Diseases of Human Systems: Psychiatry Flashcards
What act is concerned with those with management and treatment with those with psychiatric disorders (neuroses and psychoses)?
Mental health Scotland act 2003
How long is a psychiatric patient detained for in an emergency?
72 hours
How long is a short detention for a psychiatric patient?
28 days
How long is a compulsory treatment order for a psychiatric patient?
6 months
What psychiatric disorders will we encounter in dentistry? (4)
eating disorders
personality disorders
neurosis - anxiety and phobias
psychosis - schizophrenia
what Is psychosis?
a disorder where contact with reality is lost, the individual is aware if their surroundings but perceives them in a different manner and is unable to interact with them
What is neurosis?
a mental health disorder where contact with reality is maintained, individuals are aware of their surroundings and able to interact with them regardless of their neurosis.
What are the subtypes of neuroses?
anxiety depressive obsessional hypochondrial Phobic
Describe the difference between an anxious patient and a patient with anxiety neurosis?
An anxious patient is solely concerned about the dental treatment (can be related to past dental experience) whereas the neurosis patient is concerned about everything
What are types of anxiety?
generalised = anxiety in many/all situations
phobic = intense anxiety which triggers panic in specific situs
panic - unpredictable triggers = extreme anxiety
What are somatoform disorders?
conditions where there is a manifestation of a problem that doesn’t exist medically or pathologically
how do anxiety neurosis patients present to the dentist?
with TMJ disease and parafunction
with denture intolerance
with oral dysesthesia and facial pain
When treating oral manifestations of anxiety neurosis, what is it important to remember?
You also have to address the underlying anxiety
What are phobias (anxiety neuroses)?
fears that are out of proportion to the threat
What is it important to remember when treating a patient with phobias?
Their phobias may not be of the dentist however the phobias can still interfere with visiting the dentist i.e. getting to and from the practice.
What is OCD?
A cycle of anxiety, compulsion, relief and obsession - the individual has underlying anxiety and knows that if they perform this cycle they will eliminate/prevent possible anxiety.
Whats the difference between perfectionism and OCD?
Perfectionism doesn’t happen in order to avoid anxiety, it is a personality trait, whereas OCD is a mental disorder driven by anxiety.
What is an adjustment disorder?
A common disorder related to an unpleasant past event which the patient has difficulty coping with.
Patients also have difficulty adapting to new circumstances which leaves them stressed, anxious and depressed
Name examples of adjustment disorders (neurosis)
PTSD
bereavement
list depressive mood disorders. (7)
- Major depressive disorder
- Persistent depressive disorder – never returns to normal mood always in low moods
- Bipolar
- Puerperal
- Premenstrual
- Seasonal affective disorder
- Atypical depression
what are the symptoms of depression? (10)
- Low mood
- Reduced interests
- Lethargy and tiredness
- Sleep disturbance/ cant sleep
- Appetite disturbance
- Poor concentration
- Low confidence and self esteem
- Recurrent thoughts of death and suicide
- Unreasonable self-reproach and guilt
- anxiety
what is cyclothymia?
mood swings not as extreme as bipolar disorder
What is a Unipolar depressive disorder?
- depression
Patient suffers from low moods
should we treat patients during active depression?
can treat but avoid major decisions
What is bipolar 1 defective disorder?
When a patient moves Up in mood then down in mood.
What is bipolar 2 defective disorder?
Exaggerated hypothymia (depression) and progression on to hypomania and possibly mania with psychosis and then back to depressive states.
what are the symptoms of mania and hypomania?
- Increased productivity and wellbeing
- Reduced need for sleep
- Reduction in social functioning
- Increased reckless behaviour
- Followed by period of depression
what is monopolar mania?
Where the patients mood only rises and returns to normal - no depression
What is puerperal mood disorder?
Post natal depression
Prone to it after 1 will be prone to it after all pregnancy
how do we treat mood disorders? (3)
Psychological – CBT
Drug therapy
Physical – exercise, phototherapy
why are drugs used to treat mood disorders used for 2 years even if the patient starts to feel better?
patient will start to feel better because of the drug but you have to persist with the medication to let brain adapt to this biochemistry
what is the first line antidepressant used? name examples.
