Psychiatry Flashcards
what is psychiatry
Psychiatry is the medical specialty concerned with the recognition and treatment of disorders of the mind
how many people are affected by disorders of the mind - mental health
1 in 4
compare normal anxiety and pathological anxiety
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
compare psychiatry and psychology
psychiatry = train as doctor, specialism, can prescribe, use talking therapy and medications
psychology = talking therapy
what are some psychological symptoms of anxiety
Sense of dread
Irritability
Fear of loss of control
Avoidance
Panic
what are some physical symptoms of anxiety
Palpitations
Shortness of breath
Chest pain
‘Butterflies’
Sweating
Dry mouth
Nausea
sympathetic nervous system
when does anxiety become pathological
when it alters the function in life
too intense, often or severe
what is generalized anxiety disorder
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
what is phobia disorder
In common these are situational, predictable, with anticipatory anxiety and avoidance. any phobia can cause panic attacks
what types of phobia are there
Simple phobias e.g. specific animal phobias
Social phobia e.g. scared of being with people
Agoraphobia e.g. scared of a place
what are some signs of Odontophobia
Delayed presentation
Looking anxious
Cancel appointments at short notice / fail to attend
what are some causes/reasons of Odontophobia
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
how do we prevent Odontophobia
Dental health education
Calm, sympathetic paced approach
Honest and tactful explanation of procedures
Relaxed, welcoming atmosphere
Confident and professional manner
how can we treat Odontophobia
Education regarding anxiety
Relaxation techniques
Desensitisation (graded exposure)
Short term pharmacological anxiolytics (e.g. diazepam)
Long term pharmacological antidepressants
what is Body Dysmorphic disorder
The affected person is excessively concerned about a perceived defect in his or her physical features - commonly in oral setting
what is Hypochondriasis
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.
what is somatoform pain
The cause is psychological rather than organic/physical
Absence of organic pathology
Evidence of a psychological cause
what are some key features of somatoform pain
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.
what are affective disorders
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’
same 2 affective disorders
Unipolar affective disorder
Bipolar affective disorder
what percent of women and men have depression
10% of men and 20% of women
what is classed as depression
low mood for >2 weeks
loss of happiness and enjoyment
what are some symptoms of depression
Poor appetite/ Weight loss
Sleep disturbance
Loss of libido
Psychomotor retardation
Poor concentration
Guilt and worthlessness
Hopelessness / Suicidal ideation
Delusions / hallucinations - psychotic symptoms
how many people have bipolar disorder
1% , men and women equally
what is Bipolar Affective Disorders
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
what classes as psychotic symptoms
delusions and hallucinations
what is mania classed as
elevated or irritable mood for over 1 week or resulting in admission
affecting function of life
give some symptoms of mania
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
if a patient has ‘mild’ mania, what is this called
hypomania
how many people have schizophrenia
1 in 100, men = women and early adulthood
what is schizophrenia
Abnormal thoughts and experiences
Reduction in drive, social function and alteration in personality and emotion
what two types of symptom of schizophrenia are there
positive and negative
what are negative symptoms of schizophrenioa
Social withdrawal
Emotional blunting - emotion seems unchanging
Apathy: A lack of drive, motivation and volition
what are positive symptoms of schizophrenia
Delusions
Hallucinations
Passivity Phenomena
Thought disorder - difficult to understand
what is passivity phenomena
feeling as if they are controlled by an external body e.g. government
what is anorexia nervosa classed as
Body weight <15% expected
BMI <17.5
Self induced weight loss
Body image distortion
Widespread endocrine disorder
Arrest of puberty
what is bulimia Nervosa
BMI = normal
Pervasive preoccupation with eating
Attempts to counteract the fattening effects of food
Morbid dread of fatness
what are some oral representations of eating disorders
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
what is the acronym CAGE used for
assessment of alcohol intake
what does CAGE stand for
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?”
how do we use CAGE in alcohol assessment
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
what are personality disorders
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.
