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CHHD > Psychiatric Conditions > Flashcards

Psychiatric Conditions Flashcards

1
Q

What is neurosis and name some symptoms of neurosis

A
  • Excessive degrees of normal phenomena
  • Common
  • Quantitatively different
  • Anxiety
  • Depression
  • Somatisaiton
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2
Q

What is psychosis and name some symptoms of it

A
  • Thought disorder
  • Rare
  • Qualitatively different
  • Schizophrenia
  • Manic depressive illness
  • Delusions
  • Hallucinations
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3
Q

What are anxiety neuroses

A

Various combos of psychological and physical manifestations of anxiety, not attributable to real danger - extensions of normal emotions

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4
Q

What are the signs and symptoms of anxiety neuroses caused by and what can they present as

A

Caused by sympathetic overactivity can occur as panic attacks or as a persisting state could result from a specific trigger = phobias

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5
Q

What are the psychological symptoms and signs of anxiety neuroses

A
  • Fearful anticipation
  • Irritability
  • Restlessness
  • Sensitivity to noise
  • Repetitive worrying
  • Poor concentration
  • Subjective reports of poor memory
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6
Q

What are the respiratory symptoms of anxiety neuroses

A

RS - difficulty inhaling (exhalation in asthma), feeling of chest constriction, overbreathing

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7
Q

What are the cardiovascular symptoms of anxiety neuroses

A

Cardiac discomfort, Palpitations

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8
Q

What are the Gastrointestinal symptoms of anxiety neuroses

A 
XS wind
Aerophagy
Difficulty swallowing
Dry mouth
Loose stools
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9
Q

What are the genitourinary symptoms of anxiety neuroses

A

Increased frequency of micturition

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10
Q

What are the neurological symptoms of anxiety neuroses

A
  • Tinnitus
  • Dizziness
  • Blurring of vision
  • Paraesthesia
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11
Q

What are the muscle-skeletal symptoms of anxiety neuroses

A

Aching

Stiffness

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12
Q

What are the sleep disturbance symptoms of anxiety neuroses

A
  • Difficulty in getting off to sleep
  • Night terrors
  • Intermittent waking
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13
Q

What are some of the psychological symptoms of panic disorders

A
  • Intense fear
  • Impending doom
  • Impaired concentration
  • Depersonalisation
  • Fear of losing control
  • Going crazy or dying
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14
Q

What are some of the psychological symptoms of physical disorders

A
  • Chest tightness
  • Palpitations
  • Tachycardia
  • Trembling
  • Paraesthesias
  • Sweating
  • Dry mouth
  • Shortness of breath
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15
Q

What is generalised anxiety disorders

A
  • Generalised, persistent, excessive anxiety about everyday circumstances lasting > 6 months
  • Prolonged waxing and waning course
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16
Q

What must be excluded when diagnosing generalised anxiety disorders

A

Organic causes like thyrotoxicosis, phaechromocytoma, hypoglycaemia

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17
Q

What psychological treatment is there for generalised anxiety disorders

A
  • Reassurance, counselling and psychotherapy

- Behavioural therapy once avoidance behaviour established

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18
Q

What pharmacological treatment is there for generalised anxiety disorders

A
  • Anxiolytic agents e.g. benzodiazepines (short term)
  • Antidepressants may be helpful owing to anxiolytic properties
  • Beta blockers (symptomatic relief)
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19
Q

What management can there be for simple specific phobias e.g. spiders, darkness, heights

A

Cognitive behaviour therapy - exposure

Anxiety management training - flooding

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20
Q

What is agoraphobia and who is most likely to develop it

A

Fear of open spaces or situations from which escape might be difficult e.g. crowd, bus, train. Severe cases patients may be confined to home
Most common in females

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21
Q

What is social phobia

A
  • Anxiety provoked by social performance situations

- Fear of behaving in a manner that will be humiliating or embarrassing

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22
Q

What are some treatment methods for social phobia

A
  • Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (anxiolytics)
  • Exposure by systematic desensitisation
  • Cognitive therapy
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23
Q

