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My BDS3 > Diseases of Human Systems: Psychiatry > Flashcards

Diseases of Human Systems: Psychiatry Flashcards

1
Q

What act is concerned with those with management and treatment with those with psychiatric disorders (neuroses and psychoses)?

A

Mental health Scotland act 2003

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2
Q

How long is a psychiatric patient detained for in an emergency?

A

72 hours

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3
Q

How long is a short detention for a psychiatric patient?

A

28 days

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4
Q

How long is a compulsory treatment order for a psychiatric patient?

A

6 months

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5
Q

What psychiatric disorders will we encounter in dentistry? (4)

A

eating disorders
personality disorders
neurosis - anxiety and phobias
psychosis - schizophrenia

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6
Q

what Is psychosis?

A

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

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7
Q

What is neurosis?

A

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.

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8
Q

What are the subtypes of neuroses?

A 
anxiety 
depressive 
obsessional
hypochondrial 
Phobic
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9
Q

Describe the difference between an anxious patient and a patient with anxiety neurosis?

A

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

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10
Q

What are types of anxiety?

A

generalised = anxiety in many/all situations

phobic = intense anxiety which triggers panic in specific situs

panic - unpredictable triggers = extreme anxiety

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11
Q

What are somatoform disorders?

A

conditions where there is a manifestation of a problem that doesn’t exist medically or pathologically

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12
Q

how do anxiety neurosis patients present to the dentist?

A

with TMJ disease and parafunction

with denture intolerance

with oral dysesthesia and facial pain

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13
Q

When treating oral manifestations of anxiety neurosis, what is it important to remember?

A

You also have to address the underlying anxiety

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14
Q

What are phobias (anxiety neuroses)?

A

fears that are out of proportion to the threat

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15
Q

What is it important to remember when treating a patient with phobias?

A

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.

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16
Q

What is OCD?

A

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.

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17
Q

Whats the difference between perfectionism and OCD?

A

Perfectionism doesn’t happen in order to avoid anxiety, it is a personality trait, whereas OCD is a mental disorder driven by anxiety.

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18
Q

What is an adjustment disorder?

A

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

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19
Q

Name examples of adjustment disorders (neurosis)

A

PTSD

bereavement

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20
Q

list depressive mood disorders. (7)

A
  1. Major depressive disorder
  2. Persistent depressive disorder – never returns to normal mood always in low moods
  3. Bipolar
  4. Puerperal
  5. Premenstrual
  6. Seasonal affective disorder
  7. Atypical depression
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21
Q

what are the symptoms of depression? (10)

A
  • 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
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22
Q

what is cyclothymia?

A

mood swings not as extreme as bipolar disorder

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23
Q

What is a Unipolar depressive disorder?

A
  • depression

Patient suffers from low moods

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24
Q

should we treat patients during active depression?

A

can treat but avoid major decisions

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25
Q

What is bipolar 1 defective disorder?

A

When a patient moves Up in mood then down in mood.

26
Q

What is bipolar 2 defective disorder?

A

Exaggerated hypothymia (depression) and progression on to hypomania and possibly mania with psychosis and then back to depressive states.

27
Q

what are the symptoms of mania and hypomania?

A
  • Increased productivity and wellbeing
  • Reduced need for sleep
  • Reduction in social functioning
  • Increased reckless behaviour
  • Followed by period of depression
28
Q

what is monopolar mania?

A

Where the patients mood only rises and returns to normal - no depression

29
Q

What is puerperal mood disorder?

A

Post natal depression

Prone to it after 1 will be prone to it after all pregnancy

30
Q

how do we treat mood disorders? (3)

A

 Psychological – CBT

 Drug therapy

 Physical – exercise, phototherapy

31
Q

why are drugs used to treat mood disorders used for 2 years even if the patient starts to feel better?

A

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

32
Q

what is the first line antidepressant used? name examples.

A

Selective serotonin reuptake inhibitors (SSRI)

e.g. fluoxetine, citalopram and sertraline

33
Q

describe what SSRIs do.

