Psycho-social Flashcards
What is anxiety and when does it become generalised anxiety disorder?
It is a feeling of unease when feeling under threat.
Generalised when the anxiousness lasts for most days in the week.
What are the clinical features of anxiety?
- Dizziness
- Stomach ache
- Tachycardia
- Sweating
- Dry mouth
- Headaches
- Lack of concentration
- Feeling restless
What is depression and are men or women more likely to get it?
Feeling low and sad over a long period of time.
Women
What is bipolar disorder and are men or females more common?
Alternating episodes of depression and euphoria.
Women
What are the clinical features of depression?
- Low mood
- Loss of concentration
- Inability to enjoy pleasure
- Suicidal
- Lack of energy
- Loss of appetite
- Lack of energy
What are the features of bipolar?
- Wearing bright clothes
- Acting over familiar
- Disinhibition
- Pressure of speech
- Flight of ideas
- Risk taking
What is schizophrenia and what are the clinical features?
A loss of contact with reality.
- Hallucinations
- Delusions (believing in something untrue)
- Thought insertion (believing thoughts are being put in their head)
- Broadcasting (believing their thoughts are being read by others)
What is the treatment for schizophrenia?
- Anti-psychotic medication
- Therapy
Who is anorexia nervosa common in and what is it associated with?
- Young girls aged 10-19
- Voluntary reduction in oral intake
- Anxiety about body shape and weight
- Disturbance of weight perception
- Low self esteem, depression and anxiety
- Light headed, dizziness and absence of menstruation
What is bulimia?
Who is it common in?
It is a way of controlling weight by binge eating and then inducing vomiting or laxative abuse.
Common in women aged 20-30
How do all these disorders affect oral health?
- Tend to be poor dental attendance
- Poor oral hygiene
- Increased risk of smoking, alcohol intake and drug use
- Antidepressants and anti psychotics can lead to dry mouth
- Increased risk of dental trauma
What is the dental relevance of eating disorders?
- Dental erosion (typically palatal surface of upper incisors)
- Salivary gland enlargement
- Increased risk of fainting
- Give them less drugs due to lower body weight
What is dementia?
What are the causes of it?
What are the clinical features?
Dementia is the gradual deterioration of intellect, memory and cognitive function.
Causes:
- Degenerative diseases (Alzheimer’s)
- Genetic
- Vascular (multi-infarct disease)
- Metabolic
- Toxic (alcohol)
- Brain lesion (tumour, infection or inflammation)
Clinical features:
- Lack of memory
- Poor concentration
- Difficulty reading and speaking
- Personality changes
What is Alzheimer’s disease?
Causes?
Treatment?
Atrophy to parts of the brain
- Unknown! increased with age, familiy history, smoking, obesity, diabetes, hypertension
Treatment = donepezil (to reduce memory loss and confusion) and social support
What is Parkinson’s disease?
What treatment can these patients have?
What is the dental relevance?
Resting tremor due to degeneration of nerve cells and loss of dopamine.
Treatment = social support, physiotherapy, dopamine agonists
Dental relevance = poor oral hygiene, difficulty in dental chair, increases risk of aspiration of equipment
What are drugs and what are the 3 problems that come from long term use?
Natural or synthetic substances which alter mental state.
- Psychological dependance = promotes the feeling of satisfaction and this drives the person to repeat having this drug
- Physical dependance = physical disturbances when reduction in drug taken
- Tolerance = increased amounts of drug are needed to achieve the same desired effect
Which drug has the highest % of drug misuse in those between 16-24years?
Cannabis
What are the 3 main reasons as to why people become drug dependant?
1) Environment - drugs are more acceptable and available
2) Constitution - more people with psychiatric illness, worse experiences, genetic disposition
3) Drug itself - pharmacological affect of drug leading to abuse, tolerance and physical dependance
CANNABIS:
1) What class of drug is this?
2) What does acute intoxication lead to?
3) What does chronic abuse lead to?
4) What are the oral manifestations?
1) B
2) Happy feeling, carelessness, more sociable, tachycardia, impairment of memory and judgement
3) Lack of interest, withdrawal, depression and lack of motivation
4) Dry mouth, oral ulceration
COCAINE:
1) Where does this come from?
2) What type of dependance occurs?
3) What feelings does it lead to?
4) Oral manifestations?
1) Coca plant leaf
2) Psychological
3) Feelings of invincibility, happiness, tachycardia, hypertension, hallucinations
4) Ulceration, Oro-nasal fistula
ECSTASY:
1) What is the other name for it?
2) What happens in the acute phase?
3) Oral manifestations?
1) MDMA
2) tachycardia, hypertension, sweating, dilated pupils, acute renal failure
3) trismus, TMJ disorders, dry mouth
QAT:
1) What type of drug is this?
2) What are the complications?
3) What are the oral effects?
1) Stimulant
2) Abdominal pain, constipation
3) Plasma cells gingivitis, ulceration, lichenoid reactions
SOLVENTS:
1) What dependance occurs here?
2) What are the clinical features?
3) What serious life threatening risks do solvents have?
1) Psychological and tolerance
2) Dizziness, blurring of vision, slurred speech, hallucinations, coma
3) Accidents, suffocation through inhalation, inhalation of vomit, brain damage, renal damage, peripheral neuropathy
What are the characteristics of someone taking drugs?
- Lying about drug use
- Dependance on analgesics
- Knowledge of how to prescribe drugs
- IV is hard due to lack of veins
- Mood swings
- Lack of interest
- Inappropriate wear of sunglasses
What is detoxification?
Reduction in drugs use, may need substitution drugs to avoid withdrawal symptoms such as methadone.
What is rehabiliation?
Leaving drug culture and adopting a new life.
How do most people who over use alcohol die?
Liver disease
What are the 4 levels of drinking?
1 - social
2 - at risk
3 - problem drinking
4 - dependence and addiction
Which people tend to drink more?
- Men
- Professional occupation
- Homelessness
What can help dentists recognise a drinking problem?
- Drinking history
- Number of units
- Time of first alcoholic drink in day
- Presence of withdrawal symptoms
What problems does alcohol dependence cause?
- Social
- Medical
- Dental
- Psychiatric
Social:
Requests for medical certificates
Marital financial problems
Prosecution for violent behaviour
Medical Gastrointestinal problems Cardiovascular problems Obstetrics (fetal alcohol syndrome) Neurological (pyschosis) Joint problems Oral problems (smelling of alcohol and oral cancer)
Dental factors: Poor attenders Taking other drugs Oral cancer risk increased Liver disease (increasing bleeding and affecting metabolism)
Psychiatric problems: Depression Anxiety Personality changes Sexual dysfunction Hallucinations
How do we help someone who have alcohol dependance?
4 steps
- Initial intervention
Assess alcohol consumption
Provide information about alcohol effects
Give advice on reducing consumption - Controlled drinking or abstinence
Reducing the alcoholic strength of drinks
Spacing drinks
Alternating alcoholic and non-alcoholic drinks
Eating with drinks - Detoxification
Daily supervision to allow early detection of complications
Multivitamins to prevent Wernicke’s encephalopathy (confusion, inability to coordinate voluntary movement)
Benzodiazepines to prevent withdrawal symptoms
4. Support after withdrawal Primary healthcare tram Community alcohol team Residential rehabilitation programmes Voluntary organisations Disulfiram (makes you feel unwell if you drink alcohol)
What are the common withdrawal symptoms from alcohol?
- Headache
- Sweating
- Nausea
- Vomiting
- Tremor
