic amines e.g. ephedrine - Has enhanced vasoconstrictor effect - Cold and cough remedies Foodstuffs - Tyramine containing products like alcohol/low alcohol, bovril/oxo/marmite, cheese, herring, beans - Patients can't be given these drugs unless they understand the threat to their life if eating these
26
What are some other drugs that can be used as antidepressants but not usually started by a GP but a Psychiatrist?
- Venlafaxine - Mirtazapine - Nefazadone - Reboxetine
27
What should you avoid if prescribing Lithium?
- NSAIDs - Metronidazole
28
What antipsychotic medicines can be given to treat episodes of mania?
- Aripiprazole - Olanzapine - Quetiapine - Risperidone
29
What are the direct drug effects of antidepressants in dentistry?
- Dry mouth which can ultimately cause caries - Sedation - Facial dyskinesias (uncontrollable facial twitches)
30
What are Psychoses?
- Perceptual abnormalities - Can be manic depression - Schizophrenia - Korsakoff's Psychosis (alcohol induced brain degeneration) - Difficult to treat in dentistry during acute episodes
31
What are the drug effects of Psychoses meds?
- Dry mouth - Drug interactions - Dyskinesia (tonic or dystonia)
32
What is Schizoprenia?
- Thought disorder - Fundamental and characteristic distortions of thinking and perception - Various types of delusion (sometimes bizarre) - Auditory hallucinations which are often threatening and derogatory
33
What does Schizophrenia include?
- Relapsing and remitting periods of acute psychosis - Cumulative, chronic deficits in motivational, affective and social domains
34
Why does Schizophrenia occur?
Genetic susceptibility - multigene Environmental - potential risk factors Drug abuse - Cocaine, amphetamine, ectasy, opiate - Prevalence is 1-2%
35
How is Schizophrenia managed?
Psychological therapy - CBT - Cognitive remediation - Family intervention Drug therapy - Oral or depot IM injection (issue with compliance and frequency of requirement as they may not see themselves with an illness or anything wrong) - Dopamine antagonist drugs - Atypical antipsychotics
36
What side effects can dopamine antagonist drugs cause?
- Cause extrapyramidal side effects like inability to sit still, involuntary muscle contraction, involuntary facial movements - Sedation - Dry mouth - Atypical antipsychotics preferred as less likely to produce these side effects
37
What are some older antipsychotic drugs used?
- Butyrophenones - Phenothiazines - Thioxanthenes
38
What are some new atypical antipsychotics drugs?
- Sulpiride - Respiridone - Clozapine - Quetiapine - Aripiprazole - Olanzapine
39
What are some extrapyramidal side effects of antipsychotics?
- Akathisia - Dystonia - Parkinsonism - Tardive dyskinesia (only one that doesn't go away if medicine stopped)
40
What is Dystonia?
- Muscles involuntary contract and contort leading to painful positions and movement
41
What is Akathisia?
- Restlessness, hard to sit still or down - Tapping fingers, rocking, crossing and uncrossing legs
42
What is Parkinsonism?
- Same as Parkinson's but caused by meds not disease - Tremor, slower thought process, slower movements, rigid muscles , facial stiffness
43
What is tardive dyskinesia?
- Uncontrollable facial movements like sucking or chewing, lip smacking, sticking tongue out - Does not go away if medicine stopped
44
How are extrapyramidal symptoms treated?
- Use atypical antipsychotic instead - Use beta-adrenergic blockers (Propanolol/Metropolol) - Anticholinergics to reduce effect of acytlycholine e.g. Benxtropine (Dry mouth)
45
What is anorexia nervosa?
- Altered perception of body image - Don't eat - oral effects of malnutrition inc ulcers, dry mouth, infections, bleeding gums
46
What is Bulimia?
- Normal weight - Tend to binge/vomit - Use laxatives, excessive exercise, diuretics - Comfort eating as maybe stress reaction - Dental erosion and oesophageal stricture
47
What is comfort eating?
- Eating out of comfort of anxiety
48
What are the variations of personality types?
- Overachiever - Dramatic - Daydreamer - Worrier - Isolated introvert - Perfectionist
49
What are the different personality disorders?
- Borderline personality disorder - Antisocial personality disorder - Histrionic personality disorder - Narcissistic personality disorder - Avoidant personality disorder - Dependent personality disorder - Schizoid personality disorder
50
What is borderline personality disorder?
- Instability in interpersonal relationships, self image and affects and marked impulsivity
51
What is antisocial personality disorder?
- Disregard for and violation of rights of others?
52
What is Histrionic personality disorder?
- Excessive emotionality and attention seeking
53
What is narcissistic personality disorder?
- Grandiosity, need for admiration, lack of empathy
54
What is avoidant personality disorder?
- Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
55
What is dependent personality disorder?
- Submissive and clinging behaviour related to excessive need to be taken of
56
What is Schizoid personality disorder?
- Detachment from social relationships and restricted range of emotional expression
57
What are some symptoms of borderline personality disorder?
- Deep fear - Very black or white thinking - Stress paranoia - Unstable relationships - Changes in self image - Impulsive behaviour - Suicidal threats - Excessive mood swings - Feelings of solitude
58
What are the subtypes of borderline personality disorder?
- Discouraged borderline - Impulsive borderline - Petulant borderline - Self-destructive borderline

BDS3 BAMS (15 decks)

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