psychiatry - overview and anxiety neuroses Flashcards
mental health act (scotland) 2003
aim
Concerned purely with management and treatment of psychiatric disorders
- No provision for compulsory treatment of physical problems
- Needs to be pts choice for physical problems – once reality is restored
Can have detained pts in the community on “Leave of Absence”
emergency detention
under mental health act (scotland) 2003
72 hrs
needs assessed by a mental health guardian to assess tx and dentition is fit
short term detention
under mental health act (scotland) 2003
28 days
Needs assessed by mental health guardian to assess tx and dentition is fit
compulsory treatment order
under mental health act 2003
6 months
Needs assessed by mental health guardian to assess tx and dentition is fit
removal to placed of safety is done by
mental health act 2003
police
what can happen after removal by police
detained for 2 hours for doctors assessment
decide if 72hrs emergency dentition is to be enforced
application of the mental health act (scotland) 2003
5 points
That the person has a mental disorder
Medical treatment is available which could stop their condition getting worse, or help treat some of their symptoms
- E.g. for personality disorders there is no medical tx available so dentition under the mental health act would not be appropriate
If that medical treatment was not provided, there would be a significant risk to the person or others
Because of the person’s mental disorder, his/her ability to make decisions about medical treatment is significantly impaired
- That the use of compulsory powers is necessary
2 groups of psychiatric disorder
neurosis
psychosis
neurosis
contact retained with realist
- Aware of surroundings*
- Able to function within them but has a mental health illness*
psychoses
contact lost with reality
- Aware of surroundings*
- But perceives them in a different way than the normal population so unable to interact appropriately within them*
psychiatric conditions in dentistry to be aware of (can affect dentist or pt)
- neuroses
- anxiety states
- phobias
- psychoses
- eating disorders
- personality disorders
the ‘normal’ pt behaviour
- Is anxious
- May not behave rationally (from the dentist’s perspective)
- Does not have psychiatric diagnosis
neuroses is part of a
spectrum of mood and social disorder
More unstable emotions – variety of symptoms
Related to intrinsic personality as well as changes brought upon them by circumstances
5 examples of neuroses
- anxiety
- phobic
- obsessional
- hypochondiacal
- depressive
differentiate the anxious pt from someone with anxiety neurosis
The anxious pt
- Concerned about dental treatment (reasonable)
Anxiety neurosis
- Concerned about everything (worry about everything, even if nothing happened yet worried missed something)
3 anxiety disorders
generalised anxiety disorder
phobic anxiety
panic disorder
generalised anxiety disorder
free floating anxiety in many/all situations (wide variety of circumstances)
phobic anxiety
intense anxiety/panic in specific situations
panic disorder
unpredictable extreme anxiety
may cause other issues e.g. MI
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”
There may or may not be clear psychological/psychiatric symptomatology e.g. depression
- Manifestation of problem that doesn’t exist medically or pathologically
- Frequently seen in dentistry
2 management strategies for anxiety disorders
psychological treatment
drug treatment
Medication doesn’t get to the root of the anxiety so psychological treatment (CBT etc) more effective
pscyhological treatments for anxiety disorders
- ‘psycho education’
- anxiety management strategies
- cognitive behavioural therapy
drug treatment for anxiety disorders
self medication
prescribed medication
Medication doesn’t get to the root of the anxiety so psychological treatment (CBT etc) more effective
3 anxiolytic drug families
alcohol
Benzodiazepines
antidepressants - with anxiolytic features
4 examples of benzodiazepines
- diazepam
- midazolam
- temazepam
- lorazepam
examples of antidepressants with anxiolytic features
Tricyclic (noradrenaline & 5HT)
- Amitriptyline, Dosulepin, Nortriptyline, Imipramine
Mirtazepine
SSRI (Selective Serotonin Reuptake Inhibitors – 5HT
- Fluoxetine, Sertraline, Citalopram
how can anxiety neurosis be seen in dental pts
- TMD
- parafunction
- oral dysaesthesias (change in sensation in mouth e.g. dry, burning)
- facial pain
- denture intolerance
how to tx anxiety neurosis in dental setting
need to get cause of AN treated otherwise dental tx will be unsuccessful
phobia
fear out of proportion to threat
how phobias may affect dental tx
Find out what trigger is and why is has arisen
- Past experience of pt
- Individual to pt
Remember that other phobias may prevent dental treatment
- Agoraphobia (fear of outside)
- Claustrophobia (fear of enclosed spaces)
what tx works best for phobias
psychological therapy
OCD
obsessive compulsive disorder
neuroses
OCD is
- Fear of infection
- Fear of ‘dirty’ oral environment (dental link)
how do OCD sufferers cope
Rituals developed to contain anxiety
- Less likely for fear to occur
- Ritual may have nothing to do with that fear but helps release anxiety
- Cycle – obsession, anxiety, compulsion, relief
- Hard to break cycle
- Cycle – obsession, anxiety, compulsion, relief
what can OCD lead to
depression
particularly if pt realises that the ritual has no bearing on their fear/obsession
perfectionism
- A personality trait
- May have habits or rituals that they follow rigidly
- Not doing it out of anxious avoidance
OCD characteristics
(how it differs from perfectionism)
- A mental health disorder
- Involves repeated, unwanted thoughts or urges that cause a person anxiety
- The individual performs a compulsive action or ritual to prevent the development of anxiety
- Fear of unwanted anxiety that drives the ritual process – not personality trait
- Ritual may not be related to the anxiety itself
adjustment disorders
type of neuroses
common
maladaptive responses to severe past or continuing stress/trauma’
- Occur during adaptation to new circumstances
- E.g. bereavement, separation, loss
- Often bereavement does not lead to acceptance of change in circumstance – become distressed, anxious and depressed
- E.g. bereavement, separation, loss
PTSD requires stress of ‘exceptionally threatening or catastrophic nature’
how to manage adjustment disorders
Managed by psychological intervention
- don’t respond solely to medication need highly trained counsellor to bring out the issues and settle and resolve them through variety of strategies
Mood disorders usually accompany Adjustment disorders
- tx with medication