What are obsessions

A

Unwelcome, persistent, recurrent ideas, thoughts, impulses or images that are intrusive senseless and recognised and absurd

Can occur as thoughts, ruminations, doubts, impulses, phobias

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24
Q

What are compulsions

A

Repetitive, purposeful, behaviours performed in response to an obsession in a stereotyped fashion -
70% of patients will have an anankastic personality trait - involves cleanliness, hand washing, touching, checking

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25
Q

What is OCD

A

Obsessive-compulsive disorder

- Absurd, time-consuming (>1hr/day) obsessions and compulsions that interfere with individual’s everyday functioning

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26
Q

What management options are there for OCD

A 
Cognitive-Behaviour therapy:
- Exposure and response prevention
- Thought stopping
- Habituation training
Drug Therapy
- Clomipramine
- Serotonin uptake inhibitors e.g. fluoxetine
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27
Q

Describe Cognitive Behaviour Therapy (CBT)

A
  • Patients challenge their patterns and belief
  • Replaces errors in thinking with more realistic and effective thoughts
  • Encourages patients to take a more open, mindful and aware posture towards them to diminish their impact
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28
Q

Describe psychosis and name some key features

A
  • Contact with reality is lost
  • Normal mental processes suspended
  • Normal constraints abandoned
    Features:
  • Halluncinations
  • Delusions
  • Thought disorder
  • Loss of insight
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29
Q

What disorders can psychosis be associated with

A
  • Bipolar affective disorder
  • Schizophrenia
  • Paranoid state
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30
Q

Define delusion

A

Fixed, false belief which is out of keeping with person’s religious and cultural background and which is maintained even in the face of evidence to the contrary

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31
Q

Define hallucination

A

False sensory perception in absence or real external stimulus

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32
Q

Describe what schizophrenia is

A
  • Disintegrative psychosis involving loss of contact with reality
  • Splitting of normal links between perception, mood, thinking, behaviour and contact with reality
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33
Q

What classes can be schizophrenia be split into

A
  • Paranoid
  • Herbephrenic or Disorganised
  • Catatonic
  • Undifferentiated, simple
  • Residual
  • Type I
  • Type II
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34
Q

Describe the paranoid class of schizophrenia

A

Prominent persecutory or grandiose delusions and auditory hallucinations may appear normal until abnormal beliefs uncovered

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35
Q

Describe the Hebephrenic/Disorganised class of schizophrenia

A

Silly and childish behaviour, thought incoherence, disorganised behaviour

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36
Q

Describe the Catatonic class of schizophrenia

A

Motor immobility, rigidity, posturing, excitement, copying speech and behaviour

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37
Q

Describe the undifferentiated, simple class of schizophrenia

A

Insidious social withdrawal deterioration, defect state, absence of delusions, hallucinations. Will have negative symptoms such as withdrawal

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38
Q

Describe type 1 schizophrenia and symptoms

A

Acute onset, positive symptoms:

  • Delusions, hallucinations
  • Thought disorder
  • Speech
39
Q

Describe type II schizophrenia and symptoms

A

Chronic, negative symptoms

  • Lack of drive
  • Withdrawn
  • Depression common
  • Poverty of speech
  • Poor attention and memory
40
Q

What are the clinical features of schizophrenia

A

Auditory hallucinations:

  • 3rd person arguing about the subject
  • 3rd person commentary on subject’s actions
  • Audible thoughts
  • Thought insertion/withdrawal
  • Thought broadcasting
  • Somatic passivity
  • Delusional perceptions
41
Q

What are the treatment options for schizophrenia

A

Antipsychotics - neuroleptics/major tranquillisers

  • Orally e.g. chlorpromazine, fluphenazine, risperidol
  • IM with long acting depot injections
  • Psychotherapy
42
Q

What is the action and side effects of antipsychotics that treat schizophrenia

A
  • Alter dopamine/Cholinergic balance in basal ganglia
  • Extrapyramidal and anticholinergic effects frequent
  • Dystonia/Dyskinesia
  • Akathisia
43
Q

