Mental Health Flashcards
which are the 4 main disorders we need to be aware of as dentists
Anxiety
affective
psychotic
eating
what is the most common disorder that a dentist may encounter
Anxiety disorder
what are the 3 types of anxiety disorders
- Generalised Anxiety disorder
- Panic disorders
- obsessive compulsive disorders
what are the 2 types of affective disorders
depression
bipolar disorder
what is a type of psychotic disorders
schizophrenia
what are the two types of Eating disorders
anorexia nervosa
bulimia nervosa
what health condition can panic attacks be misunderstood for
cardiac medical emergency
describe how long panic attacks last
- Panic attack is a brief or sudden attack of intense terror
- They usually last for 10 mins but can go on for hours
how do we differentiate between a cardiac emergency and panic attack
- if:
- Sudden severe chest pain
- Pressure in chest lasting 2 or 3 minutes
- Chest pain radiating to arm or into the jaw
these are signs of cardiac emergency
How long must a patient experience anxiety for it to be considered GAD
more than 6 months
what are the sign and symptoms of GAD
- Restlessness
- Easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
what is the difference between GAD and normal anxiety
- The difference is GAD find it hard to control their worries, anxiety is more constant and it can affect their daily lives
what is OCD
- This is the repeated unwanted thoughts or sensations (obsessions) or the urge to do something over and over again (compulsions)
- Some people can have both obsession and compulsions
- These patients have no control over their negative thoughts and they believe that not doing things a certain way will cause harm
what are the 4 types of OCD
- checking
- contamination
- symmetry. And ordering
- ruminitions and intrusive thoughts
what are the dental manifestations of OCD
- Severe loss of tooth structure or bleeding gums due to repetitive tooth brushing
- Localised gingival lesions due to overzealous toothbrushing
- TMD and osteomyelitis secondary to chronic nail-biting
what are affective disorders
These are disorders that affect the mood
Usually accompanied by abnormalities in thinking and perception
what is depression and describe how long a depressive episode can range from
- This is the persistent feeling of sadness and loss of interest
- Consists of episodes where the symptoms last for at least 2 weeks but some may have it for weeks or years
signs and symptoms of depression
In the 2 week period they may experience:
- Depressed mood most of the day
- Diminished interest in pleasure/activities
- Significant weight loss/gain
- Slowed down thoughts
- Reduced concentration
- Reduced physical movement/ fatigue
- Feeling worthless
- Recurrent thoughts of death/ suicide
what is bipolar disorder
-This is altering high moods (mania/ hypomania) and low moods (depression)
describe the symptoms of a patient with bipolar disorder
Patient must experience the depressive symptoms but also some of the following manic symptoms:
- Inflated self-esteem
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts/ easily distracted
- Increase in goal directed activity
- Doing things that are damaging to oneself like unrestrained buying sprees
How may affective disorders and GAD affect dental hygiene:
- Reduced energy and motivation leads to neglection of oral hygiene increasing caries and periodontal risk
- Burning mouth syndrome
- Atypical facial pain
- Disturbed taste
- TMD symptoms
- Antidepressants can induce xerostomia and alter taste sensation
what can trigger a psychotic disorder
mental illness
physical injury
physical illness
substance abuse
extreme stress or trauma
is psychosis a symptom or illness
- Psychosis is a symptom it is not an illness e.g people who have schizophrenia experience psychosis
does psychosis have a sudden start
no it gradually develops
-There are several early warning signs
what are the warning signs before psychosis
It starts with gradual change in the way one thinks and understands the world
- A drop in grades or job performance
- Trouble thinking clearly or concentrating
- Suspiciousness or unease around others
- Spending more time alone
- Lack of self-care or hygiene
- Feeling strong emotions towards situations or no emotions at all
what are the Signs of early psychosis:
- Hearing, seeing, tasting things that others don’t
- Hanging on to unusual beliefs or thoughts regardless of other opinions
- Pulling away from family and friends
- Stop taking care of oneself
- Not thinking clearly or paying attention
what does a patient experience during a psychotic episode
Hallucinations:
1. Auditory – hearing voices when no one is around
2. Tactile – strange sensations or unexplainable feelings
3. Visual – seeing people or things that are not there
Delusions
- Beliefs that are different from their culture or don’t make sense
what is schizophrenia
-This is a disintegrative psychosis involving loss of contact with reality
what are the positive symptoms of schizophrenia
The addition of experiences or behaviours
e.g. hearing or seeing thing that others don’t or having belief that something is real or true when it isn’t
The detraction of experiences or behaviours
e.g. finding things less interesting or enjoyable, moving your body less or having less motivation
what is the impact of psychosis disorder on dental health
- struggling to follow OHI
- dental specific delusions - alien controlling them through silver fillings
- higher DMFT
- Side effects from their neuroleptic (depresses nerve function) drugs - Haloperidol and clozapine can cause hyposalivation – cadidosis and caries
what does eating disorder usually co-exist alongside with
anxiety, depression, OCD or personality disorders
what can be the first presentation of eating disorder
oral signs
what is anorexia nervosa
a condition characterised by deliberate weight loss through food restriction and or over-exercising
what is bulimia nervosa
is a condition characterised by repeated bursts of overeating with an excessive preoccupation with controlling body weight
how are the behaviours of anorexia and bullimia similar
- Being preoccupied with food, body size and or dieting
- Skipping meals or eating very small meals
- Restricting foods to certain food types
- Frequent mood changes
is eating disorder just about relationship with food
no it’s the need to control something of substance in the individual’s life
how do we explore the severity of the psychiatric conditions
- Ask about the support they are receiving – do they have access to therapy?