A

Return low mood to normal – can make people overly high in mood = hypomania

34
Q

what are the side effects of SSRI’s (antidepressants) (5)

A
  • 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
35
Q

what can we use alongside SSRI’s to combat the anxiety.

A

tricyclic AD’s

36
Q

name examples of the second line antidepressant used.

A

venlafaxine - SNRI

mirtazapine

37
Q

what drugs can we use to treat depression when no other drugs work?

A

MAOI (monoamine oxidase inhibitor)

-phenelzine

38
Q

what are the interactions of MAOI (monoaminde oxidase inhibitor) used in depression?

A
  • Sympathomimetic amine – ephedrine and noradrenaline (LA has no effect)
  • Tyramine containing foodstuff – beer, bovril, cheese, herring and beans
39
Q

list drugs used in mood stabilising and bipolar disorder. (4)

A

 Lithium
 Carbamazepine
 Sodium valproate
 Lamotrigine

40
Q

what are the interactions of lithium used to treat mood instability and bipolar?

A

NSAIDS

metronidazole

41
Q

why can patients be taking antidepressants?

A
  • Depression
  • Anxiety and panic
  • Pain relief – tricyclics and mirtazapine
42
Q

what antidepressants are used to manage pain?

A

tricyclics and mirtazapine

43
Q

what are the dental implications of antidepressants?

A
  • Dry mouth = caries in extremes
  • Sedation
  • Facial dyskinesias – uncontrolled twitches
  • Drug interactions – not significant
44
Q

name examples of psychoses.

A

schizophrenia
manic depression
korsakoffs psychosis

45
Q

what is korsakoffs psychosis?

A

brain degeneration caused by alcohol

46
Q

what kind of disorder is schizophrenia?

A

thought disorder

47
Q

what are the signs of schizophrenia?

A

Hallucinations – auditory or visual

Delusions

Lose interest – neglect personal hygiene

48
Q

what are causes of schizophrenia?

A

genetic susceptibility

abnormal brain development

abnormal levels of the neurotransmitter dopamine

environmental factors such as drugs and stressful events.

49
Q

how do we treat schizophrenia?

A

combination of drug and psychological therapy

50
Q

what are the psychological methods for managing schizophrenia?

A

CBT

family therapy

Therapy - arts = how to express themselves

Support groups

51
Q

what pharmacological methods can be used to manage schizophrenia?

A

typical antipsychotics - dopamine antagonist

atypical antipsychotics

52
Q

list the side effects of typical antipsychotics? (6)

A
  • 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
53
Q

name examples of atypical antipsychotics.

A

clozapine
sulpiride
aripiprazole

54
Q

why is drug taking compliance low in those with schizophrenia? how to we overcome this?

A

patients are detached from reality and don’t think they have a problem

Long lasting IM injections

55
Q

how do we treat the extrapyramidal symptoms of typical antipsychotics?

A

 Use atypical antipsychotic drugs instead

use alongside the typical drug;
 Beta-adrenergic blockers e.g. propranolol
 Anticholinergics e.g. procyclidine (also cause dry mouth)

56
Q

why would patients on typical antipsychotics have an extremelt dry mouth?

A

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!!
57
Q

what is anorexia?

A

Eating disorder

Altered perception of body image which makes you try to lose weight/maintain a low weight.

58
Q

what are the dental implications of anorexia?

A

Malnutrition – ulcers, dry mouth, infections

59
Q

what is bulima?

A

Individual with normal weight who binges with anxiety and stress and then vomit after.

60
Q

what are the dental implications of bulimia?

A

Dental erosion

Oesophageal stricture

61
Q

what is comfort eating?

A

Overeating as a coping strategy for anxiety

62
Q

what are the symptoms of borderline personality disorder? (7)

A
  • Deep fear of being isolated
  • Unstable relationships
  • Paranoia
  • Impulsive behviour
  • Suicidal threats
  • Excessive mood swings
  • Solitude

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