Selective serotonin reuptake inhibitors (SSRI)
e.g. fluoxetine, citalopram and sertraline
describe what SSRIs do.
Return low mood to normal – can make people overly high in mood = hypomania
what are the side effects of SSRI’s (antidepressants) (5)
- Can cause acute anxiety when stopped or started – can combine with tricyclic AD’s to combat this
- Unpleasant withdrawals – feel addicted
- Sedation
- Dry mouth
- GI upset
what can we use alongside SSRI’s to combat the anxiety.
tricyclic AD’s
name examples of the second line antidepressant used.
venlafaxine - SNRI
mirtazapine
what drugs can we use to treat depression when no other drugs work?
MAOI (monoamine oxidase inhibitor)
-phenelzine
what are the interactions of MAOI (monoaminde oxidase inhibitor) used in depression?
- Sympathomimetic amine – ephedrine and noradrenaline (LA has no effect)
- Tyramine containing foodstuff – beer, bovril, cheese, herring and beans
list drugs used in mood stabilising and bipolar disorder. (4)
Lithium
Carbamazepine
Sodium valproate
Lamotrigine
what are the interactions of lithium used to treat mood instability and bipolar?
NSAIDS
metronidazole
why can patients be taking antidepressants?
- Depression
- Anxiety and panic
- Pain relief – tricyclics and mirtazapine
what antidepressants are used to manage pain?
tricyclics and mirtazapine
what are the dental implications of antidepressants?
- Dry mouth = caries in extremes
- Sedation
- Facial dyskinesias – uncontrolled twitches
- Drug interactions – not significant
name examples of psychoses.
schizophrenia
manic depression
korsakoffs psychosis
what is korsakoffs psychosis?
brain degeneration caused by alcohol
what kind of disorder is schizophrenia?
thought disorder
what are the signs of schizophrenia?
Hallucinations – auditory or visual
Delusions
Lose interest – neglect personal hygiene
what are causes of schizophrenia?
genetic susceptibility
abnormal brain development
abnormal levels of the neurotransmitter dopamine
environmental factors such as drugs and stressful events.
how do we treat schizophrenia?
combination of drug and psychological therapy
what are the psychological methods for managing schizophrenia?
CBT
family therapy
Therapy - arts = how to express themselves
Support groups
what pharmacological methods can be used to manage schizophrenia?
typical antipsychotics - dopamine antagonist
atypical antipsychotics
list the side effects of typical antipsychotics? (6)
- Block dopamine everywhere in the brain, ‘extrapyramidal’ side effects are similar to parkinsons symptoms .
- Dystonia: involuntary contractions of muscles
- Tardive dyskinesia: uncontrollable facial movements from antidopaminergic response (persists when drugs are withdrawn)
- Akathisia: restlessness
- Sedation
- Dry mouth
name examples of atypical antipsychotics.
clozapine
sulpiride
aripiprazole
why is drug taking compliance low in those with schizophrenia? how to we overcome this?
patients are detached from reality and don’t think they have a problem
Long lasting IM injections
how do we treat the extrapyramidal symptoms of typical antipsychotics?
Use atypical antipsychotic drugs instead
use alongside the typical drug;
Beta-adrenergic blockers e.g. propranolol
Anticholinergics e.g. procyclidine (also cause dry mouth)
why would patients on typical antipsychotics have an extremelt dry mouth?
typical antipsychotics have the side effects of dry mouth
then the BB and anticholinergics used to treat the extrapyramidal side effects of the typical drug also have dry mouth as a side effect
- double dry mouth!!
what is anorexia?
Eating disorder
Altered perception of body image which makes you try to lose weight/maintain a low weight.
what are the dental implications of anorexia?
Malnutrition – ulcers, dry mouth, infections
what is bulima?
Individual with normal weight who binges with anxiety and stress and then vomit after.
what are the dental implications of bulimia?
Dental erosion
Oesophageal stricture
what is comfort eating?
Overeating as a coping strategy for anxiety
what are the symptoms of borderline personality disorder? (7)
- Deep fear of being isolated
- Unstable relationships
- Paranoia
- Impulsive behviour
- Suicidal threats
- Excessive mood swings
- Solitude
