Psychiatry 1 - Overview and Anxiety Neurosis Flashcards
What is the Mental Health Act (Scotland) 2003 concerned with?
- Concerned purely with management & treatment of psychiatric disorders
- Can have detained patients in the community on ‘leave of absence’
What does the Mental Health Act (Scotland) 2003 have no provision for?
- No provision for compulsory treatment of physical problems
- Treatment of the physical problems will be the patients choice once their realist has been restored
What is the different types of detention that are allowed under the Mental Health Act (Scotland) 2003? (5)
- Emergency detention (72h)
- Short term detention (28 days)
- Compulsory treatment order (6 months)
(if any of these are used the patient will need to be assessed by a mental health guardian to assess whether or not the treatment and detention is appropriate) - Removal to a safe space (police)
- Detention for assessment by a doctor (2hrs)
What are the requirements for the Mental Health Act (Scotland) 2003 to be allowed to apply this to a person? (5)
- That the person has a mental disorder
- Medical treatment is available which could stop their condition getting worse, or help to treat some of the 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
Psychiatric disorders are divided into 2 groups. What are they?
- Neurosis (contact remained with reality)
- Psychosis (contact lost with reality)
What is the difference between a neuroses and a psychosis?
- The difference between a neuroses and a psychosis is the contact that the patient has with the reality of the observer
- In a neurosis the patient is aware of their surroundings and is able to function within them but has on top of that a mental health problem
- With a psychosis the patient is aware of their surroundings but perceives them in a different way than the normal population and is therefore unable to interact appropriately with them
Give examples of psychiatric conditions that are commonly seen in dentistry (can be dentist or patient)? (5)
Neuroses:
- Anxiety states
- Phobias
- Psychoses
- Eating disorders
- Personality disorders
What is a neuroses?
- The neuroses is a group of uncertain functional neuro-psychical disorders that exhibit themselves in specific clinical phenomena in the absence of physical phenomena
What is a psychosis?
- The psychosis is a critical mental illness, occurs due to loss of contact with the reality and deep disturbance of the relationships with other people, causing social unacceptance
What is the ‘normal’ dental patient like?
- Is anxious
- May not behave rationally
- Does not have a psychiatric diagnosis
Neuroses are part of a spectrum of mood and social disorders. Give examples of some neuroses? (5)
- Anxiety
- Phobic
- Obsessional
- Hypochondriacal
- Depressive
In anxiety states, how do we differentiate the anxious patient with the anxiety neurosis?
- The anxiety patient is concerned about dental treatment
- Whereas, the anxiety neurosis is concerned about everything
What are the different sub-groups of anxiety disorders? (3)
- Generalised anxiety disorder
- Phobic anxiety
- Panic disorder
What is generalised anxiety disorder?
- Free-floating anxiety in many/all situations
What is phobic anxiety?
- Intense anxiety/ panic in specific situations
What is a panic disorder?
- Unpredictable extreme anxiety (the triggers may vary tremendously)
What are somatoform disorders?
- Repeated presentation of physical symptoms and persistent requests for medical investigations, in spite of negative findings and reassurance that the symptoms have np physical basis
- There may or may not be a clear psychological/psychiatric symptomatology e.g. of depression
What are the different types of management strategies we can use? (2)
- Psychological treatment
- Drug treatment
What are the different types of psychological treatment we can use? (3)
- Psycho-education
- Anxiety management strategies
- Cognitive behavioural therapy
- These are often much more successful at tackling the problem compared to drug treatments
What are the different types of drug treatments that can be used? (2)
- Self medication (alcohol)
- Prescribed medication (e.g. tricyclic antidepressants)
- However, drug treatment does not get to the root of the problem
Give examples of anxiolytic drugs? (3)
- Alcohol
- Benzodiazepines (diazepam, midazolam, temazepam, lorazepam)
- Antidepressants - with anxiolytic features
Give examples of antidepressants - with anxiolytic features that can be used? (3)
- Tricyclic (Amitriptyline, Dosulepin, Nortriptyline, Imipramine)
- Mirtazepine
- SSRI (selective serotonin reuptake inhibitors- 5HT) (Fluoxetine, Sertraline, Citalopram)
Many patients who have anxiety neurosis may present with symptoms dentally. Give examples of these? (3)
- TMD and parafunction
- Oral dysesthesias (dry, burning) & facial pain
- Dental intolerance
- We want to treat the anxiety neuroses as well as symptoms:
- BRA & tricyclics (benzodiazepines)
- CBT
What is a phobia?
- A fear out of proportion of the threat
- This is an individual thing and depends on the past experience of the patient
Remember that other phobias may prevent dental treatment. Give 2 examples of these?
- Agoraphobia (patient who cannot go outside)
- Claustrophobia (patient who does not like small spaces)
When we encounter a patient with phobia anxiety, what is really important that we find out?
- Important when patient says they have a phobia anxiety to find out what the trigger is and why this has arisen - psychological therapy works best for these
One type of neuroses is obsessive-compulsive disorder. What is this?
- Fear of infection
- Fear of ‘dirty’ oral environment
- Rituals developed to contain anxiety
- Can lead to depression - insight
What is perfectionism? (3)
- A personality trait
- May have habits or rituals that they follow rigidly
- Important: not doing it out of anxiety avoidance
What is obsessive compulsive disorder? (4)
- 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
- Occur during adaptation to new circumstances e.g. bereavement, separation, loss
- PTSD requires stress of ‘exceptionally threatening or catastrophic nature’
- Managed by psychological intervention (mood disorders usually accompany adjustment disorders - treat with medication)
