Psychiatry, Addiction

Question 1

List some anxiety disorders:

Answer 1

• generalised anxiety disorder
• specific phobias
• obsessive compulsive disorder
• post traumatic stress disorder
• panic attacks/panic disorder

Question 2

What is generalised anxiety?

Phobias?

Panic attacks?

How are anxiety disorders treated?

Answer 2

Generalised anxiety: free-floating anxiety, apprehension, motor tension, autonomic overactivity

Phobias: only arises in context of specific situation/object (dentist/drilling)

Panic attacks: crescendo of fear, intense autonomic symptoms

Treatment of anxiety disorders:

• psychological/psychotherapy
• pharmacological

Question 3

What are the core symptoms of depressive disorders?

How is depressive disorder managed?

Answer 3

Depressive disorders: depressed mood, loss of interest/enjoyment, fatigue, guilt, worthlessness, concentration, appetite, sleep, libido, suicidal ideations/intent

Management:

• non-pharmacological: psycology
• pharmacological: antidepressants, augmentation, ECT

Question 4

What are some symtpoms of bipolar affective disorder?

Management?

Answer 4

• hypomania/psychosis
• increased mood, talkativeness, grandiosity
• decreased appetite, sleep
• depression
• episodic - commonly recover between episodes

Management:

• mood stabilisers (lithium, sodium valproate, lamotrigine)
• antipsychotics
• antidepressants
• ECT

Question 5

What is psychosis?

Difference between psychosis and schizophrenia?

Answer 5

Psychosis: inability to distinguish between internal world and external reality

• delusions, hallucinations, insight impaired

Psychosis = a symptom

Schizophrenia = a syndrome

Question 6

List some dental aspects of psychiatric conditions:

Treatment issues:

Answer 6

• anorexia nervosa - vomiting
• bulimia nervosa
• somatisation

Treatment issues:

• anxious
• many psychotropic medications –> dry mouth
• multiple issues with substance abuse patients

Question 7

Give an overview of paracetamol:

Answer 7

Paracetamol:

• well absorbed in small intestine
• peak plasma concentration at 60 mins
• half life of 2 hours
• less potent inhibitor of the cyclo-oxygenase system than conventional NSAIDs
• inhibits brain prostaglandin synthesis (PGE1 and PGE2) - analgesic effect
• inhibits prostaglandin synthesis in the hypothalamus - antipyretic effect
• side effects: rash, WBC disorders, hepatotoxicity

Question 8

What happens in an overdose of paracetamol?

Answer 8

In overdose, available gluthathione is exhausted and N-acetyl-p-benzoquinone imine accumulates leading to hepatocellular necrosis

Question 9

Define a paracetamol overdose:

What is the drug given in a paracetamol overdose?

Answer 9

Normal toxic dose > 10g/24hrs or 150mg/kg

'’At risk’’ toxic dose > 7g/24hrs or 75mg/kg

N-acetyl cysteine supplements (NAC or parvolex) supply thiol groups –> enables production of additional glutathione therefore reducing hepatocellular damage

• NAC carries risk of severe allergic reaction