Intro to psychiatry Flashcards
What is psychiatry?
Psychiatry is the medical specialty concerned with the recognition and treatment of disorders of the mind
How common are psychiatric problems?
One in four
Anxiety (neurotic) disorders
Anxiety is said to be pathological when it becomes too intense, frequent or persistent, and as a consequence interferes with the functioning of the individual
Anxiety
Anxiety is a normal experience to a perceived threat or danger
It serves to mobilise energy reserves for action and enhances performance by increasing arousal
Psychological symptoms of anxiety
Sense of dread Irritability Fear of loss of control Avoidance Panic
Physical symptoms of anxiety
Palpitations Shortness of breath Chest pain ‘Butterflies’ Sweating Dry mouth Nausea
Generalised anxiety disorder
The anxiety experienced is not confined to a specific situation but is pervasive
Anxiety is experienced more days than not
Understandably, whilst frequently anxious, anxiety levels typically rise in stressful situations
May result in panic attacks
Phobic disorders
In common these are situational, predictable, with anticipatory anxiety and avoidance
Common in general population but only 2% considered “severely disabling”
Types of phobic disorders
Simple phobias
-specific animal phobias
Social phobia
Agoraphobia
Dental phobia =
Odontophobia
Possible presentations of odontophobia
Delayed presentation
Looking anxious
Cancel appointments at short notice / fail to attend
Possible reasons for odontophobia
Specific phobia (e.g. drills, needles, sounds, smells)
Anxiety about somatic reactions (gagging, injection)
Generalized anxiety disorder
Social phobia
Prevention of dental anxiety
Dental health education Calm, sympathetic paced approach Honest and tactful explanation of procedures Relaxed, welcoming atmosphere Confident and professional manner
Treatment of dental anxiety
Education regarding anxiety
Relaxation techniques
Desensitisation (graded exposure)
Short term pharmacological anxiolytics (e.g. diazepam)
Long term pharmacological antidepressants
Body dysmorphic disorder
The affected person is excessively concerned about a perceived defect in his or her physical features
May well present to dentists
Hypochondriasis
Abnormal preoccupation about the presence of an underlying serious physical disease
Pts can place an abnormal interpretation upon a normal sensation (e.g. transient dry mouth is proof of oral cancer)
Often very difficult to persuade pts that symptoms might have largely psychological component
Somatoform pain
The cause is psychological rather than organic/physical
- absence of organic pathology
- evidence of a psychological cause
Key characteristics of somatoform pain
Inconsistent with anatomical landmarks
May be continuous and bilateral
May prevent sleep but does not wake patient
Repeated negative investigations
Analgesia ineffective
Associated with emotional factors and may have symbolic meaning
Affective disorders
Alterations of mood are a normal part of life
Extremes of mood, if accompanied by associated symptoms and impaired function can be delineated into ‘illnesses’
Mood can go up as well as down
-unipolar affective disorder
-bipolar affective disorder
Depression epidemiology
10% of men
20% of women
Depression symptoms
Depressed mood 2 weeks or more Lack of energy Loss of enjoyment Poor appetite/ Weight loss Sleep disturbance Loss of libido Psychomotor retardation Poor concentration Guilt and worthlessness Hopelessness / Suicidal ideation Delusions / hallucinations
Bipolar affective disorder
Elevated mood may be a normal experience Most pts with mania also experience depression Very disruptive condition Men and women are at equal risk 1% of population
Mania symptoms
Elated or irritable mood -for more than 1 week Or -resulting in admission Over-activity Disinhibition Risk taking activity Distractibility Reduced need for sleep Inflated self esteem Rapid, loud speech Racing thoughts Delusions/ Hallucinations
Schizophrenia
Schizophrenia is a serious psychiatric condition:
-abnormal thoughts and experiences
-reduction in drive, social function and alteration in personality and emotion
The age of onset is usually in early/mid adulthood
Male=Female, 1 in 100
“positive” symptoms of schizophrenia
Delusions
Hallucinations
Passivity phenomena
Thought disorder
“Negative” symptoms of schizophrenia
Social withdrawal
Emotional blunting
Apathy (lack of drive, motivation and volition)
Anorexia nervosa
Body weight <15% expected BMI <17.5 Self induced weight loss Body image distortion Widespread endocrine disorder Arrest of puberty
Bulimia nervosa
Pervasive preoccupation with eating
Attempts to counteract the fattening effects of food
Morbid dread of fatness
Eating disorders and dental problems
Erosion of dental enamel
Thermal hypersensitivity (cold/hot sensitive)
Salivary gland enlargement
Dryness of the mouth and decreased salivary flow
Redness of the throat and palate
Reddened, dry, and cracked lips and fissures at angles to the lips
Screening for alcohol misuse
CAGE
- have you ever felt you should Cut down?
- are you Annoyed if people comment on your drinking?
- do you feel Guilty about the amount you drink?
- have yo ever drunk early in the morning as an Eye-opener?
Personality disorders
Severe disturbance in the characterological constitution and behavioural tendencies of the individual
Associated with considerable personal and social disruption
Appear in late childhood/adolescence
Persist into adulthood.
Dementia
An acquired impairment of global cognitive function which is progressive & irreversible
- alzheimer’s Dementia
- vascular Dementia
- frontotemporal Dementia
- other
Delirium
A reversible state characterised by: -impairment of consciousness -disturbed attention -perceptual abnormalities -emotional disturbances -disturbed sleep wake cycle Fast onset
Causes of delirium
Infection
Drugs
Systemic illness
The health of dentists
Doctors and Dentists are a vulnerable population
They can have a wide-range of difficulties, including burnout, stress, anxiety, depression, substance misuse and enduring mental illness.
Several occupational groups in the UK appear to have considerably elevated risk of suicide.
-these include farmers, doctors, dentists, pharmacists and veterinary surgeons
