Psycho-Social Disorders Flashcards
Generalised Anxiety Disorder clinical features and examples of certain ones
- Long-term condition with feeling of anxiousness about a wide range of situations
- People with GAD feel anxious most days
Clinical Features: Physical -Nausea -Dizziness -Tachycardia -Palpatations -Dry mouth -Headaches -Insomnia
Psychological
- Aggression
- Lack of concentration
- Poor memory
- Irritability
- Worries
- On edge
Phobias Panic disorders OCD PTSD Social Anxiety disorder
Phobia def
Type of generalised anxiety disorder
Associated with an irrational feat of an object or a situation
Often triggers severe anciety
Panic disorder
Type of GAD
Associated with episodes of intense anxiety or panic
OCD def
Type of GAD
Associated with recurring thoughts leading to need to repeatedly perform certain acts
PTSD
Anxiety caused by stressful, frightening or distressing events
GAD disorder
Social Anxiety Disorder
Fear of social situations
Type of GAD
Depression definition and clinical features
- Sustained depression of mood
- More females than men
- Lowering of mood
- Loss of appetite
- Lack of energy
- Reduced libido
- Difficulty concentrating
- Early morning waking
- Sustained lowering of mood
- Inability to experience pleasure
- Suicidal thoughts
Bipolar disorder
- Alternating episodes of depression and euphoria
- Onset 20-40
- Episodes of elevation of mood associated with mental and physical overactivity
- Bright clothes, over familiar, pressure of speech, flight of ideas, grandidose ideas and risk taking
Schizophrenia definition and clinical features
Treatment
- Mental illness associated with relapsing episodes of psychosis
- Psychosis is a loss of contact with reality
Clinical Features:
-Hallucinations (perception in absence of reality)
Auditory, visual, tactile, gustatory
-Delusions (belief in something untrue)
Persecutory, grandiose, delusions of reference
-Thought disorders
Insertion, broadcasting, withdrawal
- Paranoid beliefs
- Social withdrawal
- Tx is anti-psychotic meds and therapy (Cognitive behavioural therapy)
Anorexia Nervosa definition
- More females than men
- Voluntary reduction in oral intake to reduce body weight
- Increase in exercise, laxative abuse, vomiting
- Anxiety about body shape and weight
- Fear of obesity
- Low self esteem, depression, anxiety
- Light headed, dizziness amenorrhoea
- May take several years to fully recover
Bulimia nervosa definiton
- attempt to control weight by restricting amount that they eat, then binge eating and then self inducing vomiting or laxative abuse
- Associated with abnormal attitude towards food or body image
- Normal body weight or some weight loss
- More common than anorexia
- Low self esteem, depression, anxiety, self harm
Dental relevance of common psychiatric disorders
- Poor dental attenders
- Mood on clinics
- Poor oral hygiene
- Increased risk of smoking, alcohol abuse, illegal drug abuse
- Anti-depressants, and anti psychotics may lead to a dry mouth
- Dental phobias
- Increased risk of dental and maxillofacial trauma
- TMJ disorders and chronic orofacial pain
Dental relevance of common eating disorders
Dental Erosion especially on palatal surfaces of the upper incisors
Salivary gland enlargement
Need to take low body weight into account when calculating drug dosages
Increased risk of fainting/postural hypotension
Dementia causes, clinical features, treatment and dental relevance
-Gradual deterioration of intellect, memory and cognitive function in the absence of a disturbance of consciousness
Caused by:
- Degenerative disease (Alzheimer’s)
- Genetic (Huntington’s chorea)
- Metabolic (Wilson’s disease)
- Toxic (alcohol)
- Brain lesion (tumour, infection and inflammation)
Clinical features:
- Impaired intellect
- Memory
- Concentration
- Diffculty reading, writing and speaking
- Personality changes
Treatment:
-Social support
Dental Relevance
- Poor OH
- Poor attenders
Alzheimers Disease causes, association and tx
- 70% of dementia are due to Alzheimers
- Parts of brain atrophy
- Unknown cause
- Increased risk w fam history, smokign obesity
Depression
Aggressive behaviour
Uncoorpoeration
Tx
- Drugs (donepezil, acetyl choline esterase inhibitors)
- Social Support
Parkinsons Disease
Clinical features, definition, tx and dental relevance
Degeneration nerve cells in substantia nigra with loss of dopamine (vital role in regulating the movement of body)
Tremor- at rest, may affect the tongue and jaw
Rigidity- resistance to passive movements
Hypokinesia- slowness of movement
Postural changes
Loss of facial expression
Weak voice
Social support (dressing, cooking, cleaning), physiotherapy, drugs- levodopa, dopamine agonists
Poor OH
increased risk of aspiration
Difficulty tolerating tx eg sitting in chair
Drooling
Psychological dependence definition
Condition in which the drug promotes a feeling of satisfaction and a drive to repeat the consumption of the drug in order to induce pleasure or avoid discomfort
Physical Dependence
- Physical disturbances occur when the amount of drug in the body is markedly reduced
