Mental Health Flashcards
Who did 1970s psychiatric hospital study?
Rosenhan
Describe Rosenhan’s study
1970s
8 normal people at 12 psychiatric hospitals in USA - hearing voices (empty, hollow, thud)
All admitted with schizophrenia / mania depression.
Patients thought they were CQC/journalist
7-52 days to be discharged - all given mediation and ‘Sx/Mania in remission’
what illness are included under mental health?
depression, stress, anxiety, eating disorders, drug dependence, mania, schizophrenia, OCD, bipolar
Define psychiatrist
Medical doctor specialising in psychiatry
Can prescribe drugs
Define psychologist
Psychological / mental management / treatment of patients. Not medical
Define psychiatric nurses
Work with patients and families in the community
Define psychiatric social workers
Welfare rights
community facilities
powers under Mental Health Act (2005)
Rosenhan’s second study
Psychiatric hospital told about
- first study
- in next 3 months pseudo patients will arrive
- rate each new arrival 0-10 (0=pseudo, 10=def has mental illness)
Results:
- 193 patients admitted
- 83 may have been pseudo (41 - confident they were pseudo)
- Rosenhan didn’t send any pseudo, all were ‘real’
What are affective disorders?
depression
anxiety
What ratio suffer from a mental disorder in the UK?
1:7 NB diagnosed (clinical iceberg)
What % of people with mental disorders are female in the UK?
55%
Out of 1000 in general pop, how may have POOR mental HEALTH?
300
NB these people have same problems and are entitled to same OH care, but have:
- increased disease / needs (medications, poor OH, reduced ability to look after themselves)
- increased barriers to dental care
- increased risk of dental anxiety/phobia
What is DSM-V?
Diagnostic and Statistical Manual of Mental Disorders - Version 5
- used in the UK
- ICD-10 (International Classification of Disease, Version 10) used in USA
Categories:
- neurodevelopmental disorders, schizophrenia, bipolar, depression, anxiety, OCD, post traumatic stress disorder, dissociative disorder (memory, awareness, identity, or perception affected), medically unexplained symptoms (eg IBS), eating disorders, elimination disorders (not going to toilet properly), sleep-wake disorders, dysmorphia, substance/addiction disorders, personality disorders, medication induced disorders
What are 5 models of psychiatric disorders?
- Historical
- witchcraft, demons
- Biomedical Model
- 1950/60s, physiological issues, fix with medicine
- Extreme forms of normal behaviour
- Psychological Models
- thoughts, attitudes, beliefs, experiences and associated responses
- Biopsychosocial Model
- all of above
- most recent model
- biology, chemistry, psychological, social
- NB what is social acceptable? African tribe - witch doctor on hallocinating drugs is ok
Define Historical Model of Mental illness
witchcraft, demons
Define Biomedical Model of Mental illness
1950/60s
physiological issues, fix with medicine
Define Psychological Model of Mental illness
thoughts, attitudes, beliefs, experiences and associated responses
Define Biopsychosocial Model of Mental illness
most recent model
- biology, chemistry, psychological, social
- NB what is social acceptable? African tribe - witch doctor on hallocinating drugs is ok
Prevalence of alcohol addiction in men and women
Men - 6%
Women - 1%
Prevalence of illicit drug addiction
36% (9%)
Prevalence of depression (lifetime)
10-20%
Prevalence of anxiety (1 year)
4%
Prevalence of schizophrenia (1 year)
0.4%
Prevalence of eating disorders (lifetime)
0.5 - 1% (probably higher)
Study of 508 new dental patients - how many reported 1 / 2 / 3 / 4 mental illnesses?
1 = 20% 2 = 6% 3 = 0.8% 4 = 0.6% Over or under reporting? Likely under reporting - stigma, denial
What is the relationship between:
- mental health and GP visits?
- mental health and GDP visits?
Inverse relationship
- increase mental illness = increase GP visits
- increase mental illness = decrease GDP visits (anxious / different priorities - hard to get out of bed)
Inpatients with mental illness have what types of worse oral health?
- more missing teeth
- increased caries
- increased perio
- poorer oral hygiene
- fewer dental visits
Outpatients with mental illness have what types of worse oral health?
- more missing teeth
- fewer dental visits
- better OH cf inpatients
Who has better OH - inpatients or outpatients with mental illnesses?
Outpatients
What barriers to professionals / dentists have towards mentally ill patients?
- lack of knowledge
- attitudes towards mental illness
- low tolerance of ppl crying / angry / hard to treat
- poor communication
Can diagnosis vary globally?
Yes
Cooper et al 1972 - psychiatrist taped patients
- UK = more depression / mania diagnosed
- USA = more schizophrenia diagnosed
Symptoms of depression
- Temporal differences - morning / evening (diff for diff ppl)
- anxious
- irritable
- can’t concentrate / relax
- adverse reaction to stress
- lack of interest / apathy / lethargy
- sleep disturbances (too much / little)
- loss of appetite / weight
- amplification of pain / lower pain threshold
- lack of insight (don’t realise what they’re doing is detrimental)
How does DSM-V diagnose / catergorise depression?
Must have 2 of the following: - fatigue / low mood / anhedonia (lack pleasure) / irritable Then needs minor symptoms - eg sleep / eating - 4 minor symptoms = mild depression - 5-6 = moderate - 7+ = severe NB symptoms must be persistent / impact daily life
What are oral manifestations of depression?
- Chronic facial pain
- 18 mo study at Eastman (take pt others don’t want)
- 813 new referrals
- mean pain duration 4.2yrs
- 70% responded to appropriate MH / SH and medication
- Oral ulcers
- obtain SH and ulcer diary
- reduce with tricyclic antidepressants
- NB factitious ulcers - chewing lips / cheeks, cause harm to seek treatment
NB protect patients with depression from unneeded investigations, eg biopsy - increase stress levels
