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BDS3 BAMS Diseases of Human Systems > psychiatry - mood disorders and psychoses > Flashcards

psychiatry - mood disorders and psychoses Flashcards

1
Q

example of mood disorder

A

mood disoder

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2
Q

how can mood disorder affect pt

A

May present to the dentist (RARE)

  • Oral effects (somatiform disorders)
    • Dysaesthesias
    • Facial pain

Patient’s general demeanor – particular if familiar with pt/staff

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3
Q

should you tx pt during period of depression?

A

any important decision – extraction, appearance etc – may be better to delay if pt not in best reflection on themself

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4
Q

mood disorder spectrum

A

Change depend on circumstances (environment and within ourselves)

  • Cyclothmia – normal mood swing

Different severities of depression – most not psychotic (still have contact with environment - neuroses)

  • At extremes of depression, psychoses can take over and pt have a psychotic view on world/reality

Depressive disorder can persist for some time or return to normal mood (be recurrent depressive disorder)

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5
Q

cyclothemia

A

normal mood swing

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6
Q

unipolar disorder

A

moves only in one direction on mood spectrum

(usually low mood)

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7
Q

bipolar affective disorder

A

moves in both directions

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8
Q

natural changes in mood progression

A

Normal mood swings

Cyclothymic

  • Temperament - quite common
  • Disorder –exaggerated mood swings

Bipolar type II

  • more depressed – never reach mania

Monopolar mania

  • does span into depression, just normal to mania

Bipolar type I a.k.a true

  • range from mania with psychosis to depression with psychosis (returning to euthymic state)
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9
Q

two classess oc cychlothymic issues

A
  • Temperament - quite common
  • Disorder –exaggerated mood swings
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10
Q

bipolar type II

A

more depressed – never reach mania

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11
Q

monopolar mania

A

does span into depression, just normal to mania

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12
Q

bipolar type I

A

true

range from mania with psychosis to depression with psychosis (returning to euthymic state)

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13
Q

mood disorders prevalance

A

common

Female: Male

2-3 : 1

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14
Q

unipolar point prevalence

A

6%

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15
Q

bipolar life prevalence

A

1.2%

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16
Q

puerperal mood disorder a.k.a

A

post natal depression

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17
Q

prevalence of puerpral mood disorder

A

0.5/1000 in one month

1/1000 in one year

Prone to have with next pregnancy if had already

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18
Q

effect of puerperal mood disorder

A

inability to enjoy the moment - thinking of months and years ahead with baby

Prone to have with next pregnancy if had already

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19
Q

common types of depressive disorders (7)

A
  • major depressive disorder
  • persistent depressive disorder
  • bipolar depression
  • postpartum depression
  • premenstrual dysphoric disorder
  • seasonal affective disorder
  • atypical depression
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20
Q

major depression disorder

extent

A

can reach severe and psychotic depression

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21
Q

persistent depression disorder

extent

A

pt runs at low mood, never returning to normal or reaching depths of depression

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22
Q

10 common symptoms of depression

A
  • Low mood
  • Reduced interest and motivation – in people and environment
    • inc things that used to be enjoyable for them
  • Lethargy and tiredness
  • Sleep disturbance
  • Appetite disturbance – eat excessively or lose all interest in food
  • Poor concentration
  • Loss of confidence and self esteem
  • Recurrent thoughts of death and suicide
    • pt may not want to carry them out – scary for them
      • Ask if they have thought about how to carry out
  • Unreasonable self-reproach and guilt
  • Any form of anxiety
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23
Q

clinical criteria for major depressive disorder

A

5 or more with depressed mood and interest loss, for at least 2 weeks

S sleep changes

I interest loss (anhedonia

G guilt (worthless)

E energy lack

C concentration reduced

A appetite change

P psychomotor change

S sucidide ideation/thoughta

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24
Q

2 types of bipolar on bipolar spectrum

A

Bipolar 1

  • Mania – normal to high mood

Bipolar 2

  • Cyclothymia, Hypomania (with psychosis) and then down into depressive state
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25
Q

5 mania and hypomania symptoms

A
  • Increased productivity and feeling of wellbeing
  • Reduced need for sleep
  • Gradual reduction in social functioning and occupational functioning
  • Increase in reckless behaviour
    • Thinking downsides of behaviour will not happen to them – speeding, drugs
  • Followed by a period of depression
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26
Q

2 ways elevated mood disorders can present

A

euphoric

dysphoric

(some overlap)

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27
Q

soley euphoric characteristics

A

upbeat

more talkative

inflated self esteem

felt everything was possible

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28
Q

soley dysphoric characteristics

A

irritable

agitated

aggressive energy

restlessness

rage

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29
Q

characteristics that can be seen in both euphoric and dysphoric (elevated mood disorders)

