Mental Health Flashcards
What are the features of dental anxiety?
Normal state
- Managed with communication and trust
- Can develop into panic disorder
- Extremely difficult with mental health issues superimposed on top of this
What % experience a mental disorder in their life time?
50%
What are some of the comorbidities of mental health disorders?
Obesity
Asthma
COPD
Hypertension
Life expectency- can be reduced by 10-20 years (schizophrenia, schizoaffective, bipolar)
What are the dental impacts of mental health disorders?
More susceptible to oral disease:
poor OH
poor diet
dental phobia
difficulty registering
costs
difficulty in access
adverse orofacial side effects caused by antipsychotics and antidepressants- xerostomia
What is the issue with mental health training for dentists?
No current training on dealing with mental health emergencies
What are the general impacts of good mental health?
- Improved educational attainment- better job
- Greater productivity
- Less sickness absence
- Better physical health
- Reduced mortality
- Reduced risk of suicide
- Increased social interaction
- Reduced risk taking behaviour- smoking, drugs, alcohol
- Increased resilience
What are some examples of protective factors against mental health issues?
- Genetics
- Family background (loving safe environment)
- Personality
- Age
- Gender
- Marital status
- Social support
- Socioeconomic factors- access to resources
- Reduced inequality
- Employment- purposeful activity
- Community factors- participation
- Self esteem
- Autonomy
- Altruism
- Emotional and social literacy
- Physical health
What are some of the causes in children of poorer mental health?
- Parental use of alcohol, tobacco and drugs during pregnancy
- Maternal stress during pregnancy
- Parental poor mental health
- Low birth weight
- Impaired cognitive function and language development as a child
- Unemployed parents
- Child abuse
- Use of cannabis (at young age)
What are some of the causes of poorer mental health in adulthood?
- Lower income
- Debt
- Violence
- Stressful life events- bereavement
- Unstable housing
- Fuel poverty
- Unemployment
- Suicide
- Personality traits
- Abuse experience
What are the features of generalised anxiety disorder?
- Regular uncontrollable worries about things in every day life
- Individual to each person
What are the features of panic disorder?
- Frequent panic attacks without clear cause or trigger
- Constant fear of having another panic attack (can be a trigger)
What is a phobia?
Extreme fear or anxiety triggered by particular situation or object
What is a social anxiety disorder?
Fear or anxiety triggered by social situations
- Parties, workplaces, talking to others
What are the features of PTSD?
Development anxiety problems after going through traumatic experience
- Flashbacks
- Nightmares
- Reliving fear and anxiety of traumatic event
What is OCD?
Occurs when anxiety causes repetitive thoughts, behaviours, urges, obsessions
What is health anxiety?
Obsessions and compulsions related to illness
Researching symptoms and thinking they have them
What is body dysmorphia disorder?
obsession and compulsions relating to physical appearance
When does perinatal anxiety occur?
During pregnancy or first year after giving birth
What are the symptoms of depression?
- Low mood
- Diminished interest in activities
- Weight gain or loss
- Psychomotor agitation or retardation
- Fatigue
- Inappropriate guilt
- Difficulty concentrating
- Recurrent thoughts of death
- Sleep issues
What are the causes of depression?
- Stressful events- bereavement, relationship breakdown
- Personality traits- low self-esteem, overly self-critical
- Genetics
- Life experience
- Family history
- Giving birth
- Loneliness
- Alcohol and drugs
- Illness
What are the dental impactions of depression
- Less likely to seek treatment
- Chronic facial pain
- TMD
- Burning mouth- oral dyaesthesia
- Somatoform issues- spots/lumps, dry mouth, excess salivation, halitosis, disturbed taste
What is a tardive dyskinesia?
Involuntary movements of tongue, lips, face, trunk, extremities
Associated with antipsychotics (atypical), neuroleptics
Mild- patient may be unaware
Does not respond to removal of medication
What is psychosis?
Loss of contact with reality
Auditory/visual/gustatory/olfactory hallucination
Delusions- believing things that are not true (belief not shared by others- conspiracy to harm patient)
What are some of the causes of psychosis?
- Schizophrenia
- Bipolar- mood disorder, episodes of low mood or elation
- Severe depression
- Trauma
- Stress
- Drug/alcohol misuse
- Side effects of prescribed medicine
- Brain tumours
What is bipolar?
Severe mood swings (out with cyclothymic mood changes)
- Lasts weeks or months
What are the different phases of bipolar?
Low mood/depressive phase- intensely low feeling, depressed, despairing
High/mania- elation, overactivity, grandiose delusions, spending issues
Hypomanic- mood is high but not as extreme
Manic- mixture of depression and mania (restless)
How common is bipolar?