What are the oral effects of schizophrenia

A
  • Neglect of dental care - caries and periodontal disease
  • Smoking - dental staining risk or oral precancer and cancer
  • Difficulties with communication
  • Delusional oral symptoms
  • Side effects of neuroleptics - haloperidol and clozapine can cause hyposalivation - decreased salivary flow = cadidosis and caries
44
Q

What are affective disorders

A
  • Characterised by mood disturbances - inappropriate depression or elation
  • Usually accompanied by abnormalities in thinking and perception out of mood disturbance
45
Q

Give some examples of affective disorders and describe them a likkle

A
  • Bipolar affective disorders (BAD) - recurring attacks of mania and elation
  • Unipolar affective disorders - recurring attacks of depression only
  • Mixed affective states - manic and depressive symptoms occur simultaneously
46
Q

What are the clinical features of depression

A
  • Depression of mood
  • Loss of enjoyment (anhedonia)
  • Reduced attention and concentration
  • Poor memory
  • Ideas of guilt and worthlessness
  • Lowered self esteem
  • Reduced energy (anergia)
  • Hopelessness, helplessness
  • Suicidal ideation
47
Q

What are some of the biological features of depression

A
  • Sleep disturbance
  • Change in appetite/weight
  • Change in psychomotor activity
  • Diurnal variation in mood, worse in am
  • Loss of interest in work and pleasure activities
  • Loss of energy
  • Loss of libido
  • Constipation
  • Change in menstrual cycle - amenorrhoea
48
Q

Describe the appearance and speech of a person with depression

A
  • Dishevelled, neglected dress and grooming
  • Facial features - down-turning of corners of mouth, furrowing of brow
  • Reduced rate of blinking
  • Reduced gestural movements
  • Shoulders bent, head inclined forwards, downwards gaze
  • Poverty of speech
  • Speech slow and hesitant
49
Q

What are some of the psychotic features of depression

A

Delusions:
- concerned with ideas of worthlessness, guilt, ill-health, poverty
- Persecutory which patient feels to be justified
Hallucinations:
- Usually second person auditory confirming patients ideas of worthlessness

50
Q

What is required to diagnose someone with depression

A

Loss of interest or pleasure or depressed mood for > 2 weeks + 4 or more of the following:

  • Appetite change of weight change
  • Insomnia or hypersomnia
  • Early morning waking with diurnal mood variation
  • Psychomotor retardation or agitation
  • Decreased sexual drive
  • Reduced ability to concentrate
  • Ideas of worthlessness
  • Recurrent thoughts of death/suicide attempts
51
Q

What management options are there for depression

A
  • Cognitive behaviour therapy (CBT)
  • Antidepressants - take at least 4 weeks to start working:
  • Lithium/carbamazepine for mood stabilisation
  • Electroconvulsive therapy ECT - severe cases
52
Q

What are types of antidepressant are used for depression and give some examples

A
  • Tricyclic antidepressants - amitriptyline, dolesupin

- SSRI’s - fluoxetine, partoxetine, citalopram - fewer adverse effects, less dry mouth

53
Q

What are the dental aspects of depression

A
  • Defer treatment until depression is controlled - care with analgesics
    Oral symptoms of depression:
  • Disturbed taste
  • Persistent idiopathic facial pain
  • TMJ dysfunction
  • Delusions - discharges/slime from mouth, halitosis
54
Q

What are the adverse effects of treatment

A 
Dry mouth (TCAs, lithium)
Altered taste sensation
55
Q

Describe what bipolar disorder is

A

Spectrum of mood disorders includes bipolar I, bipolar II, cyclothymia (oscillating high and low moods, and major depression

56
Q

What happens in bipolar affective disorders (mania)

A

Sustained period of elevated, euphoric or irritable mood

57
Q

What happens in the individual episodes of bipolar affective disorders (mania)

A
  • Brief depressive episodes
    Manic episodes:
  • increased speech, pressure of speech
  • decreased need for sleep, absence of fatigue
  • overspending, uninhibited sexual behaviour
  • insight impaired
  • 10-20% of patients have schneiderian first rank symptoms of schizophrenia
58
Q

