Psychiatry 1 - Overview and Anxiety Neurosis

Question 1

What is the Mental Health Act (Scotland) 2003 concerned with?

Answer 1

• Concerned purely with management & treatment of psychiatric disorders
• Can have detained patients in the community on ‘leave of absence’

Question 2

What does the Mental Health Act (Scotland) 2003 have no provision for?

Answer 2

• No provision for compulsory treatment of physical problems
• Treatment of the physical problems will be the patients choice once their realist has been restored

Question 3

What is the different types of detention that are allowed under the Mental Health Act (Scotland) 2003? (5)

Answer 3

• 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)

Question 4

What are the requirements for the Mental Health Act (Scotland) 2003 to be allowed to apply this to a person? (5)

Answer 4

• 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

Question 5

Psychiatric disorders are divided into 2 groups. What are they?

Answer 5

• Neurosis (contact remained with reality)

- Psychosis (contact lost with reality)

Question 6

What is the difference between a neuroses and a psychosis?

Answer 6

• 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

Question 7

Give examples of psychiatric conditions that are commonly seen in dentistry (can be dentist or patient)? (5)

Answer 7

Neuroses:

• Anxiety states
• Phobias
• Psychoses
• Eating disorders
• Personality disorders

Question 8

What is a neuroses?

Answer 8

• The neuroses is a group of uncertain functional neuro-psychical disorders that exhibit themselves in specific clinical phenomena in the absence of physical phenomena

Question 9

What is a psychosis?

Answer 9

• 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

Question 10

What is the ‘normal’ dental patient like?

Answer 10

• Is anxious
• May not behave rationally
• Does not have a psychiatric diagnosis

Question 11

Neuroses are part of a spectrum of mood and social disorders. Give examples of some neuroses? (5)

Answer 11

• Anxiety
• Phobic
• Obsessional
• Hypochondriacal
• Depressive

Question 12

In anxiety states, how do we differentiate the anxious patient with the anxiety neurosis?

Answer 12

• The anxiety patient is concerned about dental treatment

- Whereas, the anxiety neurosis is concerned about everything

Question 13

What are the different sub-groups of anxiety disorders? (3)

Answer 13

• Generalised anxiety disorder
• Phobic anxiety
• Panic disorder

Question 14

What is generalised anxiety disorder?

Answer 14

• Free-floating anxiety in many/all situations

Question 15

What is phobic anxiety?

Answer 15

• Intense anxiety/ panic in specific situations

Question 16

What is a panic disorder?

Answer 16

• Unpredictable extreme anxiety (the triggers may vary tremendously)

Question 17

What are somatoform disorders?

Answer 17

• 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

Question 18

What are the different types of management strategies we can use? (2)

Answer 18

• Psychological treatment

- Drug treatment

Question 19

What are the different types of psychological treatment we can use? (3)

Answer 19

• Psycho-education
• Anxiety management strategies
• Cognitive behavioural therapy
• These are often much more successful at tackling the problem compared to drug treatments

Question 20

What are the different types of drug treatments that can be used? (2)

Answer 20

• Self medication (alcohol)
• Prescribed medication (e.g. tricyclic antidepressants)
• However, drug treatment does not get to the root of the problem

Question 21

Give examples of anxiolytic drugs? (3)

Answer 21

• Alcohol
• Benzodiazepines (diazepam, midazolam, temazepam, lorazepam)
• Antidepressants - with anxiolytic features

Question 22

Give examples of antidepressants - with anxiolytic features that can be used? (3)

Answer 22

• Tricyclic (Amitriptyline, Dosulepin, Nortriptyline, Imipramine)
• Mirtazepine
• SSRI (selective serotonin reuptake inhibitors- 5HT) (Fluoxetine, Sertraline, Citalopram)

Question 23

Many patients who have anxiety neurosis may present with symptoms dentally. Give examples of these? (3)

Answer 23

• 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

Question 24

What is a phobia?

Answer 24

• A fear out of proportion of the threat

- This is an individual thing and depends on the past experience of the patient

Question 25

Remember that other phobias may prevent dental treatment. Give 2 examples of these?

Answer 25

• Agoraphobia (patient who cannot go outside)

- Claustrophobia (patient who does not like small spaces)

Question 26

When we encounter a patient with phobia anxiety, what is really important that we find out?

Answer 26

• 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

Question 27

One type of neuroses is obsessive-compulsive disorder. What is this?

Answer 27

• Fear of infection
• Fear of ‘dirty’ oral environment
• Rituals developed to contain anxiety
• Can lead to depression - insight

Question 28

What is perfectionism? (3)

Answer 28

• A personality trait
• May have habits or rituals that they follow rigidly
• Important: not doing it out of anxiety avoidance

Question 29

What is obsessive compulsive disorder? (4)

Answer 29

• 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

Question 30

What is an adjustment disorder?

Answer 30

• 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)