Mental Health

Question 1

At what point must be a non-healing ulcer suspected to be oral cancer be referred for investigation?

Answer 1

• non-healing after 2 weeks
• unchanged or increasing in size
• rolled border
• indurated (hard and firm, suggests tumour present)

Question 2

What questions should be asked of a smoker?

Answer 2

• how long have they been smoking?
• what type of cigarettes do they smoke?
• how may do they smoke a day?
• have they tried to quit before?
• would they consider quitting now?
• why do they smoke?

Question 3

What is clozapine?

Answer 3

• anti-psychotic prescribed for schizophrenia
  
  • not first line (highlights poor management)
• requires considerable monitoring
  
  • regular blood tests
• full blood count required before starting treatment
  
  • can cause neutropenia (increased infection risk)
  • neutrophil numbers should be greater than 1

Question 4

What platelet count is required for dental treatment?

Answer 4

• over 100 for treatment in GDP
• over 50 for treatment in SCD and hospital

Question 5

What neutrophil count is required for dental treatment?

Answer 5

• over 1 for GDP
  
  • under is high infection risk
  • consider antibiotic prophylaxis
  • post operative antibiotics

Question 6

What is schizophrenia?

Answer 6

• mental condition potentially causing visual, auditory or touch hallucinations
• delusions
  
  • belief that someone is trying to control them
  • believe something nobody else can understand
  • belief that people are talking to you when they aren’t
• positive symptoms
  
  • something is there that shouldn’t be
  • hallucinations
• negative symptoms
  
  • apathetic
  • reduced emotions
  • no response to delusions
  • limited communication
• potentially linked to trauma, usually predisposed
  
  • adverse childhood event
  • bereavement
  • loss of job
  • illness
  • drug induced (e.g. cannabis, LSD, cocaine)
• thought to be a neurotransmitter imbalance
  
  • GABA
  • serotonin
  • dopamine

Question 7

How is schizophrenia treated?

Answer 7

• antipsychotics
  
  • dopamine blockers
• uncontrolled may require extra support on top of medications
  
  • talking therapies
    - CBT
    - psychiatrist
• multidisciplinary team
  
  • occupational therapy
  • life skills
  • social work
  • enrichment

Question 8

What is the link between clozapine and smoking?

Answer 8

• sudden withdrawal from smoking results in release of bound clozapine
  
  • levels in blood greatly increase

Question 9

How can antipsychotic medications affect sedation?

Answer 9

• antipsychotics can lead to a build up of tolerance to sedation
  
  • anaesthetist led sedation
  • not for active uncontrolled mental health (strange reactions)