A

rapid speech

restlessness

reckless behaviour

excessive energy

decreased sleep

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30
Q

3 tx modalities for mood disorder

A
  • psychological
  • drug treatment - usually 2 years tx
  • physical

best is combination

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31
Q

psychological tx for mood disorders (2)

A

cognitive behavioural therapy

  • particular depressive - as unusual perception in own worth and ability

interpersonal psychotherapies

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32
Q

drug families that can be used in mood disorder tx

A

antidepressant

mood stabilising

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33
Q

why does drug tx for mood disorders last 2 years

A

Even if returned to ‘normal’ before then as the ‘normal’ they are in is due to drugs so need to have a while before the brain will accept the new eqm and biochemistry as normal

  • Withdrawal too soon - replase
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34
Q

3 physical tx options for mood disorders

A
  • exercise
  • phototherapy (SAD)
  • ECT less now, post natal
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35
Q

examples of acute phase antidepressants that can be used in mood disorders

A
  • selective serotonin reuptake inhibitor (SSRI)
  • venlafaxine/mirtazapine
    • second line if SSRI not worked
  • tricyclic antidepressants (TCA)
  • monoamine oxidase inhibitor (MAOI) - last resort
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36
Q

TCA use in mood disorders

A

older - more effective with anxiety than SSRIs but less effective with depression

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37
Q

why are MAOI last resort for drug tx of mood disorder

A

many side effects

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38
Q

issue with drug tx for mood disorder

A
  • Possible to overshoot – go from low up to hypomania
  • Not always predictable

Assess each individual to see how they are managing

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39
Q

4 reasons why a pt may be taking an ‘antidepressant’

A
  • Treating depression
  • Treating anxiety disorders
    • Includes OCD and panic attacks
  • Pain relief
    • TCA and mirtazapine, boost NorA in brain and reduce pain transmission in CNS
  • Help psychological treatments
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40
Q

4 examples of mood stabilising drugs that can be used in mood disorders

A
  • lithium
  • carbamazepine
  • valoproate
  • lamotrigine

pts who are prone to mood cycling

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41
Q

tricyclic antidepressants examples

A

original

  • amitriptyline
  • nortiptyline
  • dosulepin

new TCAs

  • imipramine
  • doxepin
42
Q

issue with TCAs

A

side effects

  • dry mouth, sedation, weight gain (reduction in feeling full)
    • more side effects in older drugs

Dangerous in overdose - caution with depression pt

Use with caution in

  • glaucoma (rise in eye pressure), prostatism (blockage in urine outflow)
    • not common
43
Q

SSRIs examples

A

‘prozac’ type drugs

  • fluoxetine
  • paroxetine
  • fluovoxamine
  • citalopram
  • sertraline

most common

variety - try to find best suited to pt

44
Q

SSRIs side effects

A
  • acute anxiety disorders
  • some pts similar to TCAs - sedation, dry mouth
  • gastrointestinal upset

Can cause anxiety when starting and ending

  • Negative withdrawal syndromes – can feel addicted to them (need control and maybe use of benzodiazepines)
45
Q

monamine oxidase inhibitors (MAOI) examples

A

(5HT and norA)

  • phenelzine
  • isocarboxazid
  • selegeline
46
Q

interactions of MAOIs

A

Indirect acting sympathetic amines (e.g. ephedrine and noradrenaline)

  • Enhanced vasoconstrictor effect (adrenaline containing LA no problem appears)
  • Cold and cough remedies

Foodstuffs – tyramine containing, alcohol/low alcohol

  • Bovril/oxo/marmite, cheese, herring, beans

ensure pt aware

47
Q

4 other drugs that can be used as antidepressant but usually started by psychiatrise (not GP)

A
  • Venlafaxine (mixed SRI/NRI)
  • Mirtazapine (complex 5HT actions presynaptic alpha2 antagonist)
  • Nefazadone (SSRI/5GT blockade)
  • Reboxetine (SNRI)
48
Q

4 drugs used in bipolar mood disorder

as mood stabilisers

A

lithium

carbamazepine

lamotrigine

valporate

49
Q

lithium

A

mood stabiliser

K+ substitute

avoid - NSAID, metronidazole

50
Q

medicines used to tx episodes of mania

A

antipsychotic medicines

  • Aripiprazole
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Not antidepressants*
  • Reduce tendency to mania and psychosis*
51
Q

antidepressant drugs impact on dentistry

A

Direct drug effects

  • Dry mouth – caries may result in extreme (lithium)
  • Sedation
  • Facial dyskinesias – uncontrollable facial twitches

