Mental Health Flashcards
Mpsychoses
Loss of contact with reality
Features: delusions, hallucinations, distorted though -form/thinking patterns
Schizophrenia
Fractured mind
Prevalence:1%
Positive symptoms:delusions, hallucinations, though -form disorder/muddled thinking
Negative symptoms: lack of thoughts, absence of emotions, lack of drive, social and occupational difficulties
Treatment: antipsychotics (clozapine can cause immunosuppression), rehabilitation
Oral findings:
Poor OH, high caries risk and perio disease common
Usually smokers
Decreased salivary flow
Acute dystonia (facial grimacing, tongue protrusion, neck stiffness)
May have delusional oral symptoms
Can have impaired gag reflex so need to protect airway during the treatment
No whispering to avoid worsening paranoia
No elective treatment during acute illness
Shorter appointments needed
Care with smoking cessation (clozapine levels can increase leading to potential toxicity)
Oral findings in depression
Dry mouth - due to medication like tricyclic antidepressants or lithium), oral candidiasis, increased caries risk
Facial dyskinesis/tardive dyskinesia - can be side effects of monoamine oxidase inhibitors and tricyclic antidepressants
Atypical facial pain
Burning mouth/sore tongue
TMJ pain dysfunction syndrome
*Tricyclic antidepressants and monoamine oxidase inhibitors (maoi) can cause postural hypotension
Maoi can make GA a risk due to prolonged respiratory depression and can interact with many analgesics
Bipolar disorder
Cyslic mood changes from severe highs (mania) to lows (depression)
Manic phase: affecting thinking, judgement, social behaviour (overactive, over talkative, excessive energy, risk taking..)
Depressive phase: depression symptoms
Management: CBT, mood stabilizer (lithium, carbamezapine, valporate), antipsychotics
Dental aspect:
In manic phase: difficult to manage
Lithium can cause dry mouth
NSAIDs, metronidazole and tetracycline can induce lithium toxicity
Oral findings in eating disorders
Erosion of teeth
Petechiae in palate
Ulcers
Abrasions in soft palate
Xerostomia
Dental management:
May have poor compliance and associated behavioral problems
Due to hypersensitivity can stop eating even further
Advice to rinse with bicarbonate after vomiting to reduce the damage to teeth
Use of topical fluoride to reduce sensitivity
Psychiatric disorders relevant to dentistry
Dental anxiety
Dental phobia
Obsessive compulsive disorders
Hypochondriasis
Psychogenic pain (atypical facial pain, TMJ dysfunction, atypical odontalgia, oral dysaesthesia)
Eating disorders
Drug and alcohol misuse
Depression
Schizophrenia
Bipolar disorder
Symptoms of anxiety
Psychological: worry sense of dread, irritability, poor concentration, restlessness
Physical: GI (dry mouth, nausea,. swallowing difficulty, disturbance of bowel habit)
CV/respiratory ( SOB, chest pain, palpitations, tachycardia)
Neuromuscular (headache, weakness, tremor, muscle aches)
Other: sweating
Clinical depression
Lowering of the mood but also symptoms like disturbance of sleep appetite and reduced enjoyment that affect daily life
It is then a part of a syndrome
Symptoms in cocaine users
Pain in gums and teeth due to teeth clenching and grinding
Localised vasoconstriction caused by cocaine can cause gingival necrosis (e.g. when testing the drug and putting it directly into gums)
Symptoms of benzodiazapine withdrawal
In 50% there will be syndrome of paresthesia, hypersensitivity and pain in the teeth and jaw
Similar happens in opioid withdrawal
Side effects of many psychiatric drugs
Oral dystonia, drooling and bruxism
Dry mouth due to anticholinergic properties
What is cage questionnaire
C- have you ever felt you should Cut down the amount you are drinking
A- are you Annoyed if people comment upon the amount you are drinking?
G- do you ever feel Guilty about the amount you are drinking?
E- have you ever had a drink early in the morning as a Eye- opener?
Dementia
Acquired impairment of global cognitive function, generally progressive and largely irreversible
Alzheimer’s is the most common cause of dementia
Vascular dementia is due to atherosclerosis
If individual lacks capacity to make decision
Either defer treatment and reassess
Or
Act in their best interest
