Psychiatry Flashcards
What does the Mental Health Act (Scotland) 2003 consider?
- concerned purely with management and treatment of psychiatric disorders
- compulsory detainment of patients
- no provision for compulsory treatment of physical problems
- patient choice once reality is restored
- can detain patients in the community on “Leave of Absence”
- can be in hospital
- may be allowed leaves of absence into population
- can be in community under compulsory treatment order
What are the detainment periods under the Mental Health Act (Scotland) 2003?
- emergency detention: 72 hours
- short term detention: 28 days
- compulsory treatment order: 6 months
Who is involved in the detainment of a patient?
- police
- removal of patient to place of safety
- doctor
- assessment for detention within 2 hours
- mental health guardian
- assess whether detainment and treatment are appropriate
- in case of emergency detention powers
What are the conditions of the application of the Mental Health Act (Scotland) 2003?
- the person has a mental disorder
- medical treatment is available
- to stop condition deteriorating
- to treat some symptoms
- some conditions (personality disorders) do not apply - risk to individual or others in lack of treatment
- in absence of medical treatment - decision making is impaired
- because of mental disorder
- cannot make decision on medical treatment
- if lucid and refuses, treatment cannot be provided in a compulsory nature - the use of compulsory powers is necessary
How are psychiatric illnesses categorised and what do they mean?
- neurosis
- contact with reality retained
- aware of surroundings and can function within them
- anxiety states and phobias
- psychosis
- contact with reality lost
- aware of surroundings but perceives them differently
- unable to interact appropriately
What other psychiatric conditions are present in dentistry?
- eating disorders
- personality disorders
What is normal dental anxiety?
- patient is anxious about accessing dental treatment
- may be from previous experiences
- may not behave rationally
- from dentist’s perspective
- does not have a psychiatric diagnosis
What are the 5 ways in which neuroses can be categorised?
- anxiety
- phobic
- obsessional
- hypochondriacal
- depressive
- part of a spectrum of mood and social disorders
- patient with unstable emotions will experience a variety of symptoms
- related to intrinsic personality as well as circumstantial changes
What are the anxiety states and what characterises each?
- the anxious patient
- concerned about dental treatment
- reasonable anxiety
- anxiety neurosis
- concerned about everything
- can be disabling for patient
- ask if worried about everything or just the dentist
What are the anxiety disorders and what characterises each?
- generalised anxiety disorder
- presents in a wide variety of circumstances
- free-floating anxiety
- phobic anxiety
- intense anxiety
- specific situations
- panic disorder
- unpredictable extreme anxiety
- triggers can vary between episodes
- can simulate other issues such as MI
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 no physical basis
- problem does not exist medically or pathologically
- may be physiological/psychiatric symptomatology
- potentially depression
- commonly seen within dentistry
What are the management strategies for anxiety disorders?
-psychological treatment
- psycho-education
- anxiety management strategies
- cognitive behavioural therapy
- usually more successful as target problem
- drug treatment
- self medication (alcohol)
- prescription medication
what medications can be used to manage anxiety disorders?
anxiolytic drugs
- alcohol
- self medicated
- benzodiazepines
- diazepam
- midazolam
- temazepam
- lorazepam
- highly addictive medication
- antidepressants with anxiolytic features
- tricyclic antidepressants (noradrenaline + 5HT)
- amitriptyline
- dosulepin
- nortriptyline
- imipramine - mirtazapine
- SSRI
- selective serotonin reuptake inhibitor (5HT)
- fluoxetine
- sertraline
- citalopram
- tricyclic antidepressants (noradrenaline + 5HT)
How does anxiety neurosis present in dentistry?
- TMJ pain
- parafunctional clenching
- oral dysesthesias
- changed sensation perceived in mouth and face
- dry, burning, painful
- anxiety is major aetiological factor in oral somatisation
- treat anxiety neurosis as well as symptoms
- medications
- CBT
- underlying anxiety must be manages or treatment of symptoms will be ineffective
What are phobias?
- fear out of proportion to the treat
- individual experience, sometimes related to past experiences
- common for children of 50/60s to have dental phobia
- phobias in dentistry
- dental phobia
- phobias affecting access to dental environment
- management
- determine trigger
- determine when in contact with trigger
- psychological therapy
What is OCD?
- neuroses
- Obsessive Compulsive Disorder
- fear of something happening
- in dentistry can be infection, dirty oral environment
- rituals and acts
- performed to manage anxiety
- OCD cycle
- obsessions (unwanted distressing thoughts)
- anxiety (distress, fear, worry, disgust)
- compulsion (behaviour performed to reduce anxiety)
- relief (temporary relief from negative feeling)
- increased risk of depression
- if patient has insight to fact behaviour is abnormal or has no bearing
- difficult to break the OCD cycle
In what ways does perfectionism differentiate from OCD?
- perfectionism
- personality trait
- may follow habits or rituals rigidly
- performed due to desires, not anxiety avoidance
- OCD
- mental health disorder
- repeated unwanted thoughts or urges that cause anxiety
- compulsive action or ritual to prevent anxiety development
- ritual often not related to anxiety
What are adjustment disorders?
- neuroses
- maladaptive response to severe past or continuing circumstances
- occur during adaption to new circumstances
- bereavement
- separation
- loss
- PTSD requires stress of exceptionally threatening or catastrophic nature
- managed by physiological intervention
- often accompanied by mood disorders (medication)
- does not respond solely to medication
- highly trained counsellor
What are mood disorders and how to they present to the dentist?
- affective disorders
- rarely present to dentist
- may notice change to general demeanour over time
- oral effects (somatiform disorders)
- dysesthesias
- facial pain
- consider the necessity of dental treatment
- important decisions should not be made
What is the mood disorder spectrum?
A chart showing the ways in which moods can change with circumstances (intrinsic or environmental)
- mania with psychosis on one end
- normal mood central
- severe depression with psychosis on the other end
