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3rd BDS IHD > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

what is psychiatry

A

Psychiatry is the medical specialty concerned with the recognition and treatment of disorders of the mind

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2
Q

how many people are affected by disorders of the mind - mental health

A

1 in 4

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3
Q

compare normal anxiety and pathological anxiety

A

Anxiety is a normal experience to a perceived threat or danger
It serves to mobilise energy reserves for action and enhances performance by increasing arousal

Anxiety is said to be pathological when it becomes too intense, frequent or persistent, and as a consequence interferes with the functioning of the individual

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4
Q

compare psychiatry and psychology

A

psychiatry = train as doctor, specialism, can prescribe, use talking therapy and medications
psychology = talking therapy

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5
Q

what are some psychological symptoms of anxiety

A

Sense of dread
Irritability
Fear of loss of control
Avoidance
Panic

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6
Q

what are some physical symptoms of anxiety

A

Palpitations
Shortness of breath
Chest pain
‘Butterflies’
Sweating
Dry mouth
Nausea
sympathetic nervous system

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7
Q

when does anxiety become pathological

A

when it alters the function in life
too intense, often or severe

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8
Q

what is generalized anxiety disorder

A

The anxiety experienced is not confined to a specific situation but is pervasive
Anxiety is experienced more days than not
Understandably, whilst frequently anxious, anxiety levels typically rise in stressful situations
May result in panic attacks

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9
Q

what is phobia disorder

A

In common these are situational, predictable, with anticipatory anxiety and avoidance. any phobia can cause panic attacks

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10
Q

what types of phobia are there

A

Simple phobias e.g. specific animal phobias
Social phobia e.g. scared of being with people
Agoraphobia e.g. scared of a place

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11
Q

what are some signs of Odontophobia

A

Delayed presentation
Looking anxious
Cancel appointments at short notice / fail to attend

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12
Q

what are some causes/reasons of Odontophobia

A

Specific phobia (e.g., drills, needles, sounds, smells) - specific to autism
Anxiety about somatic reactions (gagging, injection)
Generalized anxiety disorder
Social phobia.

think of this when providing a treatment plan

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13
Q

how do we prevent Odontophobia

A

Dental health education
Calm, sympathetic paced approach
Honest and tactful explanation of procedures
Relaxed, welcoming atmosphere
Confident and professional manner

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14
Q

how can we treat Odontophobia

A

Education regarding anxiety
Relaxation techniques
Desensitisation (graded exposure)
Short term pharmacological anxiolytics (e.g. diazepam)
Long term pharmacological antidepressants

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15
Q

what is Body Dysmorphic disorder

A

The affected person is excessively concerned about a perceived defect in his or her physical features - commonly in oral setting

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16
Q

what is Hypochondriasis

A

Abnormal preoccupation about the presence of an underlying serious physical disease

Patients can place an abnormal interpretation upon a normal sensation (e.g. transient dry mouth is proof of oral cancer).

It is often very difficult to persuade patients that their symptoms might have a largely psychological component.

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17
Q

what is somatoform pain

A

The cause is psychological rather than organic/physical
Absence of organic pathology
Evidence of a psychological cause

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18
Q

what are some key features of somatoform pain

A

Inconsistent with anatomical landmarks
May be continuous and bilateral
May prevent sleep but does not wake patient
Repeated negative investigations
Analgesia ineffective
Associated with emotional factors and may have symbolic meaning.

