Psycho-Social I & II Flashcards
What is generalised anxiety disorder (GAD)?
Long-term condition with feeling of anxiousness about a wide range of situations.
People with GAD feel anxious most days
What are the physical clinical features of GAD?
Dizziness, tachycardia, palpitations, diarrhoea, dry mouth, headaches, insomnia.
What are the psychological clinical features of GAD?
Aggression, lack of concentration, poor memory, loss of sleep, irritability, feel restless, worried, on edge.
What is a phobia?
Irrational fear of an object or situation- triggers severe anxiety
What is panic disorder?
Episodes of intense anxiety or panic.
What is OCD?
Recurring thoughts leading to need to repeatedly perform certain acts
What is PTSD?
Anxiety caused by stressful, frightening or distressing events
What is social anxiety disorder?
Fear of social situations
What is depression and describe its incidence & lifetime expectancy?
Sustained depression of mood
Affects up to 400/100,000 per year
Lifetime expectancy 10-20%
F>M 2 : 1
What are the clinical features of depression?
Sustained lowering of mood
Loss of appetite
Early morning waking
Lack of energy
Loss of concentration
Reduced libido
Anhedonia (inability to experience pleasure)
Suicidal thoughts
What is bipolar disorder and describe its incidence & lifetime expectancy?
Alternating episodes of depression & euphoria
Onset 20-40
Incidence: 20-100,000 per year
Lifetime expectancy 1%
F>M 1.3 : 1
What are the clinical features of bipolar disorder?
Episodes of elevation of mood associated with mental & physical overactivity
Bright clothes, over familiar, disinhibition, pressure of speech, flight of ideas, grandiose ideas, risk taking
What is schizophrenia?
Psychosis (loss of contact with reality)
What is the lifetime risk of developing schizophrenia?
Up to 1%
For those who have a first degree relative affected, it’s around 12%
What is usually the age of onset for schizophrenia?
15-35
What are the clinical features of scizophrenia?
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
Others- paranoid beliefs, social withdrawal
What is the treatment for schizophrenia?
Anti-psychotic medication
Therapy e.g. CBT
What is an eating disorder?
Disturbance in eating behaviour
What is anorexia nervosa?
Voluntary reduction in oral intake to reduce body weight
Often also increase in exercise, laxative abuse, vomiting
Anxiety about body shape and weight
Fear of obesity
Disturbance of weight perception- belief that they are overweight
What is the prevalence of anorexia nervosa?
2% schoolgirls and affects F>M 20:1
Peak incidence 10-19
What are the signs associated with anorexia nervosa?
Low self-esteem, depression, anxiety
Light-headed, dizziness, amenorrhoea
Risk of suicide 10%
May take several years to fully recove
What is bulimia nervosa?
Attempt to control weight by restricting amount they eat, then binge eating and then self-induced vomiting or laxative abuse
Associated with abnormal attitude towards food or body image
Normal body weight or some weight loss
Is bulimia more common than anorexia?
Yes
Who tends to be affected by bulimia?
Up to 10% of women aged 20-30 affected
What are the signs associated with bulimia nervosa?
Low self-esteem, depression, anxiety, self-harm
Social pressure to be slim
What is the dental relevance of common psychiatric disorders?
Poor dental attenders
Poor oral hygiene
Increased risk of smoking, alcohol abuse, illegal drug abuse
Antidepressants & anti-psychotics- dry mouth
Dental phobia
Increased risk of dental & maxillofacial trauma
Increased risk of TMJ disorders; chronic orofacial pain
What is the dental relevance of common eating disorders?
Dental erosion- esp palatal surfaces of upper incisors
Salivary gland enlargement
Need to take low body weight into account when calculating drug dosages
Increased risk of fainting/postural hypotension
What is dementia?
A condition where there is a gradual deterioration of intellect, memory and cognitive function in the absence of a disturbance of consciousness
This usually affects older patients >65 yrs
What are the potential causes of dementia?
Degenerative disease (Alzheimer’s which is responsible for over 70%)
Genetic (Huntington’s chorea)
Vascular (multi-infarct dementia)
Metabolic (Wilson’s disease)
Toxic (Alcohol)
Brain lesion - tumour, infection (CJD), inflammation (SLE)
What does treatment for dementia include?
Social support
What are the clinical features of dementia?
Impaired intellect, memory & concentration
Difficulty reading, writing, speaking
Personality change
What is the dental relevance of a patient having dementia?
