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BDS3 BAMS Diseases of Human Systems > psychiatry - overview and anxiety neuroses > Flashcards

psychiatry - overview and anxiety neuroses Flashcards

1
Q

mental health act (scotland) 2003

aim

A

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”

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2
Q

emergency detention

under mental health act (scotland) 2003

A

72 hrs

needs assessed by a mental health guardian to assess tx and dentition is fit

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3
Q

short term detention

under mental health act (scotland) 2003

A

28 days

Needs assessed by mental health guardian to assess tx and dentition is fit

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4
Q

compulsory treatment order

under mental health act 2003

A

6 months

Needs assessed by mental health guardian to assess tx and dentition is fit

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5
Q

removal to placed of safety is done by

mental health act 2003

A

police

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6
Q

what can happen after removal by police

A

detained for 2 hours for doctors assessment

decide if 72hrs emergency dentition is to be enforced

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7
Q

application of the mental health act (scotland) 2003

5 points

A

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
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8
Q

2 groups of psychiatric disorder

A

neurosis

psychosis

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9
Q

neurosis

A

contact retained with realist

  • Aware of surroundings*
  • Able to function within them but has a mental health illness*
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10
Q

psychoses

A

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*
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11
Q

psychiatric conditions in dentistry to be aware of (can affect dentist or pt)

A
  • neuroses
    • anxiety states
    • phobias
  • psychoses
  • eating disorders
  • personality disorders
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12
Q

the ‘normal’ pt behaviour

A
  • Is anxious
  • May not behave rationally (from the dentist’s perspective)
  • Does not have psychiatric diagnosis
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13
Q

neuroses is part of a

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

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14
Q

5 examples of neuroses

A
  • anxiety
  • phobic
  • obsessional
  • hypochondiacal
  • depressive
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15
Q

differentiate the anxious pt from someone with anxiety neurosis

A

The anxious pt

  • Concerned about dental treatment (reasonable)

Anxiety neurosis

  • Concerned about everything (worry about everything, even if nothing happened yet worried missed something)
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16
Q

3 anxiety disorders

A

generalised anxiety disorder

phobic anxiety

panic disorder

17
Q

generalised anxiety disorder

A

free floating anxiety in many/all situations (wide variety of circumstances)

18
Q

phobic anxiety

A

intense anxiety/panic in specific situations

19
Q

panic disorder

A

unpredictable extreme anxiety

may cause other issues e.g. MI

20
Q

somatoform disorders

A

‘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
21
Q

2 management strategies for anxiety disorders

A

psychological treatment

drug treatment

Medication doesn’t get to the root of the anxiety so psychological treatment (CBT etc) more effective

22
Q

pscyhological treatments for anxiety disorders

A
  • ‘psycho education’
  • anxiety management strategies
  • cognitive behavioural therapy
23
Q

drug treatment for anxiety disorders

A

self medication

prescribed medication

Medication doesn’t get to the root of the anxiety so psychological treatment (CBT etc) more effective

24
Q

3 anxiolytic drug families

A

alcohol

Benzodiazepines

antidepressants - with anxiolytic features

25
Q

4 examples of benzodiazepines

A
  • diazepam
  • midazolam
  • temazepam
  • lorazepam
26
Q

examples of antidepressants with anxiolytic features

A

Tricyclic (noradrenaline & 5HT)

  • Amitriptyline, Dosulepin, Nortriptyline, Imipramine

Mirtazepine

SSRI (Selective Serotonin Reuptake Inhibitors – 5HT

  • Fluoxetine, Sertraline, Citalopram
27
Q

how can anxiety neurosis be seen in dental pts

A
  • TMD
  • parafunction
  • oral dysaesthesias (change in sensation in mouth e.g. dry, burning)
  • facial pain
  • denture intolerance
28
Q

how to tx anxiety neurosis in dental setting

A

need to get cause of AN treated otherwise dental tx will be unsuccessful

29
Q

phobia

A

fear out of proportion to threat

30
Q

how phobias may affect dental tx

A

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)
31
Q

what tx works best for phobias

A

psychological therapy

32
Q

OCD

A

obsessive compulsive disorder

neuroses

33
Q

OCD is

A
  • Fear of infection
  • Fear of ‘dirty’ oral environment (dental link)
34
Q

how do OCD sufferers cope

A

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
35
Q

what can OCD lead to

A

depression

particularly if pt realises that the ritual has no bearing on their fear/obsession

36
Q

perfectionism

A
  • A personality trait
  • May have habits or rituals that they follow rigidly
  • Not doing it out of anxious avoidance
37
Q

OCD characteristics

(how it differs from perfectionism)

A
  • 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
38
Q

adjustment disorders

A

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

PTSD requires stress of ‘exceptionally threatening or catastrophic nature’

39
Q

how to manage adjustment disorders

A

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

BDS3 BAMS Diseases of Human Systems (13 decks)

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