Drug interactions

  • Drug metabolism (none significant to dental)
  • Local anaesthetics
52
Q

psychoses is

3 conditions

A

Perceptual abnormalities

  • Manic depression
  • Schizophrenia
  • Korsakoff Psychosis – Alcohol induced brain degeneration
53
Q

psychoses acute episodes

A

difficult to tx

no insight to trouble

54
Q

antipsychotic drug effects

A
  • Dry mouth
  • Drug interactions
  • Dyskinesias – tonic or dystonia (tardive) – larger problem
55
Q

schizophrenia

A

Thought disorder

  • ‘fundamental and characteristic distortions of thinking and perception’
  • Various types of delusions – sometimes bizarre
    • Visual hallucinations
    • Auditory hallucinations
  • often threating or derogatory – gnaw at pt conscious

Relapsing and remitting periods of acute psychosis

Multifactorial abnormality of Dopaminergic neurotransmission

Prevalence – 1-2%

56
Q

factors which can cause abnormality in dopaminergic neurotransmission in schizophrenia

A
  • Genetic Susceptibility – multigene
  • Environmental – perinatal risk factor
  • Drug abuse – cocaine, amphetamine, ecstasy, opiate (cannabis and alcohol)
57
Q

how may a person with schizophrenia appear to behave

A

Person usually behave appropriately for the situation they find themselves in

However, their reality not the same as actual reality so behaviours seem unusual

58
Q

effects of schizophrenia

A

Cumulative, chronic deficits in motivational, affective and social domains

59
Q

2 types of schizophrenia management

A

psychological therapy

drug therapy

60
Q

3 psychological therapy options for schizophrenia

A
  • CBT
  • cognitive remediation
  • family intervention
    • everyone involved as affects everyday life
61
Q

2 drug types for schizophrenia

A

Dopamine antagonist drugs

  • Block affects of dopamine receptors in brain
  • cause ‘extrapyramidal’ side effects (distressing), dry mouth and sedation
    • don’t just block dopamine in areas of concern in brain but also elsewhere in brain

Atypical antipsychotics

  • less likely to cause extrapyramidal side effects - preferred
62
Q

pyramidal controls and link to dopamine

A

pyramidal – control of movement

dopamine shortages in Parkinson

similar side effects in extrapyramidal side effects of dopamine antagonist drugs

63
Q

drug therapy regime options for schizophrenia pts

A

Oral or depot IM injection

  • compliance, frequency of requirement

pt doesn’t see issue (their reality they feel is correct and normal) – can affect compliance as see no need to take medicines

  • long lasting injections may be more appropriate rather than daily oral tablets until pt has recovered
64
Q

4 groups of antiphsycotic drugs

A

butryrophenones

phenothiazines

thioxanthenes

new ‘atypical’ antipsychotics

65
Q

2 butryrophenones

(antipsychotics)

A

haloperidol

droperidol

66
Q

4 phenothiazines

(antipsychotics)

A

chlorpromazine

thioridazine

prochlorperazine (depot injections)

fluphenazine (depot injections)

67
Q

2 thioxanthenes

(antipsychotics)

A

fluphenthixol

zucleopenthixol

68
Q

new ‘atypical’ antipsychotic drugs (6)

advantage

A

Do not act by being dopamine antagonist

Less side extrapyramidal side effects

  • sulpiride
  • repiridone
  • clozapine
  • quetiapine
  • aripipraxole
  • olanzapine
69
Q

4 extrapyramidal side effects of antipsychotics

A

akathisia

dystonia

parkinsonism

tardive dyskinesia

70
Q

when are extrapyramidal side effects of antipsychotics seen

A

Not always present at initial commencement of drugs

  • Can take a while to manifest

Most will settle if drug withdrawn (not last tardive dyskinesia)

71
Q

akathisia

A

extrapyramidal side effect of antipsychotic

  • feeling of restlessness, making it hard to sit down or hold still
  • Symptoms include tapping your fingers, rocking, and crossing and uncrossing your legs
72
Q

dystonia

A

extrapyramidal side effect of antipsychotic

  • muscles involuntarily contract and contort leading to painful positions or movements (can be neck, intraoral – dentist present)
73
Q

parkinsonism

A

extrapyramidal side effect of antipsychotic drug

  • the same symptoms as someone with Parkinson’s disease, but your symptoms are caused by medications, not by the disease
  • may include tremor, slower thought processes, slower movements, rigid muscles, difficulty speaking, and facial stiffness.
74
Q

tardive dyskinesia

A

extra pyramidal side effect of antipsychotic

  • uncontrollable facial movements such as sucking or chewing, lip-smacking, sticking your tongue out or blinking your eyes repeatedly
  • Do not go away if medicine is stopped (develops over many months and years and persists – devasting for pt)
75
Q

how to treat extrapyrimdal symtoms

3 strategies

A
  • Use an ‘atypical’ antipsychotic instead
  • beta adreniagic blockers (non-selective)
  • Anticholinergics
76
Q

how does beta-adrenergic blockers (non-selective) tx extra pyramidal side effects

