Psychiatric Flashcards
What is the mental health act Scotland 2003?
Concerned purely with management and treatment of psychiatric disorders
No provision for compulsory treatment of physical problems
Can have detained patients in the community on “leave of absense”.
What are the different detentions in the mental health act 2003?
Emergency- 72 hours Short term- 28 days Compulsory treatment- 6 months -Removal to a place of safety- police -Detention for assessment by. doctor.
What is the application of the mental health act 2003?
That the person has a mental disorder
Medical treatment is available which could stop their condition getting worse, or help treat some of their symptoms
If that medical treatment was not provided, there would be a significant risk to the person or to others
Because of the person’s mental disorder, his/her ability to make decisions about medical treatment is significantly impaired
That the use of compulsory powers is necessary.
What does neurosis means?
Contact retained with retality.
What is psychosis?
Contact lost with reality.
What are the 4 different psychiatric conditions we deal with in dentistry?
Neuroses
Psychoses
Eating disorders
Personality disorders.
What are the different types of neuroses?
Anxiety Phobic Obsessional Hypochondrial Depressive.
What is generalised anxiety disorder?
Free-floating anxiety in many/all situations.
What is phobic anxiety?
Intense anxiety/panic in specific situations.
What is panic disorder?
Unpredictable extreme anxiety.
What is somatoform disorders?
Repeated presentation of physical symptoms and persistent requests for medical investigations, in spite of negative findings and reassurance that the symptoms have no physical basis. There may or may not be psychological/psychiatric symptomatology e.g. of depression.
What are the two types of management strategies and name examples of them?
Psychological treatment (Psycho-education, anxiety management strategies and CBT) Drug treatment (self medication and prescribed medication).
What are some anxiolytic drugs?
Alcohol
Benzodiazepines (diazepam, midazolam etc)
Antidepressants with anxiolytic features (tricyclic- amitriptyline, nortiptyline etc)
Mirtazepine
SSRI (fluoxetine, sertraline, citalopram).
What are some symptoms dental patients can get from an anxiety neurosis?
TMD and parafunction
Oral dysaesthesia and facial pain
Denture intolerance.
What is a phobia?
Fear out of proportion to the threat
Find out the cause
(agoraphobia and claustrophobia might impact dental treatment).
What is OCD?
Rituals developed to contain anxiety
Fear of infection or fear of dirty oral environment.
What are the four steps in the OCD cycle?
Anxiety
Compulsion
Relief
Obessions.
What is the difference between perfectionism and OCD?
Perfectionism is a personality trait, may have habits or rituals that they follow rigidity and not doing it out of anxiety avoidance
OCD is a mental health disorder, involves repeated unwanted thoughts or urges that cause a person anxiety, the individual performs a compulsive action or ritual to prevent the development of the anxiety, ritual may not be related to the anxiety itself.
What is an adjustment disorder?
Maladaptive responses to severe past or continuing stress/trauma. Occurs in adaption to new circumstances. PTSD requires stress of exceptionally threatening or catastrophic nature. Managed by psychological intervention (mood disorders usually accompany disorders- treat with medication).
How might a patient present to the dentist with an effective disorder?
Dysaesthesias
Facial pain
Patients general demeanor.
What is cyclothymia?
Cyclothymia- normal mood swing
Most depressive disorders are not psychotic- they are neurosis.
What is a recurrent depressive disorder?
Depressive disorders can alternate with returning to normal mood- recurrent depressive disorder.
What is unipolar?
Unipolar- patient moves usually down to low mood, if they move up in mood and then down in mood- bipolar.
What is hypomania?
Hypomania and mania are periods of over-active and excited behaviour that can have a significant impact on your day-to-day life. Hypomania is a milder version of mania that lasts for a short period (usually a few days) Mania is a more severe form that lasts for a longer period (a week or more)
What is mania?
Mania is a psychological condition that causes a person to experience unreasonable euphoria, very intense moods, hyperactivity, and delusions. Mania (or manic episodes) is a common symptom of bipolar disorder.
What are the different names of changing in mood in order from normal mood swings?
Normal mood swings Cyclothymic temperament Cyclothymic disorder Biopolar type 2 Monopolar mania Biopolar type 1 disorder.
What is an example of puerperal mood disorder?
Post natal depression.
What is the ratio for developing a mood disorder in females to males?
2-3:1.
What are the different types of depressive mood disorders?
Major depressive disorders Persistent depressive disorders Bipolar depression Postpartum depression Premenstrual dysphoric disorder Seasonal affective disorder Atypical depression.
What are common symptoms of depression?
Low mood Reduced interest and motivation Lethargy and tiredness Sleep disturbance Appetite disturbance Poor concentration Loss of confidence and self-esteem Recurrent thoughts of death and suicide Unreasonable self-reproach and guilt Any form of anxiety.
What are mania and hypomania symptoms?
- Bipolar 1= mania
- Bipolar 2= cyclothymia and hypomania.
Increased productivity and feeling of wellbeing Reduced need for sleep Gradual reduction in social functioning Increase in reckless behaviour Followed by period of depression.
What is euphoria?
A feeling of great happiness or well-being. Euphoria may be a side effect of certain drugs.
What is dysphoria?
“Dysphoria” is a feeling of dissatisfaction, anxiety, and restlessness. With gender dysphoria, the discomfort with your male or female body can be so intense that it can interfere with your normal life, for instance at school or work or during social activities.
How can you treat mood disorders?
Psychological (cognitive therapy, interpersonal psychotherapies) Drug treatment (usually 2 years treatment, antidepressant, mood stabilising) Physical (exercise, phototherapy, ECT).