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19
Q

what are affective disorders

A

Alterations of mood are a normal part of life
Extremes of mood, if accompanied by associated symptoms and impaired function can be delineated into ‘illnesses’

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20
Q

same 2 affective disorders

A

Unipolar affective disorder
Bipolar affective disorder

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21
Q

what percent of women and men have depression

A

10% of men and 20% of women

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22
Q

what is classed as depression

A

low mood for >2 weeks
loss of happiness and enjoyment

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23
Q

what are some symptoms of depression

A

Poor appetite/ Weight loss
Sleep disturbance
Loss of libido
Psychomotor retardation
Poor concentration
Guilt and worthlessness
Hopelessness / Suicidal ideation
Delusions / hallucinations - psychotic symptoms

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24
Q

how many people have bipolar disorder

A

1% , men and women equally

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25
Q

what is Bipolar Affective Disorders

A

Elevated mood may be a normal experience
Most patients with mania also experience depression
-must have had one bout of mania
Bipolar disorder is a very disruptive condition

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26
Q

what classes as psychotic symptoms

A

delusions and hallucinations

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27
Q

what is mania classed as

A

elevated or irritable mood for over 1 week or resulting in admission
affecting function of life

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28
Q

give some symptoms of mania

A

for more than 1 week with 4 or more symptoms, affecting function:
Over-activity
Disinhibition
Risk taking activity
Distractibility
Reduced need for sleep
Inflated self esteem
Rapid, loud speech
Racing thoughts
Delusions/ Hallucinations

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29
Q

if a patient has ‘mild’ mania, what is this called

A

hypomania

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30
Q

how many people have schizophrenia

A

1 in 100, men = women and early adulthood

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31
Q

what is schizophrenia

A

Abnormal thoughts and experiences
Reduction in drive, social function and alteration in personality and emotion

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32
Q

what two types of symptom of schizophrenia are there

A

positive and negative

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33
Q

what are negative symptoms of schizophrenioa

A

Social withdrawal
Emotional blunting - emotion seems unchanging
Apathy: A lack of drive, motivation and volition

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34
Q

what are positive symptoms of schizophrenia

A

Delusions
Hallucinations
Passivity Phenomena
Thought disorder - difficult to understand

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35
Q

what is passivity phenomena

A

feeling as if they are controlled by an external body e.g. government

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36
Q

what is anorexia nervosa classed as

A

Body weight <15% expected
BMI <17.5
Self induced weight loss
Body image distortion
Widespread endocrine disorder
Arrest of puberty

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37
Q

what is bulimia Nervosa

A

BMI = normal
Pervasive preoccupation with eating
Attempts to counteract the fattening effects of food
Morbid dread of fatness

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38
Q

what are some oral representations of eating disorders

A

Erosion of dental enamel
Thermal hypersensitivity (cold/hot sensitive)
Salivary gland enlargement
Dryness of the mouth and decreased salivary flow
Redness of the throat and palate
Reddened, dry, and cracked lips and fissures at angles to the lips

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39
Q

what is the acronym CAGE used for

A

assessment of alcohol intake

40
Q

what does CAGE stand for

A

C “Have you ever felt you should Cut down?”
A “Are you Annoyed if people comment on your drinking?”
G “Do you feel Guilty about the amount you drink?”
E “Have you ever drunk early in the morning as an Eye-opener?”

41
Q

how do we use CAGE in alcohol assessment

A

If a person scores 1 or more point in CAGE (need to Cut down, Annoyed if people comment, Guilty about drinking or eye-open mornigng drinking) then they need full alcohol assessment

42
Q

what are personality disorders

A

Severe disturbance in the characterological constitution and behavioural tendencies of the individual
Associated with considerable personal and social disruption
usually caused by trauma
Appear in late childhood/adolescence
Persist into adulthood.

43
Q

what is dementia

A

An acquired impairment of global cognitive function which is progressive & irreversible
-Alzheimer’s Dementia
-Vascular Dementia
-Frontotemporal Dementia
-Other

44
Q

what types of dementia are there

A

Alzheimer’s Dementia
-Vascular Dementia
-Frontotemporal Dementia

45
Q

what is delerium

A

A reversible state characterised by:
Impairment of consciousness
Disturbed attention
Perceptual abnormalities
Emotional disturbances
Disturbed sleep wake cycle
Fast onset

46
Q

compare dementia and delierium

A

dementia is irreversible. delirium is reversible
both cause memory loss and personality changes
delirium has very fast onset, dementia slow
dementia is neurological, delirium has many causes e.g. infection/drugs