how doe we explore the interventions the patient may have in place
- ask what current or previous interventions they have had
- Ask about any previous or recent alterations to medications and why those changes were made
- Psychiatric medications are known to cause xerostomia
why might a patient’s mental health affect stabilisation phase
Patients with acute psychiatric conditions can often struggle with self-care, regular dental attendance, increased sugar intake and substance abuse.
All these factors can contribute to rapidly deteriorating oral health, which can produce feelings of shame and further negatively impacta patients self-esteem.
This can form a positive feedback loop, where shame about worsening oral health leads to increased dental avoidance.
how do we address the issues mental health can cause for stabilisation phase
- Filter your advice to what is essential and what is additionally beneficial
- Example: “If you can only manage to brush once a day, then brush last thing at night before you go to bed, as it’s the most useful.If you can brush in the morning too then that would be even better.” - adjust the standard
- When we talk about stabilising a patient’s dental health, we talk about improving their diet and aiming for plaque and bleeding scores of less than 20%.
- Bleeding scores of 20% are necessary to reflect gum disease but we could adjust the plaque score of 20% standard for certain patients - Signpost to support
- patients struggling with self-care and psychiatric wellbeing may need to be signposted to their GP
- GP can help manage that positive feedback loop
In mentally unwell patient the duration of their mental illness is a big predictor of poor dental health – early detection and signposting is key
Patients with severe mental illness suffer from what three major negative health determinants
- Poor oral hygiene
- Reduced access to routine dental care
- The dental team unable to manage these patients
why is it a challenge to treat patient with mental health problems who are not being treated for their mental health
the dental treatment is more likely to fail
how do we monitor substance abuse
the guidance of AUDIT-C and smoking cessation “Ask, Advice, Act”
how do we use Audit-C
- How often do you drink a drink containing alcohol?
- Never = 0
- Once a month = 1
- Several times a month = 2
- Several times a week = 3
- 4+ times a week = 4 - How many drinks containing alcohol do you have on a typical day when you are drinking?
- 1 or 2 = 0
- 3 or 4 = 1
- 5 or 6 = 2
- 7 to 9 = 3
- 10+ = 4 - How often do you have six or more drinks on one occasion?
- Never = 0
- Less than monthly = 1
- Monthly = 2
- 2-3 times per week = 3
- 4 or more times a week = 4
A score of 5+ is high-risk drinking – explore further with full audit
describe how we carry out smoking cessation using 3 A’s
3 A’s
- Ask – ask about the patient’s smoking status
- Advise – If they are interested advise them on best way to quit – evidence base states that the best way to quit is with medication and specialist support
- Act – offer a referral to a local stop smoking service
how can a dental professional talk to a patient about their psychiatric condition
You can start with a fact “1 in 4 people in the UK will experience mental health problem in a year”
Ask how they are doing – listen and engage with response
Consider bringing up your own personal experience of mental health to help empathise
If there is not enough time to speak then acknowledge their positive step in wanting to speak and arrange a better time to have the conversation e.g. at a review appointment – if they need urgent help then signpost them to support or A&E
how can a dental professional hold conversation when patient is speaking about mental health issues
- Actively listen – most important
- Avoid asking too many questions – ask more open ones
- Reassure them
- Signpost/refer
- Ask patient what they would like to happen in this situation
How can a dental professional end conversation when patient is speaking about mental health issues
- Give gentle indication that convo needs to end
- Summarise the conversations with any actions you have decided to take
- Ask them to reflect on what they want to do moving forward
how does a dental professional refer a patient for intervention
- For low risk – contact patient’s GP
- High risk – advise pt to attend a&e
- Acute risk – when u don’t feel comfortable with pt leaving as they may be an immediate risk to themselves or others – call police or ambulance
