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BDS2; CHHD > Psychiatry > Flashcards

Psychiatry Flashcards

1. Recognise signs and symptoms of common psychiatric conditions 2. Be aware of management stratergies for anxiety, affective disorders including depression and bipolar affective disorder, schizophrenia, eating disorders and alcoholism 3. Be aware of dental relevance of common psychiatric conditions and implications of their management 4. Be aware of integral role of anxiety and depression in aetiology of non-odontogenic orofacial pain

1
Q

What is neurosis and give examples

A
  • Excessive degrees of normal phenomena
  • Common
  • Quantitively different

Anxiety, depression, somatisation (where people experience different body parts)

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2
Q

What is psychosis and give examples

A
  • Thought dissorder
  • Rare
  • Qualitatively different

Schizophrenia, manic depressive illness, delusions, hallucinations

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3
Q

What is anxiety neuroses/ anxiety disorder

A

A combination of psychological and physical manifestations of anxiety, not attributable to real danger

Signs and symptoms are due to sympathetic overactivity and can occur as panic attacks

Typically begins in early adult life and is more common in females

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4
Q

Describe types of anxiety

A

Persisting state (generalised anxiety disorder = anxiety trait)

Due to specific trigger = phobia

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5
Q

Outline the clinical features - psychological symptoms and signs of anxiety

A
  1. Fearful anticipation
  2. Irritability, restlessness
  3. Noise sensitivity
  4. Repetitive worrying
  5. Poor concentration
  6. Subjective reports of poor memory
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6
Q

Outline the clinical features - physical symptoms of anxiety

A
  • RS = difficulty inhaling, chest constriction, hyperventilating
  • CVS = cardiac discomfort, palpitations
  • GI = XS wind, aerophagy, difficulty swallowing, dry mouth, loose stools
  • Neurological = tinnitus, dizziness, blurred vision, paraesthesia (related to hyperventilation)
  • Musculo-skeletal = aching and stiffness
  • Sleep disturbance = difficulty sleeping, tight terrors, intermittent waking
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7
Q

What are panic disorders

A

Recurrent episodic severe panic attacks occurring unpredictably and lasting minutes

Typically onsetting at 25-44 and more common in females

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8
Q

What are the psychological and physical symptoms of panic disorders

A

Psychological

  • intense fear, impending doom, impaired concentration
  • fear of losing control, going crazy/ dying

Physical

  • chest tightness, palpitations, tachycardia, trembling, paraesthesia
  • sweating, dry mouth, shortness of breath
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9
Q

What is generalised anxiety disorder

A

Generalised, persistent excessive anxiety about everyday circumstances lasting > 6 months - prolonged waxing and waning course

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10
Q

What organic causes present similarly to generalised anxiety disorder

A

Thyrotoxicosis
Phaechromocytoma
Hypoglycemia

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11
Q

How is anxiety treated

A

Psychological

  • reassurance, counselling, psychotherapy
  • behavioural therapy

Pharmacological

  • anxiolytic agents (BZ = short term)
  • antidepressants
  • beta blockers (symptomatic relief)
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12
Q

What is a simple specific phobia

A

Specific phobia for stimuli characterised by anxious thoughts in anticipation of an encounter and avoidance habits - this is managed through CBT (exposure and anxiety management with flooding)

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13
Q

What is agoraphobia

A

Fear of open spaces or situations from which escape may be difficult (crowds) - the person progressively avoids situations which provoke anxiety and may be confined to their home

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14
Q

What is social phobia/ social anxiety disorder

A

Anxiety provoked by social performance situations and the fear of behaving in a manner that will be humiliating/ embarrassing

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15
Q

How is social phobia/ social anxiety disorder treated

A
  • MAOI
  • SSRIs
  • Systematic desensitisation
  • Cognitive therapy
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16
Q

What are obsessions and compulsions

A

Obsession
- unwelcome, persistent ideas, thoughts or impulses which are intrusive, senseless and recognised as absurd

Compulsions

  • the motor component of an obsessional thought used to relieve the associated anxiety
  • performed in a stereotyped fashion
  • activity is excessive and not connected to thought in a realistic way

Typically associated with the anankastic personality trait = cleanliness, orderliness, rigid, checking

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17
Q

What is OCD

A

Obsessive-compulsive disorder = absurd, time consuming obsessions and compulsions that interfere with the individuals everyday function

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18
Q

How is OCD managed

A

CBT

  • exposure and response prevention which tackles dysfunctional emotions, maladaptive behaviours and cognitive processes
  • thought stopping
  • habituation training

Drug therapy

  • clomipramine
  • serotonin uptake inhibitors (fluoxetine)
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19
Q

Which of the following symptoms is most suggestive of anxiety:

a. Audible wheeze
b. Difficulty exhaling
c. Palpitations
d. Pill-rolling tremor
e. Severe chest pain