what is dementia
An acquired impairment of global cognitive function which is progressive & irreversible
-Alzheimer’s Dementia
-Vascular Dementia
-Frontotemporal Dementia
-Other
what types of dementia are there
Alzheimer’s Dementia
-Vascular Dementia
-Frontotemporal Dementia
what is delerium
A reversible state characterised by:
Impairment of consciousness
Disturbed attention
Perceptual abnormalities
Emotional disturbances
Disturbed sleep wake cycle
Fast onset
compare dementia and delierium
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
what might cause delerium
Infection
Drugs
Systemic illness
what main types of anti-depressant are there
Tricyclic Antidepressants (TCAs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
how do TCAs work theraptuically and what are they used for
Tricyclic Antidepressants (TCAs) - to treat depression
Inhibit 5-HT and NA uptake
5-HT is serotonin and NA is noradrenaline
what is 5HT and NA
5HT = serotonin and NA = noradrenaline
what causes TCA side effects
Tricyclic Antidepressants
Block of M1, H1, α1 receptors produces side effects
m1 = mucogenic receptor, H1 histogenic receptors, alpha 1 adrenal receptors
what are the side effects of TCA and why do they occur
sedation = H1 inhibition = reduced uptake of histamine
dry mouth + constipation = M1 = muogenic activity reduced
increased BP = alpha 1 adrenic receptors blocked
why are TCAs used in dentistry but less so in psychiatry
good therapeusis value in dentistry as reduced neurological pain and sedation
too many side effects to be used in psychiatry
name 2 types of TCA
tricyclic Antidepressants
amitriptyline, lofepramine
explain what an SSRI is
selective serotonin reuptake inhibitor
reduces uptake of only serotonin = lasts longer and increases mood
how do SSRIs work
Inhibit 5-HT uptake (serotonin)
Produces therapeutic benefit
what are SSRIs useful for
depression and anxiety
what are common side effects of SSRIs
Nausea
Early increased anxiety
decreased libido
what is a common first line drug type of depression
SSRIs
well tolerated and less side effects than TCAs
what are some names of SSRIs
fluoxetine, sertraline, citalopram
what are SNRIs
serotonin noradrenaline reuptake inhibitors
what drug is venlafaxine
SNRI anti-depressant
how do SNRIs work
inhibit 5-HT and NA
inhibit serotonin and noradrenaline re-uptake
compare SNRIs and TCAs
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
what do NaSSA’s block
H1 = histamine = sedation effect
5-H2 and 5-H3 = reduces anxiety = serotonin reuptake inhibitor
alpha 2 = releases more 5-Ht = more serotonin
what are the advantages of NaSSA’s
anti-emetic
no nausea, vomitting, sexual side effects
acts as antidepressant and anti-anxiety
(may cause weight gain)
name a type of anxiolytic
benzodiazepene e.g. diazepam & lorazepam
what are the advantages and disadvantages of diazepam
Relieve anxiety immediately, good for short term use
S/E’s - very few except dependency
what receptor do benzodiazepams work on and what other non-prescription drug works on this
GABA receptors
alcohol also acts on this
why might Z drugs be better than benzodiazepans
shorter half life
how do we treat an anxiety disorder
anti-depressants e.g. SSRIs
but they take longer to work and create initial increased anxiety
how do w etreat short term extreme anxiety
benzodiazepans or Z-drugs
what are the two types of antipsychotic with exmaples of each
Typicals/first generation antipsychotics
e.g. Haloperidol
Atypicals/second generation antipsychotics
E.g. Olanzapine and Risperidone
what is the strcutre of typical antipyschotics
H1, M1 and alpha 1 receptor inhibitors = side effects
D2 receptor = dopamine receptor antagonist = theraputic affect
what is the structure of atypical antipsychotics
no H1, M1 or A1 receptors
just D2 dopamine antagonists and a type of serotonini receptor antagonist = 5HT2A
what can be used for mood stabalisation
lithium
Valproate
what are contraindications to lithium mood stabaliser
narrow theraputic index
Renal and thyroid dysfunction
Teratogenic
Interaction with other drugs (e.g. NSAIDs)
how do we treat bipolar
mood stabaliser e.g. lithium or valproate
what can valproate be used for
mood stabiliser and anti-epileptic
how much mental ill health is genetic
<10%
what are some causes of mental health problems
moving schools
growing up in city
trauma (sexual trauma)
genetic <10%
migrant populations
how might trauma lead to hearing voices
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
why might dentistry be causative for trauma related mental health
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
what side effects of antipsychotropic medications are there and why is this a problem
tremor
insomnia
lack of sexual activity
these side effects get associated with the illness itself and make things seem worse
how do we manage an assessment of someone who says they hear voices
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
which recreational drug is contraindicated with LA and for how long
cocaine
24 hours
how do we use ‘trust’ when managing a mentally ill patient
Reliable
Consistent
Flexible
Vulnerability
Mental health worker/ NOK
Risk assessment (self harm, risk to others, self neglect)
why might a mentally ill patient not trust a dental worker
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
how can we assess capacity to consent
can they:
-Understand the information
- Retain the information
- Weigh it in the balance
- Communicate the decision
why might a patient have fluctuating capacity
mental illness
substance abuse
why might a mentally ill patient have problems accessing care
lack of motivation
choatic lifestyle and headspace
phobias
money
time
paranoia
how do we manage a mentally ill patient who struggles to access care
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!
what are some dental side effects of psychotropic drugs
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
what is methadone used for and why is this a problem
used to help come off of addictive drugs
contains sugar and causes dry mouth so can cause mouth spread cervical caries
how does alcohol affect the oral cavity
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
what must we risk assess when seeing a mentally ill patient
- risk to others = violence history, aggitation, agression
- self = self harm, picking face, overdose (prescription be careful especially with anxiolytics e.g. diazepam)
- self neglect