What symptoms are there of manic episodes

A
  • Grandiosity
  • Diminished need for sleep
  • Excessive talking or pressure speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work, or sexually
  • Excessive pleasurable activities, often with painful consequences
59
Q

Describe the appearance and behaviour of people with bipolar disorders/mania

A
  • Dressed in bright gaudy colours
  • Untidy and dishevelled
  • Over-activity leading to physical exhaustion
  • Excessive activity in risk taking pursuits, social indiscretion
60
Q

What management options are there for bipolar disorders

A
  • Antipsychotics - chlorpromazine, haloperidol, respiridone, olanzapine
  • Sedatives for rapid tranquillisation (lorazepam)
  • Lithium and carbamazepine prophylaxis - prevents relapses into mania
  • ECT
61
Q

What are the dental aspects of bipolar disorder

A
  • Lithium toxicity with GA

- Long term potential to induce hypothyroidism

62
Q

What are 2 common eating disorders

A

Anorexia Nervosa

Bullimia Nervosa

63
Q

What is anorexia nervosa

A

Deliberate weight loss, person chooses not to eat leading to potentially serious weight loss

Weight maintained at least 15% below that expected

64
Q

What are the clinical features of anorexia nervosa

A
  • Thin, emaciated
  • Dehydration
  • Dental erosion and caries
  • Hair loss from scalp
  • Fine, downy lanugo on face and back
  • Early onset - shorter stature
  • osteoporosis, pathological features
  • Hypokalaemia - muscle weakness, tetany
  • Amenorrhoea/loss of libido or ED
65
Q

What management options are there fore anorexia nervosa

A
  • Need for controlled weight gain should be agreed
  • Admit for feeding if severe, rapid weight loss, depression
  • Build relationship
  • Agree on weight targets
  • Behavioural regime - starting with bed rest which is gradually relaxed as weight is gained
  • Cognitive therapy - aims to identify and change inappropriate cognitions regarding eating behaviour, body weight and shape
  • Family therapy
66
Q

What are the dental aspects of anorexia nervosa

A
  • Caution during GA
  • Parotid enlargement
  • Erosion of teeth
  • Oral ulcers and abrasions
67
Q

What is bulimia nervosa characterised by

A
  • Repeated bouts of overeating with an excessive pre-occupation with control of body weight
  • Extreme measures to counteract fattening effects of ingested foods
  • bouts occurring>/= twice weekly for 3 months
68
Q

Who is most likely to get bulimia nervosa

A

Young women - 1-2%
Rare in males
Usually present in 3rd decade
1/3 have had anorexia

69
Q

What are the clinical features of bulimia nervosa

A
  • Weight in normal range
  • Repeated vomiting = oesophageal tears, haematemesis, hyperkalaemia, depression
  • Sialosis - salivary gland swelling
  • Dental erosion
  • Calluses on dorsum of hand - Russell’s sign
  • Ulcers on soft palate, angular cheilitis
70
Q

What methods do bulimic patients use to counteract weight gain

A
  • Self induced vomiting
  • Periods of starvation
  • Purgative and laxative abuse
  • Abuse of appetite suppressants, thyroid hormones or diuretics
  • Neglect to use insulin in diabetics
71
Q

Describe the epidemiology of suicide

A
  • More common in males
  • More common over 45 years
  • Highest rates in those who are divorced, single or widowed
  • Highest rates in social class I and V
  • Associated with lack of employment
  • Highest rates in spring and early summer
72
Q

What are the aetiologies of suicide

A

Psychiatric disorder
Physical illness - chronic painful illnesses and epilepsy
Parasuicide

73
Q

What psychiatric disorders are associated with suicide and how common are they

A

Present in 90% of those who comment suicide: depressive episodes, alcohol dependence, illicit drug use, personality disorder, chronic neuroses, schizophrenia

74
Q

What is parasuicide and what can this event do to the risk of suicide

A

An attempt at suicide/ a suicidal gesture where there is no result of death/no aim of death - often attention seeking
Risk of committing suicide in following year ~ 100xs