- Disturbances form a withdrawal or abstinence syndrome composed of somatic and mental symptoms and signs which are characteristic of each drug type
Tolerance
-Increased amount of a substance are required to achieve the desired effect
Class’s of Drugs
-Broadly graded according to harm attributable to a drug when it is misused
Class A drugs: Ecstasy, heroin, cocaine, LSD, class B drugs when prepared for injection
Class B: Cannabis, amphetamines, codeine
Class C: Benzodiazepines
Typical examples of drugs
- Alcohol
- Tobacco
- Marijuana
- Opoids
- CNS depressants (Barbiturates, Benzodiazepines)
- CNS stimulants (cocaine, amphetamines, ecstasy)
- Hallucinogens (LSD)
Aetiology of drug dependency
Environmental:
- Acceptability (Social attitude)
- Availability (over perscription, illegal acquisition)
Constitution:
-Genetic, personality, psychiatric illness, education, experience
Drug/substance:
-Pharmacological effect leading to abuse, tolerance, physical dependance
Cannabis effects, oral manifestations and complications
- Euphoria, sociability, carelessness, tachycardia, hypotension, impairment of memory and judgement
- Chronic use associated with apathy, withdrawal, depression and lack of motivation
- Oral manifestations include dry mouth, oral ulceration with chronic use
- Respiratory complications such as lung cancer
- Gateway drug
- Pregnancy- premature labour, transient, mild effect on the babty
- Social consequences
Cocaine complications and oral manifestations
- Hallucinations, psychosis
- Perforation of nasal septum
- Tachycardia, hypertension, sweating, hyperthermia
- Feeling of invincibility, euphoria, agitation
- Cardiac arrest
Ulceration especially where held in the mouth
Oronasal fistula
Ecstasy
- Appetite suppressant
- Tablets, capsules
- Tachycardia, hypertension, sweating, dilated pupils
- Exacerbated by exertion and dehydration
- Hyperthermia, acute renal failure
Oral manifestations:
- Trismus
- Temperomandibular disorders
- Dry mouth
-Treatment is just rehydration
Qat
- Drug used in Yemen and Ethiopia
- Stimulant
- Chewed
- Kept in buccal sulcus and juices swallowed
- Abdominal pain
- Constipation
- Plasma cell gingivitis
- Ulceration
- Lichenoid reactions
Solvents
- Glue
- Paint
- Nail varnish removers
- Ingaled
Euphoria, disinhibition, dizziness, blurring of vision, disorientations, hallucinations
Inhalation of vomit, brain damage, poor social functioning
Complications of IV drug misuse
- Abscesses
- Thrombophlebitis
- Arterial spasm
- Septicaemia, infective endocarditis
- Hepatitis B, C
- HIV
Signs and characteristics of drug abuse
Signs:
- Poor historians
- Lying about intake
- Disproportionate demand for analgesics
- Good knowledge of formulary
- Inappropriate fear of needles in hands of others
- IV access difficult due to lack of patient’s veins
Signs:
- Mood swings
- Loss of interest in appearance
- Inappropriate wearing of sunglasses
- Needle tracks
- Unusual tattoos over veins
Detoxification
Dose reduction
May need substitution
Symptomatic treatment
May need impatient treatment
Psychological support important
Rehabilitation
Leaving drug culture/adopting new life May need residential rehabilitation Needs involvement of patient and family Factual and practical advice Counselling Use of help groups
Legal
Social
Medical
Psychiatric needs
Units in beer/cider, wine and spirits
- 1 unit in half a pint of lager/cider
- 1 unit in 125ml glass of 9%
- 1 unit in 25ml of spirits
Recommedned weekly max alcohol intake
14 units per week male and female
Recognising drinking problems
Take a drinking history
- Amount consumed in units
- Time of first alcoholic drink in a day
- Pattern of drinking
- Presence of withdrawal symptoms
CAGE questions
Have u ever felt the need to Cut down
Have people annoyed u about critising your drinking
Have u eveer felt Guilty about ur drinking
Do you need an Eye opened in the morning
2 or more and u got a prob
Presentation of alcohol dependence
Social:
- Requests for medical ceritficates
- Marital, financial problems
- Violent behaviour
Medical: GI- Cirrhosis, pancreatitis CV- Hypertension Joints: Gout Oral: Smell of alcohol, oral cancer
Psychiatric
- Depression
- Anxiety
- Personality changes
Dental factors:
- Poor attenders
- Other drugs, tobacco
- Oral cancer
- Liver disease
Dental relevance of alcoholism
Dental factors:
- Poor attenders
- Other drugs, tobacco
- Oral cancer
- Liver disease
- Colleagues and alcoholism
- Yourself and alcoholism
Managing drinking problem
Initial Intervention:
- assess alcohol consumption
- provide info about the effects of alcohol
- give advice on reducing consumption
Controlled drinking or abstinence
- Spacing drinks
- Alternating non alcoholics and alcoholic ones
- Eating with drinks
Detoxification
- Daily supervision to allow early detection of complications
- Multivitamins
- Benzosiazepines
Support after withdrawal
Withdrawal syndrome from alcohol
Onset
3-6 hours after last drink
5-7 days duration
Common sympyoms include nausea and vomiting, sweating, tremor
Delirium tremens
48-72h after last drink
Delirium and tremor
Fits, hyperthermia, dehydration and shock
High mortality