Affects 1 in 50
-> Usually starts between age 15-25 (rarely after 50)
What are the dental implications of bipolar?
Depression phase- decline in OH, increased caries/periodontal disease
Mania- NCTSL due to overzealous OH
What is schizophrenia?
Disorder of mind affecting how patient thinks, feels, behaves
-> Fundamental distortions of thought and perception
What are the epidemiological features of schizophrenia?
Affects 1 in 100 people
M=F
Usually occurs between 15-35 (rare before age 15)
What are the symptoms of schizophrenia?
- Hallucination- hearing voices (rude, critical, abusive, irritating), discomfort in body, feeling of being touched or hit
- Delusion- unrealistic thoughts and beliefs that patient is completely sure of (can be inexplicable- not related to culture, background or religion)
- Paranoia- person feels persecuted or harassed (spied on by government, partner being unfaithful)
- Ideas of reference- patient sees special meaning in ordinary day to day events (connection to radio or TV- feeling someone is telling them to do things)
- Thought disorder- difficulty concentrating (issues finishing tasks, working, studying)
- Issues with memory
- Feeling of being controlled- thoughts suddenly disappear, thoughts are not their own, body is being taken over
- Loss of motivation/energy
- Loss of interest in life
- Isolation
- Stop taking care of themselves- washing, tidying
- Issues with social interaction
How is schizophrenia treated?
- Medication- tablet form, capsules, syrup, depot injection
- CBT
- Counselling
- Supportive psychotherapy
What are the dental implcations of schizophrenia?
- Haloperidol/phenothiazines can cause orthostatic hypotension (raise slowly from supine position in chair)
- Xerostomia- long term use of neuroleptics (candidiasis, caries, parotitis)
- Oral pigmentation
- Extrapyramidal symptoms- facial dyskinesia, issues swallowing, issues speaking, uncontrollable grimacing (dystonia)
- Haloperidol and clozapine- hypersalivation
What is schizoaffective disorder?
affects thoughts, emotions and actions
- Combination of psychoses and Bipolar
- Clear symptoms present for most of the time for more than 2 weeks
What are the types of schizoaffective disorder?
SD manic type- psychotic and manic symptoms in one episode
SD depressive type- psychotic and depressive symptoms
Mixed- both manic ad depressive symptoms, psychotic symptoms are independent
What are the signs/symptoms of annorexia nervosa?
- Worrying about weight
- Calorie counting- eating less, excluding certain food groups
- Excess exercise
- Being below safe weight
- Smoking or chewing gum to keep weight down
- Checking weight/appearance in mirrors obsessively
- Withdrawal from social situations that involve eating
- Wearing baggy clothes
- Water loading before being weighed
- Avoiding mealtimes
- Loss of interest in sex
- OCD symptoms- sticking to rigid routines and times, difficulty in spending money, need to study or work all the time
How common is AN in 15 year olds?
Girls- 1/150
Boys- 1/1000
What are the features of bulimia nervosa?
- worry more and more about their weight
- binge eat
- make themselves vomit and/or use laxatives or other ways to get rid of calories
- have irregular menstrual periods
- feel tired
- feel guilty
- stay a normal weight, in spite of their efforts to diet
What is ARIF?
avoidant/restrictive food intake disorder (not caused by worry about weight and body image)
What are the psychological signs and symptoms of eating disorders?
- Psychological- poor sleep
- issues concentrating, depression
- loss of interest in others
- obsession about food and eating (and cleaning/washing etc)
What are the physical signs and symptoms of eating disorders?
- finding it harder to eat (stomach shrunk)
- Feeling tired, weak, cold (metabolism slows)
- Constipation
- Changes in hair- falls out
- Dry skin
- Not growing to full height/loss of height
- Brittle bones- OP
- Unable to ger pregnant
- Damage to liver
- Death
What are the implications of vomiting seen in eating disorders?
- Erosive tooth wear
- Sialosis
- Palpitations- disturbed salt balance in blood
- Feeling weak and tired
- Weight swings
- Damaged kidneys
- Epileptic fits
- Issues with getting pregnant
What are some of the effects of laxatives used by patient with eating disorders?
- Persistent stomach pain
- Swollen fingers
- Issues going to toilet without using laxatives (damage caused by medication to bowel muscles)
- Weight swings- loss of fluid on purging
What are the dental implications of eating disorders?
NCTSL
-> Loss of vertical dimension
-> Dento-alveolar compensation
-> affects quality of dentine for bonding
-> Use of resin-based materials
Xerostomia
Sensitivity