47
Q

what might cause delerium

A

Infection
Drugs
Systemic illness

48
Q

what main types of anti-depressant are there

A

Tricyclic Antidepressants (TCAs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)

49
Q

how do TCAs work theraptuically and what are they used for

A

Tricyclic Antidepressants (TCAs) - to treat depression
Inhibit 5-HT and NA uptake
5-HT is serotonin and NA is noradrenaline

50
Q

what is 5HT and NA

A

5HT = serotonin and NA = noradrenaline

51
Q

what causes TCA side effects

A

Tricyclic Antidepressants
Block of M1, H1, α1 receptors produces side effects
m1 = mucogenic receptor, H1 histogenic receptors, alpha 1 adrenal receptors

52
Q

what are the side effects of TCA and why do they occur

A

sedation = H1 inhibition = reduced uptake of histamine
dry mouth + constipation = M1 = muogenic activity reduced
increased BP = alpha 1 adrenic receptors blocked

53
Q

why are TCAs used in dentistry but less so in psychiatry

A

good therapeusis value in dentistry as reduced neurological pain and sedation
too many side effects to be used in psychiatry

54
Q

name 2 types of TCA

A

tricyclic Antidepressants
amitriptyline, lofepramine

55
Q

explain what an SSRI is

A

selective serotonin reuptake inhibitor
reduces uptake of only serotonin = lasts longer and increases mood

56
Q

how do SSRIs work

A

Inhibit 5-HT uptake (serotonin)
Produces therapeutic benefit

57
Q

what are SSRIs useful for

A

depression and anxiety

58
Q

what are common side effects of SSRIs

A

Nausea
Early increased anxiety
decreased libido

59
Q

what is a common first line drug type of depression

A

SSRIs
well tolerated and less side effects than TCAs

60
Q

what are some names of SSRIs

A

fluoxetine, sertraline, citalopram

61
Q

what are SNRIs

A

serotonin noradrenaline reuptake inhibitors

62
Q

what drug is venlafaxine

A

SNRI anti-depressant

63
Q

how do SNRIs work

A

inhibit 5-HT and NA
inhibit serotonin and noradrenaline re-uptake

64
Q

compare SNRIs and TCAs

A

SNRIs inhibit 5-Ht (serotonin) and Noradrenaine
TCAs inhibit 5-HT, NA, M1, H1 and alpha 1 = more side effects
SNRIs better tolerated and used for severe depression
SNRIS are dose dependant

65
Q

what do NaSSA’s block

A

H1 = histamine = sedation effect
5-H2 and 5-H3 = reduces anxiety = serotonin reuptake inhibitor
alpha 2 = releases more 5-Ht = more serotonin

66
Q

what are the advantages of NaSSA’s

A

anti-emetic
no nausea, vomitting, sexual side effects
acts as antidepressant and anti-anxiety
(may cause weight gain)

67
Q

name a type of anxiolytic

A

benzodiazepene e.g. diazepam & lorazepam

68
Q

what are the advantages and disadvantages of diazepam

A

Relieve anxiety immediately, good for short term use
S/E’s - very few except dependency

69
Q

what receptor do benzodiazepams work on and what other non-prescription drug works on this

A

GABA receptors
alcohol also acts on this

70
Q

why might Z drugs be better than benzodiazepans

A

shorter half life

71
Q

how do we treat an anxiety disorder

A

anti-depressants e.g. SSRIs
but they take longer to work and create initial increased anxiety

72
Q

how do w etreat short term extreme anxiety

A

benzodiazepans or Z-drugs

73
Q

what are the two types of antipsychotic with exmaples of each

A

Typicals/first generation antipsychotics
e.g. Haloperidol
Atypicals/second generation antipsychotics
E.g. Olanzapine and Risperidone