75
Q

Describe the epidemiology of Deliberate self harm

A
  • More common females
  • Aged 15-25
  • Highest rates in divorced, single or teenage wives
  • Highest rates in lower social classes
  • Associated with unemployment
  • More common in urban areas
76
Q

What is a dental aspect of self harm

A

Care in prescribing analgesics

77
Q

What are psychosomatic disorders

A
  • Patients with physical symptoms for which no cause can be found
  • Very common
  • Simple reassurance and explanation may be all that is needed
78
Q

What is an alcoholic

A

Someone whose repeated drinking leads to harm in his work or social life

79
Q

What are the recommended safe limit of alcohol consumption for men and women in 2011 btw

A

Men - 0-21 units a week
Women - 0-14 units a week

Now men is same as women

80
Q

What are the features of alcohol dependence

A
  • Compulsion to drink
  • Pre-occupation with alcohol
  • Stereotype drinking pattern
  • Increased tolerance to alcohol
  • Repeated withdrawal symptoms
  • Loss of ability to regulate drinking
  • Relief drinking to avoid withdrawal symptoms
  • Persistence even after attempted withdrawal
81
Q

What gastrointestinal complications are associated with alcohol

A
  • Gastritis
  • Hepatitis
  • Cirrhosis
  • Oesophageal varices
  • Peptic ulcer
82
Q

What haematological complications are associated with alcohol

A
  • Anaemia

- Thrombocytopenia

83
Q

What cardiovascular complications are associated with alcohol

A
  • Cardiomyopathy

- Hypertension

84
Q

What neuropsychiatric complications are associated with alcohol

A

Wernicke’s encephalopathy - secondary to thiamine deficiency

85
Q

What social complications are associated with alcohol

A
  • Family/marital problems
  • Jobl oss
  • Accidents-Alcohol related road accidents
  • Criminal activities
  • Absenteeism from work
  • Vagrancy
86
Q

What are some associated features of fatal alcohol syndrome

A
  • Epicnathal folds
  • Low nasal bridge
  • Minor ear abnormalities
  • Micrognathia
  • Flat midface
  • Thin upper lip
87
Q

What is the CAGE questionnaire for drinking and alcoholism

A
  • Cut down?
  • Annoyed by criticism of drinking?
  • Guilty about drinking
  • Do you ever drink a morning Eye opener
88
Q

What are some acute withdrawal symptoms of alcoholism

A
  • Starts 10-72 hours after last drink
  • Agitation and insomnia
  • Tachycardia and hypotension
  • Pyrexia
  • Confusion and fits
  • Visual or tactile hallucinations e.g. formication or animals crawling over skin
  • Mortality - 5%
89
Q

What are the management options of acute alcohol withdrawal

A
  • Rehydration
  • Vitamins
  • Sedation
  • Chlormethiazole
  • Chlordiazepoxide
90
Q

What are the dental aspects of alcohol misuse

A
  • Poor oral hygiene
  • Malnutrition and anaemia
  • Liver disease/cirrhosis - bleeding tendency and altered drug metabolism
  • Problems with drug administration (metronidazole)
  • Accidents and fights leading to maxillofacial trauma
91
Q

What are some major classes of drugs used in psychiatry and give examples

A
  • Benzodiazepines (diazepam)
  • Phenothiazines (chloramine)
  • Tricylic antidepressants (amitriptyline, imipramine)
  • Selective serotonin rey-take inhibitors (fluoxetine-prozac, sertraline-zoloft)
  • Monoamine oxidase inhibitors (isocarboxazid-marplan)
92
Q

What psychiatric drug interactions might vasoconstrictors and LA have

A
  • with TCAs, MAO and SSRIs - hypertensive reaction
  • CNS depressants used for analgesia - enhanced effects
  • Lithium - NSAIDs, metronidazole and tetracyclines
93
Q

What can cause TCAs, MAO and SSRIs cause in the oral cavity

A

Xerostemia
Candidosis
Periodontal pathology

CHHD (27 decks)

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