A

C

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20
Q

What is psychosis

A

When contact with reality is lost and normal mental processes are suspended, the patient may encounter
- hallucinations
- delusions
- thought disorder
- loss of insight
This is found in bipolar affective disorder (mania/depression), schizophrenia, paranoia, organic disorders

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21
Q

Define delusions

A

Fixed, false beliefs which are out of keeping with the persons religious and cultural background which is maintained even in the face of evidence to the contrary

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22
Q

Define hallucinations

A

False sensory perception in absence of real external stimuli

23
Q

What is schizophrenia

A

Disintegrative psychosis involving loss of contact with reality - splitting of normal links between perception, mood, thinking, behaviour and contact with reality

There is a social drift with this affecting classes IV and V

24
Q

Outline the 5 classifications of schizophrenia

A
  1. Paranoid = prominent persecutory/ grandiose delusions, auditory hallucinations and may appear normal
  2. Hebephrenic/disorfanised = silly childish behaviour, thought incoherence and disorganised behaviour
  3. Catatonic = motor immobility, rigidity, posturing, excitement copying speech and behaviour
  4. Undifferentiated, simple = insidious social withdrawal, deterioration, defect state, absence of delusions, hallucinations
  5. Residual = at least one acute schizophrenic episode but currently no positive psychotic symptoms - will have negative symptoms such as withdrawal from society
25
Q

What is type I schizophrenia classified by

A

Acute onset, positive symptoms

  • delusions, hallucinations
  • thought disorder
  • speech
26
Q

What is type II schizophrenia classified by

A

Chronic, negative symptoms

  • lack of drive
  • withdrawn
  • depression
  • poverty of speech
  • poor attention span and memory
27
Q

Describe Schneider’s first rank symptoms

A
  1. Auditory hallucinations
    - third person arguing about subject and commentary on subject’s actions
    - audible thoughts
  2. Delusions
    - thought insertion/ withdrawal
    - thought broadcasting
    - somatic passivity (movement controlled by external source)
    - delusional perception
28
Q

What are the treatments for schizophrenia

A

Antipsychotics (neuroleptics/ major tranquillisers)

  • Orally = chlorpromazine, fluphenazine, risperidol
  • IM with long acting depot injections (those refusing oral)

Psychotherapy

29
Q

How do antipsychotics work

A

They alter the dopamine/ cholinergic balance in basal ganglia

30
Q

What are the extrapyramidal and anticholinergic effects of antipsychotics

A
  1. Dystonia/ Dyskinesia = abnormal movements
  2. Akathisia = restlessness
  3. Parkinsinism - Tardive dyskinesia (involuntary movements involving lips and tongue)
31
Q

What is the dental relevance of schizophrenia

A
  1. Neglect of dental care - caries and periodontitis
  2. Smoking - dental staining, oral precancer and cancer
  3. Hard to communicate
  4. Delusional oral symptoms
  5. Side effects of neuroleptics - haloperidol and clozapine can cause hyposalivation causing candidiasis and caries
32
Q

What are affective disorders and list examples

A
  • Disorders characterised by mood disturbances (depression/ elation)
  • Accompanied by abnormalities in thinking an perception

Bipolar affective disorder, Unipolar affective disorder, Mixed affective states

33
Q

Outline the clinical features of depression

A
  • Depression of mood
  • Loss of enjoyment = anhedonia
  • Reduced attention and concentration, poor memory
  • Ideas of guilt and worthlessness
  • Lowered self esteem
  • Reduced energy = anergia
  • Hopeless/ helplessness
  • Suicidal ideation
34
Q

Outline biological features of depression

A
  1. Sleep disturbance: early waking, insomnia, unrefreshed
  2. Change in appetite, change in weight, constipation
  3. Change in psychomotor activity - retardation
  4. Diurnal variation in mood (worse in AM)
  5. Loss of interest in work and pleasure activities
  6. Loss of energy and libido
  7. Amenorrhoea
35
Q

Outline how the appearance and speech of a patient with depression is different

A
  • Dishevelled, neglected dress and grooming
  • Facial features: down-turning corners of mouth, furrowing brow
  • Reduced rate of blinking
  • Reduced gestural movements
  • Shoulders bent, head inclined forwards, downwards gaze
  • Poverty of speech, slow and hesitant
36
Q

What are the psychotic features of depression

A
  1. Delusions = concerned with ideas of worthlessness, guilt, ill health and poverty
  2. Hallucinations = second person auditory confirming patients ideas of worthlessness
37
Q

How can depression be diagnosed

A

Loss of interest or pleasure or depressed mood for > 2 weeks, plus 4 =< clinical signs of depression