A
  • Tip towards ACh – so nerve effects increased*
  • Reduce disbalance with drugs*
77
Q

2 beta-adrenergic blockers (non-selective)

A

propranolol

metropolol

78
Q

how does anticholinergics tx extrapyramidal syptoms

A
  • Tip towards ACh – so nerve effects increased*
  • Reduce disbalance with drugs*
79
Q

4 anticholinergics and issue when using to tx extrapyramidal symptoms of antipsychotic

A

inc dryness - cumulative effect with antipsychotic

  • procyclidine
  • benztropine
  • diphenhydramine
  • pramipexole
80
Q

types of eating disorders (6)

A

anorexia nervosa

bullimia

avoidant/restrictive food intake disorder (ARFID)

other specified feeding or eating disorder (OSFED)

Binge eating disorder (BED

comfort eating

81
Q

anorexia nervosa

A
  • altered perception of body image
  • don’t eat - oral effects of malnutrition seen
82
Q

anorexia nervosa

dental appearnce

A

oral effects of mallnutrition

  • ulcers
  • dry mouth
  • infections
  • bleeding
83
Q

bulimia

A
  • normal weight - binge/vomit
  • ‘comfort eating’ - stress reaction?
  • dental erosion & oesophageal stricture
84
Q

dental signs of bulimia

A

dental eroision and oesphageal stricture

  • recurring flow of acid from stomach into tissue not made to cope with it – palatal surfaces eroded, labial surfaces normal
85
Q

comfort eating

A

is eating disorder used as a coping strategy for anxiety

86
Q

core pychopathology of eating disorder

A

“morbid fear of fatness” & self-perception of being too fat

Characteristically young females

87
Q

actions of individual with eating disorder

A
  • restriction of food intake

other behaviour aimed at losing weight:

  • self-induced vomiting,
  • excessive exercise
  • use of laxatives, appetite suppressants, diuretics
88
Q

personality types

A

variation exists

can be hard to define where personality type ends and disorders begin

89
Q

personality disorders tx

A

many have no effective tx

hard to tell how they arise - genetic or learned behaviour?

90
Q

boderline personality disorder

A

instability in interpersonal relationships, self image and affects and marked impulsitivity

91
Q

antisocial personality disorder

A

disregard for and violation of the rights of others

92
Q

histrionic personality disorder

A

excessive emotionality and attention seeking

93
Q

narcisstic personality disorder

A

gradiosity, need for admiration and lack of empathy

94
Q

dependent personality disorder

A

submissive and clinging behaviour related to an excessive need to be taken care of

95
Q

schizoid personality disorder

A

detatchment from social relationships and restricted range of emotional expression

96
Q

personality disorders comon characteristics

A
  • ‘chronic perculiarities of character’
  • ‘maladaptation to life’
  • Often ‘antisocial’ behaviour

can be Dentist or pt

97
Q

8 symtpoms for boderline personality disoder

A
  • deep fear (of getting abandoned)
  • unstable relationships
  • changes in self image
  • stress paranoia (disconnect with reality and practicality)
  • impulsive behaviour
  • suicidal threats
  • excessive mood swings
  • feelings of solitude

black and white thinking

  • Great fears – drives behaviour*
  • Disguise the person’s anxiety of being isolated*
  • knowing has doesn’t help due to lack of understanding of others - emotional centres brain outweighs logical*
98
Q

hallmark of boderline personality disorder (BPD)

A

finding it hard to regulate emotions - lead to intense mood swings, impulsivity and behavioural problems

99
Q

subtypes of BPD

A

discouraged boderline (clingy, fear alone/rejection)

impulsive boderline (seeks attention/ thrills)

petulant boderline (unpredictable, pessimistic)

self-destructive boderline (bitterness)

100
Q

BPD link to other psychiatric disorders

A
  • bipolar disorder
  • depression
  • self-harm and suicidal thoughts - higher rate
  • anxiety
  • subtance misuse
  • eating disorder

not individual problem but overall BPD

some see advantages in having BPD

101
Q

signs of BPD

A
  • patterns of ups and downs
  • disturbed cognition
  • relationship or interpersonal difficulties
  • identity disturbances, including poor self esteem and poor body image
  • impulsivity and being highly reactive

BDS3 BAMS Diseases of Human Systems (13 decks)

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