74
Q

what is the strcutre of typical antipyschotics

A

H1, M1 and alpha 1 receptor inhibitors = side effects
D2 receptor = dopamine receptor antagonist = theraputic affect

75
Q

what is the structure of atypical antipsychotics

A

no H1, M1 or A1 receptors
just D2 dopamine antagonists and a type of serotonini receptor antagonist = 5HT2A

76
Q

what can be used for mood stabalisation

A

lithium
Valproate

77
Q

what are contraindications to lithium mood stabaliser

A

narrow theraputic index
Renal and thyroid dysfunction
Teratogenic
Interaction with other drugs (e.g. NSAIDs)

78
Q

how do we treat bipolar

A

mood stabaliser e.g. lithium or valproate

79
Q

what can valproate be used for

A

mood stabiliser and anti-epileptic

80
Q

how much mental ill health is genetic

A

<10%

81
Q

what are some causes of mental health problems

A

moving schools
growing up in city
trauma (sexual trauma)
genetic <10%
migrant populations

82
Q

how might trauma lead to hearing voices

A

when a child goes through something unbarable they ‘dissociate’ to another place
this may lead to a friendly voice making them think of other things
that can change over time and becomea malicious voice

83
Q

why might dentistry be causative for trauma related mental health

A

we often try to relax the patient, lay down, have power, go in their mouth which can all relate to abuse at home and this can be associated with the dentist

84
Q

what side effects of antipsychotropic medications are there and why is this a problem

A

tremor
insomnia
lack of sexual activity
these side effects get associated with the illness itself and make things seem worse

85
Q

how do we manage an assessment of someone who says they hear voices

A

do not use music
do not use small talk
do not use humour
find out their mental health diagnosis
know about medications
self harm history
know about recreational drugs especially cocaine = cannot give LA within 24 hours
provide a tx plan that is realistic to gain TRUST

86
Q

which recreational drug is contraindicated with LA and for how long

A

cocaine
24 hours

87
Q

how do we use ‘trust’ when managing a mentally ill patient

A

Reliable
Consistent
Flexible
Vulnerability
Mental health worker/ NOK
Risk assessment (self harm, risk to others, self neglect)

88
Q

why might a mentally ill patient not trust a dental worker

A

we act very kind but can cause pain and negative impact on lives
this contradicts eachother and can be confusing and cause lack of trust with dentists and other health care professionals

89
Q

how can we assess capacity to consent

A

can they:
-Understand the information
- Retain the information
- Weigh it in the balance
- Communicate the decision

90
Q

why might a patient have fluctuating capacity

A

mental illness
substance abuse

91
Q

why might a mentally ill patient have problems accessing care

A

lack of motivation
choatic lifestyle and headspace
phobias
money
time
paranoia

92
Q

how do we manage a mentally ill patient who struggles to access care

A

consider:
do anterior restorations first to leave a good impact fast
make them want to come back, do painless things
appointment timings - suit patient e.g. not mornings if cannot wake up
involve a third person
reminders e.g. text
empathy!

93
Q

what are some dental side effects of psychotropic drugs

A

xerostomia
parafunction - grind teeth
hypersalivation
uncontrollable jaw movements = can cause self confidence problems + risk to operator
methadone - sugar compound to help come off drugs AND dries teeth = cerviacle caries over whole mouth

94
Q

what is methadone used for and why is this a problem

A

used to help come off of addictive drugs
contains sugar and causes dry mouth so can cause mouth spread cervical caries

95
Q

how does alcohol affect the oral cavity

A

increased risk of cancer, especially with smoking
increased risk of trauma related injury
less likely to brush teeth if drinking alcohol
alcohol related erosion of teeth
more likely to have parafunction = attrition

96
Q

what must we risk assess when seeing a mentally ill patient

A
  1. risk to others = violence history, aggitation, agression
  2. self = self harm, picking face, overdose (prescription be careful especially with anxiolytics e.g. diazepam)
  3. self neglect

3rd BDS IHD (14 decks)

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