Psychiatry - Mood Disorders and Psychoses Flashcards
How can mood disorders present to the dentist
oral effects (somatiform disorders) patient's general demeanor
What are the oral effects of mood disorders that may present to the dentist
dysaesthesias
facial pain
What is the mood disorder spectrum
normal mood goes from elation, normal mood, dysthymia
What are common symptoms of depression
low mood reduced interest and motivation lethargy and tiredness sleep disturbance appetite disturbance poor concentration loss of confidence and self esteem recurrent thoughts of death and suicide unreasonable self reproach and guilt any form of anxiety
What is bipolar 1
mania
What is bipolar 2
cyclothymia
hypomania
What are mania and hypomania symptoms
increased productivity and feeling of wellbein
reduced need for sleep
gradual reduction in social functioning and occupational functioning
increase in reckless behavior
followed by period of depression
What can treatment of mood disorders be split into
pyschological
drug treatment
physical
What is psychological treatment of mood disorders
cognitive therapy
interpersonal psychotherapies
What is the drug treatment for mood disorders
usually 2 yr tx
antidepressant
mood stabilising
What is the physical treatment of mood disorders
exercise
phototherapy
ECT
What are the acute phase antidepressants
selective serotonin reuptake inhibitors
venalfaxine/mirtazepine
tricyclic anti depressants
monoamine oxidase inhibitor
What are mood stabilizing drugs
lithium
carbamazepine
valproate
lamotrigine
Why is lithium not really used anymore
has potential interaction and toxicity problems
Why is the patient taking an anti depressant
treating depression
treating anxiety disorders
pain relief
help psychological treatments
What are the original types of tricyclic antidepressants
amitriptyline
nortriptyline
dosulepin
What are the new tricyclic antidepressants
imipramine
doxepine
What are the side effects of tricyclic antidepressants
dry mouth
sedation
weight gain
What should tricyclic anti depressants be used in caution with
glaucoma
prostatism
What type of drugs are SSRIs
prozac
What are the different types of prozac type SSRi drugs
fluoxetine
paroxetine
fluvoxamine
What are the side effects of SSRIs
acute anxiety disorders
some patients similar to TCA - sedation, dry mouth
GI upset
What is the issue with citalopram and sertraline SSRIs
citalopram
sertraline
What are MAOI
monoamine oxidase inhibitors
What are the 3 monoamine oxidase inhibitors
phenelzine
isocarboxazid
selegeline
What are the interactions of MAOI
indirect acting sympathomimetic amines
enhanced VC effect
cough and cold remedies
foodstuffs - tyramine containing, alcohol, low alcohol bovril/oxo/marmite, cheese, herring, beans
What are other drugs used as antidepressants that are usually prescribed by psychiatrist not GP
venlafaxine (mixed SRI/NRI)
mirtazapine (complex 5HT actions presynaptic alpha2 antagonist)
nefazadone (SSRI/5HT blockade)
reboxetine (SNRI)
What are drugs used in mood disorders
lithium - mood stabiliser
carbamezapine/lamotrigine/valproate - mood stabiliser
antipsychotic medicines to treat episodes of mania
Which should drugs should be avoided with lithium
avoid NSAID and METRONIDAZOLE
What are the antipsychotic medicines used for bipolar mood disorders
aripiprazole
olanzapine
quetiapine
risperidone
What is the direct drug effects of antidepressant drug tremtntes
dry mouth - caries (lithium)
sedation
facial dyskinesias
What is psychoses
perceptual abnormaliteit
What illnesses may we see psychoses
manic depression
schizophrenia
korsakoff psychosis (alcohol induced brain degeneration)
What are drug effects of psychoses
dry mouth
drug interactions
dyskinesias - tonic or dystonia (tardive)
What is schizophrenia
thought disorder
fundamental and characteristic distortions of thinking and perception
various types of delusion - sometimes bizarre
auditory hallucinations
What is the etiology of schizophrenia
dopaminergic neurotransmission
genetic susceptibility - multigene
environmental - perinatal risk factors
drug abuse - cocaine, amphetamine, ecstasy, opiate (cannabis and alcohol)
What’s the management for schizophrenia
psychological therapy
drug therapy
What is the psychological therapy for schizophrenia management
CBT
cognitive remediation
family intervention
What is the drug therapy for schizophrenia management
oral or depot IM injection - compliance, frequency of requirement
dopamine antagonist drugs
atypical antipsychotics - less likely to cause extrapyramidal side effects
What are the issues with dopamine antagonist drugs
cause ‘extrapyramindal’ side effects, dry mouth and sedation
What are the anti psychotics
butryophenones
phenothiazines
thioxanthenes
new ‘atypical’ antipsychotics
What is the butryrophenones
haloperidol
droperidol
What are the phenothiazines
chlorpromazine, thioridazine
prochlorperazine, fluphenazine
What are the thioxanthenes
flupenthixol, zucopenthixol
What are the new atypical antipsychotics
sulpiride, respirions, clozapine, quetiapine, aripiprazole
olanzapine
What are the extrapyramidal side effects of antipsychotics
akathisia
dystonia
parkinsonism
tardive dyskinesia
What is akathisia
feeling of restlessness, making it hard to sit down r hold still
symptoms include tapping your finger, rocking and crossing and uncrossing your legs
What is dystonia
muscles involuntary contract and concord elating to painful positions or movements
What is parkinsonism
the same symptoms as someone with parkinsons 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
What is tardive diskinesia
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
How can extrapyradimal symptoms be treated
need to restore some balance
can use an atypical antipsychotic instead
can use beta blockers (non selective)
can use anticholinergics
What are the the different types of eating disorders
anorexia nervosa
bulimia
comfort eating
What is anorexia nervosa
altered perception of body image
don’t eat
may see oral effects of malnutrition
What is bulimia
normal weight - binge / vomit
comfort eat
dental erosion and oesophageal stricture issues
comfort eating
What is the core psychopathology of eating disorders
fear of being fat
self perception of being too fat
What are other behaviors aimed at losing weight
self induced vomiting
excessive exercise
use of laxatives, appetite suppressants, diuretics
What are symptoms of borderline personality disorders
deep fear unstable relationships changes in self image stress paranoia impulsive behaviour suicidal threats excessive mood swings feelings of solitude