38
Q

How is depression managed

A
  1. Antidepressants (takes 4 weeks for onset):
    - TCAs = amitriptyline, dolesupin
    - SSRI’s = fluoxetine, paroxetine, citalopram (less side effects)
    - St John’s wort
  2. Lithium / carbamazepine for mood stabilisation between depression and elation
  3. Electroconvulsive therapy (severe cases)
39
Q

What are the dental aspects of depression

A

Treatment should be deferred until depression is controlled

Oral symptoms

  • disturbed taste
  • persistent idiopathic facial pain
  • burning mouth syndrome
  • TMJ dysfunction
  • delusions (discharge from mouth, halitosis)

Adverse effects of treatments

  • dry mouth (TCAs, lithium)
  • altered taste sensation
40
Q

What is bipolar disorder

A

Sustained episodes of an elevated/ agitated mood which alternated with episodes of depression

  • affects ability to function in life
  • increased mortality
41
Q

Outline what happens in manic episodes of bipolar disorder

A
  1. Grandiosity: dressed in gaudy colours
  2. Diminished need for sleep, untidy, dishevelled
  3. XS speech or pressured speech
  4. Racing thoughts, flight of ideas
  5. Distractibility + overactivity casing exhaustion
  6. XS pleasurable activities: overspending, uninhibited sexual behaviour and risk taking
42
Q

What are manic episodes in bipolar disorder

A

Hypomanic episodes characterised by elevated expansive, or irritable mood of at least 4 days duration

43
Q

How is bipolar disorder managed

A
  1. Antipsychotics: chlorpromazine, haloperidol, respiridone, olanzapine (rapidly brings symptoms down)
  2. Sedatives for rapid tranquillisation (lorazepam)
  3. Lithium and carbamazepine prophylaxis (prevents mania relapse)
  4. ECT
44
Q

What are the dental aspects of medications given for bipolar disorder

A
  • Lithium toxicity with GA

- Long term potential to induce hypothyroidism

45
Q

What is anorexia nervosa

A

Deliberate weightless where the person chooses not to eat and there is extreme avoidance of ‘fattening’ foods

  • weight is maintained 15% below expectation
  • BMI = <17.5kg m^-2
  • patient has body image distortion with fear of obesity
  • associated with OCD, anxiety, mood disorders
46
Q

Outline clinical features of anorexia nervosa

A
  • Thin, emaciated
  • Dehydration, dental erosion, caries
  • Hair loss from scalp, fine downy langue hair on face and back
  • Early onset causes short stature
  • Osteoporosis, pathological fractures
  • Hypokalaemia: muscle weakness, tetany
  • Amenorrhoea/ loss of libido
47
Q

How is anorexia managed

A
  • Controlled weight gain: feeding if severe, build relationship and agree on weight targets
  • Behavioural regime: bed rest which is relaxed as weight is gained
  • CBT to identify and change cognitions
  • Family therapy
48
Q

What are the dental aspects of anorexia nervosa

A
  • Caution during GA
  • Parotid enlargement
  • Erosion of teeth
  • Oral ulcers and abrasions
49
Q

What is bulimia nervosa

A

Repeated bouts of overeating (binge) with excessive preoccupation with body weight control and purging
- Bouts occurring >/= twice weekly for 3 months

50
Q

What are the clinical features of bulimia nervosa

A
  1. Normal weight range
  2. Repeated vomiting - oesophageal tears, haematemesis, hypokalaemia, depression
  3. Sialosis = salivary gland swelling
  4. Dental erosion
  5. Calluses on dorsum of hand = Russell’s sign
  6. Ulcers on soft palate, angular chelitis
51
Q

What methods are employed to counteract weight gain in patients with bulimia nervosa

A
  • Self-induced vomiting
  • Periods of starvation
  • Purgative and laxative abuse
  • Abuse of appetite suppressants, thyroid hormones and diuretics
  • Neglect to use insulin in diabetics
52
Q

What are the features of alcohol dependance

A
  1. Compulsion to drink
  2. Pre-occupation with alcohol
  3. Stereotyped drinking pattern
  4. Increased tolerance to alcohol
  5. Repeated withdrawal symptoms and relief drinking to avoid these, with persistence even after attempted withdrawal
  6. Loss of ability to regulate drinking g
53
Q

What are the acute withdrawal symptoms experienced by patients with alcohol dependance (delirium tremens)

A
  • 10-72 hours after last drink
  • agitation and insomnia
  • tachycardia and hypotension
  • pyrexia
  • confusion and fits
  • visual tactile hallucinations

Managed by rehydration, vitamins, sedation, chlormethiazole, chlordiazepoxide

54
Q

What are the dental aspects of alcohol misuse

A
  1. Poor oral hygiene
  2. Malnutrition and anaemia
  3. Liver disease/cirrhosis - bleeding tendency and altered drug metabolism
  4. Problems with drug administration = metronidazole
  5. Accidents and fights causing maxillofacial trauma

BDS2; CHHD (32 decks)

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