Psychiatric Diseases Flashcards
What is the difference between mental illness and psychiatric disease?
Psychiatric diseases are diagnosed by a mental health professional
How common is schizophrenia?
1.5% of Australians affected. Men and women equally. Features emerge between late teens and mid 30s
What are the characteristic diagnostic features of schizophrenia?
Delusions
Hallucinations
Disorganized thinking and speech
Grossly disorganized or abnormal motor behaviour
Negative symptoms
What are the dental considerations that should be made for people with schizophrenia?
Extra-pyramidal side effects
Psychotropic medications salivary gland hypofunction + xerostomia
Denture stomatitis, glossitis, gingivitis, oral ulcers
Rampant caries: due to xerostomia and habits
Antipsychotic drugs increase the risk of orthostatic hypotension
Dental treatment should be postponed if patient is having a psychotic episode.
Explain with visual teaching methods OHI
How common is bipolar disorder?
1 in 100 people with experience an episode during their lifetime.
1.8% of males and 1.7% of females have had bipolar in the previous 12 months
Lifetime prevalence of 4%
How is bipolar managed?
Lithium is the gold standard it is highly potent but doesn’t really help with the depressive phase
Antiepileptics can also be used such as carbamezapine
Antipsychotics can be used as well.
What are the dental considerations of someone with bipolar?
Manic phase: Abrasion of gingiva and teeth with brushing
Depressive: Disregard for OH, increased caries risk (preference for carbs, poor OH, decreased saliva), perio risk (Smoking and poor OH)
What are the medication side effects?
Xerostomia
Dysgeusia
Somtatitis/glossitis
Bruxism
Cravings for sugar (lithium)
What are the diagnostic features of depression?
Depressed mood
Disinterest
weight loss
insomnia
Fatigue
Feeling of worthlessness
Suicidal thoughts
What is used to treat depression?
Antidepressants for acute episodes + long term maintenance - SSRIs, SNRIs
Psychological therapies
What are the dental findings for depression?
Poor oral hygiene
Increased caries risk - sweet cravings; impaired taste perception
Majority of SSRIs and antidepressants have shown to cause xerostomia, dysgeusia, stomatitis, and glossitis
TCAs are rarely used but they block reuptake of oral anaesthetics and in turn they block muscarinic and alpha 1 adrenergic receptors which depresses cardiac function
MAOs are used sometimes and they do not impact cardiac function when using LA.
What medications are used to treat anxiety?
CBT is often highly effective
SSRIs are first line
SNRIs are second line
TCAs
Benzodiazapines (not recommended due to dependence or cognitive impairment) used for short term
How can anxiety be a problem for dentists?
Dental anxiety which requires distraction, giving control to the patient, comforting patient
How can dental anxiety be managed in extreme cases for dental care?
Sedation
What are the dental implications of PTSD?
GIngivitis and periodontitis in patients that have associated comorbidities of depression, excessive tooth wear, higher risk of dental caries.
