HUMANS- psychiatric diseases

Question 1

What is the purpose of the scottish mental health act 2003?

Answer 1

This is for the management and treatment of psychiatric disorders.

It allows the detainment of patients in order to treat their mental health problem.

Question 2

When can the scottish mental health act be applied?

Answer 2

• For patients with a psychiatric disease.
• Where there is a treatment that can stop it getting worse or reduce symptoms of the disease.
• When the patient poses a risk to others if not treated.
• When the mental disorder affects the patients ability to decide on treatment.
• The use of detainment is neccessary

Question 3

Compare neurosis and psychosis?

Answer 3

Neurosis- the patient is aware of the surroundings and able to function within them.

Psychosis- the patient percieves the surroundings in a different way.

Question 4

Compare the different types of anxiety?

Answer 4

Generalised anxiety- gets anxious about almost everything

Phobia- intense anxiety/panic in specific situations

Panic disorder-unpredictable extreme anxiety.

Question 5

What is a somatoform disorder?

Answer 5

The manifestation of a problem that does not exist medically or pathologically.

Question 6

How is anxiety treated?

Answer 6

Pyschologically- this treats the problem. (CBT, anxiety management)

Medications- Antidepressants, benzodiazepines or patients may self medicate.

Question 7

How is anxiety related to dentistry?

Answer 7

Are they dentally anxious or anxious all the time.

Anxiety can cause:

• TMD and parafunction
• Oral Dysaesthesia (a dry, burning sensation) and facial pain.

You need to treat the underlying cause (the anxiety) otherwise the treatment will not work.

Question 8

What is a phobia and give examples of some that can affect dental treatment?

Answer 8

A fear out of proportion to the threat

e.g. dentophobia

Claustrophobia

Tyranophobia (fear of needles)

Agoraphobia (fear of going outside)

Question 9

Discuss Obsessive Compulsive Disorder?

Answer 9

This is a ritual formed in order to prevent anxiety through the fear of the effects of the anxiety. (anxiety avoidance)

Question 10

What is an adjustment disorder ?

Answer 10

This is a maladaptive response to past stress or trauma (e.g. change in circumstance such as bereavement)

For Post Traumatic stress disorder- there needs to be a stress that is threatening or catastrophic.

Question 11

What is cyclothymia?

Answer 11

The normal mood swings:

Elation,normal mood and Dysthymia

Question 12

What mood disorders can patients suffer from?

Answer 12

Depression

Bipolar disorder

Elation.

Question 13

What is depression?

Answer 13

Low mood

Lack of motivation

Recurrent thoughts of suicide.

Question 14

Discuss being bipolar?

Answer 14

There are two types of bipolar:
Bipolar 1- mania

Bipolar 2- hypomania and major depression.

Symptoms of this include:

Increased reckless behaviour

Increased productivity and feeling of wellbeing.

THEN by a period of depression.

Question 15

Discuss an Elation disorder?

Answer 15

Euphoric- more upbeat, talkative, feel like everything is possible.

Dysphoric- irritable, agitated, aggressive energy, rage.

Question 16

How do we treat mood disorders?

Answer 16

Psychological- CBT and interperson psychotherapies.

Drug treatment-Antidepressants and mood stabilising drugs (carbamazepine)

Physcial- exercise, phototherapy.

Question 17

What can antidepressants be taken for?

Answer 17

• Treating depression
• Treating anxiety (OCD/panic attacks)
• For pain relief.
• To help psychological treatments.

Question 18

Compare different types of anti-depressants.

Answer 18

MAOI- e.g. Phenelzine

Tricylclics - oldies but goldies e.g. Amitriptyline

SSIRs- increases anxiety/ increased clenching . e.g. Fluoxeitine

These all have dry mouth as a side effect.

Question 19

Discuss the impact anti-depressants have on dentistry?

Answer 19

Dry mouth- increasing the caries risk.

Facial dyskinesias (uncontrollable facial twitches)

Increased clenching (SSIRs)

Consideration is needed for drug metabolism and LA interaction.

Question 20

What is the dental impact of patients with Psychoses?

Answer 20

they are difficult to treat during acute episodes.

Drug treatment- dry mouth/ dyskinesias.

Question 21

What is Schizophrenia?

Answer 21

This is a thought disorder. The patient is reacting to their reality (delusions/hallucinations) and they may think we are trying to attack them.

It is linked to an abnormality in dopaminergic neurotransmission.

Question 22

How is Schizophrenia managed?

Answer 22

Psychologically (CBT)

Medically- Dopamine antagonist drugs

Question 23

Discuss the dental treatment of a Schizophrenic patient?

Answer 23

• If you are seeing the patient the disease cannot be that bad.
• Cloazapine medication is the last line medication which tells us that the other medications did not work. (this drug dose is influenced by tobacco use)

Question 24

How does anorexia nervosa present orally?

Answer 24

Bleeding gums- due to lack of vitamins.

Ulcers- due to malnutrition.

Question 25

What is borderline personality disorder?

Answer 25

This is when the patient has polarised thinking (black or white, good or bad)

Question 26

How does bulimia present orally?

Answer 26

Palatal erosion.
Lingual cervical lesions
Dry mouth
Nutritional deficiency.

Question 27

What dental advice do we give to patients suffering from bulimia ?

Answer 27

o You want to increase the pH after vomiting
o Chew gum
o Rinse mouth with water/milk/antacid
o Avoid abrasive toothpastes (After vomiting)
o Gentle toothbrushing with desensitising toothpaste and a soft brush.