What is the most common treatment for seasonal affective disorder?
Phototherapy.
What are some sues of antidepressants?
Treating depression
Treating anxiety disorders
Pain relief
Helps psychological treatments.
What are the two classes of drugs used in mood disorders?
Acute phase antidepressants (SSRI, mirtazepine/venlafaxine, TCA and MAOI)
Mood stabilising drugs (lithium, carbamazepine, valporate, lamotrigine).
What are some examples of original and new tricylic antidepressants?
Original- amitriptyline, nortriptyline and dosulepin
New- imipramine and doxepin.
What are some side effects of tricyclic antidepressants?
Dry mouth, sedation and weight gain.
What should you use with caution in when taking tricyclic antidepressants?
Glaucoma and prostatism.
What are examples of SSRI drugs?
Prozac type drugs (fluoxetine, citalopram, paroxetine).
What are side effects of ssri drugs?
Acute anxiety disorders
Some patients similar to TCA (sedation, dry mouth)
Gastointestinal upset.
What interacts with monoamine oxidase inhibitors (MAOI)?
Indirect acting sympathomimetic amines (e.g. ephedrine)
- enhanced vasoconstrictor effect
- cold and cough remedies
Food stuffs- tyramine containing, alcohol/low alcohol
-bovril, oxo, marmite, cheese, herring, beans.
What are drugs used as antidepressants but are only usually when a psychiatrist is involved?
Venlafaxine (mixed SRI/NRI)
Mirtazipine (complex 5HT actions presynaptic a2 agonist)
Nefazadone (SSRI/5HT blockade)
Reboxetine (SNRI).
What drugs are used in bipolar mood disorder?
Lithium
Carbamazipine/Lamotrigine/Valporate
Antipsychotic meducines (treating episodes of mania)- ariprazole, olanzipine, quetiapine, risperidone).
What drugs do you need to avoid with lithium?
NSAID and metronidazole.
What are some direct drug effects of antidepressants?
Dry mouth
Sedation
Facial dyskinesias.
What is a facial dyskinesia?
Orofacial or tardive dyskinesias are involuntary repetitive movements of the mouth and face. In most cases, they occur in older psychotic patients who are in institutions and in whom long-term treatment with antipsychotic drugs of the phenothiazine and butyrophenone groups is being carried out.
What is Korsakoff’s psychosis?
“Alcohol induced brain degeneration”
Korsakoff psychosis is a late complication of persistent Wernicke encephalopathy and results in memory deficits, confusion, and behavioral changes. Korsakoff psychosis occurs in 80% of untreated patients with Wernicke encephalopathy; severe alcoholism is a common underlying condition.
What is Schizophrenia?
Fundamental and characteristic distortions of thinking and perception
Various types of delusions
Auditory hallucinations
Relapsing and remitting periods of acute psychosis
Cumulative, chronic deficits in motivational, affective and social domains
Multifactorial abnormality of dopaminergic neurotransmission
Prevalence 1-2%.
What are the causes of Schizophrenia?
Genetic susceptibility (multigene) Environmental (perinatal risk factors) Drug abuse (cocaine, ectsasy).
How is Schizophrenia managed?
CBT, cognitive remediation
(all psychological therapy)
Drug therapy
(oral or depot IM injections)
(dopamine antagonistic drugs- cause extrapyramidal side effects)
(atypical antipsychotics- less likely to cause extrapyramidal side effects).
What are some examples of antipsychotics?
Butyrophenones (haloperidol, droperidol)
Phenothiazines (chlorpromazine, prochlorperazine)
Thioxanthenes (flupenthixol)
New atypical antipsychotics (clozapine, olanzipine, queitapine etc).
What are some extrapyramidal side effects of antipsychotics?
Akathisia (feeling of restlessness)
Dystonia muscles involuntary contract and contort
Parkinsonism (the same symptoms as someone with Parkinson’s disease)
Tardive dyskinesia (uncontrollable facial movements such as chewing, lip-smacking and sticking your tongue out or blinking your eyes repeatedly)- this does not stop when the medication is stopped.
How do you treat extra-pryamidal symptoms?
Use an atypical antipsychotic instead
Beta-adrenergic blockers (propranolol, metropolol)
Anticholinergics (procyclidine, benztropine, diphenhydramine, praminpexole).
What is an anti-cholinergic drugs?
Anticholinergic drug- tips towards acetylcholine and nerve effects are increased from Ac
-these drugs can be used to reduce the effects of acetylcholine.
What are the different types of eating disorders?
Anorexia nervosa
Bulimia
Comfort eating.
What is anorexia nervosa?
Altered perception of body image
Don’t eat
Ulcers, dry mouth, infections and bleeding.
What is bulimia?
Normal weight- binge/vomit
Comfort eating- stress reaction maybe
Dental erosion and oesophageal stricture.
What is borderline personality disorder?
instability in interpersonal relationships, self image and affects, and marked impulsivity.
What is antisocial personality disorder?
Disregard for, and violation of, the rights of others.
What is histrionic personality disorder?
Excessive emotionally and attention seeking.
What is narcissistic personality disorder?
Grandiosity, need for admiration, and lack of empathy.
What is avoidant personality disorder?
Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
What is dependent personality disorder?
Submissive and clinging behaviour related to an excessive need to be taken care of.
What is shizoid personality disorder?
Detachment from social relationships and a restricted range of emotional expression.
What are symptoms of borderline personality disorder?
Deep fear Unstable relationships Changes in self image Stress paranoia Impulsive behaviour Suicidal threats Excessive mood swings Feelings of solitude.