Poor oral hygiene
Poor attenders
What are some risk factors for Alzheimer’s?
Increased risk with age, family history, previous head injury, smoking, obesity, diabetes, hypertension, hypercholesterolaemia
What behavioural tendencies are associated with Alzheimer’s?
Depression
Aggressive behaviour
Uncooperation
What does the treatment for Alzheimer’s include?
Drugs (donepezil, acetyl choline esterase inhibitors)
Social support
What happens in Parkinson’s disease?
Degeneration nerve cells in substantia nigra with loss of dopamine (vital role in regulating movement of body)
What are some features of Parkinson’s disease?
Tremor- at rest, may affect tongue & jaw
Rigidity- resistance to passive movements
Hypokinesia (slowness of movement)
What are some clinical features of Parkinson’s?
Postural changes
Loss of facial expression
Delayed swallowing, drooling
Weak voice
Depression
Insomnia
What does the treatment for Parkinson’s involve?
Social support
Physiotherapy
Drugs- levodopa, dopamine agonists
What is the dental relevance of having a patient with Parkinson’s?
Poor oral hygiene
Increased risk of aspiration
Difficulty sitting in dental chair
Drooling
What are the definitions of psychological dependence, physical dependence, and tolerance?
Psychological dependence:
A condition in which the drug promotes a feeling of satisfaction and a drive to repeat the consumption of the drug to induce pleasure or avoid discomfort (WHO 1974).
Physical dependence:
A state that shows itself by physical disturbances when the amount of drug in the body is markedly reduced. The disturbances form a withdrawal or abstinence syndrome composed of somatic and mental symptoms and signs which are characteristic of each drug type (WHO 1974).
Tolerance:
When markedly increased amounts of the substance are required to achieve the desired effect or there is a markedly diminished effect with regular use of the same dose.
What are the oral manifestations of using cannabis and what are the complications?
Dry mouth, oral ulceration with chronic use
Complications:
-Respiratory complications including lung cancer
-Other drugs- tobacco, alcohol
-Pregnancy– premature labour, transient, mild effect on baby
-Social consequences
What are the oral manifestations of using cocaine?
Ulceration esp where held in mouth
Oro-nasal fistula
What are the oral manifestations of using ecstasy?
Trismus, temporomandibular disorders, dry mouth
(Treatment includes rehydration)
What are the oral effects of taking qat (khat)?
Plasma cell gingivitis
Ulceration
Lichenoid reactions
What are some examples of complications of IV drug misuse?
Abscesses
Thrombophlebitis
Arterial spasm
Septicaemia, infective endocarditis
Hepatitis B,C
HIV
How does detoxification & rehabilitation work in drug abuse?
Detoxification:
Dose reduction: May need substitution eg methadone – opioid agonist to avoid withdrawal symptoms
Symptomatic treatment – adjunctive therapy eg IV fluids (ecstasy)
May need inpatient treatment. Psychological support important
Rehabilitation:
-Leaving drug culture / adopting a new life
-May need residential rehabilitation/community programme
-Needs involvement of patient and family
-Factual & practical advice
-Counselling
-Use of help groups
Other needs: Legal
Social
Medical
Psychiatric
What are some signs & characteristics of drug abuse?
Characteristics:
Poor historians
Lying about intake
Disproportionate demand for analgesics
Good knowledge of formulary
Inappropriate fear of needles in hands of others
IV access is difficult due to the lack of patent veins
Signs:
Mood swings
Loss of interest in appearance
Inappropriate wearing of sunglasses
Needle tracks
Unusual tattoos over veins
How do you recognise a drinking problem in your patients?
Drinking history:
Amount consumed in units
Time of first alcoholic drink in the day
Pattern of drinking
Presence of withdrawal symptoms (early morning shakes)
Ask CAGE questions:
E.g. Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticising your drinking?
Have you ever felt bad or Guilty about your drinking?
Do you need an ‘Eye-opener’ first thing in the morning?
Answering yes to 2 or more of these questions is clinically significant
How might alcohol dependence present?
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How should you manage problem drinking/alcohol dependence?
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What do alcohol withdrawal states include?
Withdrawal syndrome:
Onset is 3-6 hrs after last drink
Duration is 5-7 days
Common symptoms include headaches, nausea & vomiting, sweating, tremor
Delirium tremens:
Onset is 48-72 hrs after last drink
Features include delirium & tremor
Complications include fits, hyperthermia, dehydration, shock
Mortality is high- up to 10%
