Psychosocial Flashcards
Generalised anxiety disorder
Clinical features - physical ?
- psychological?
Feeling anxious
Physical - dizzy, tachycardia, palpitations, diarrhoea, dry mouth, headaches, insomnia
Psychological - Aggression, lack of concentration, poor memory, loss of sleep, irritability, feel restless, worried
Phobia?
Panic disorder?
OCD?
PTSD?
Social anxiety disorder?
Phobias - Irrational fear of an object or situation – triggers severe anxiety
Panic disorder - Episodes of intense anxiety or panic
OCD - Recurring thoughts leading to need to repeatedly perform certain acts
PTSD - Anxiety caused by stressful, frightening or distressing event
Social anxiety disorder - Fear of social situations
Mood disorder examples?
More common in women or men?
Depression
Bipolar disorder - altering episodes of depression and euphoria
Depression - loss of appetite, low libido, lack of energy, early morning waking, lowering of mood
Bipolar - 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
Both more common in women
Schizophrenia
What is it?
Clinical features?
Treatment?
Psychosis - loss of contact with reality
Clinical features -
Hallucinations
Delusions
Thought disorders
Others - eg paranoid beliefs and social withdrawal
Treatment - Anti psychotic medication
Therapy eg CBT
Eating disorder
What are they?
Examples?
Disturbance in eating behaviour
Anorexia nervosa
Bulimia nervosa
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
Low self-esteem, depression, anxiety
Light-headed, dizziness, amenorrhoea
Risk of suicide 10%
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
More common than anorexia
Up to 10% women aged 20-30 affected
Low self-esteem, depression, anxiety, self-harm
Social pressure to be slim
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
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
Dementia
What is it?
Causes?
Clinical features?
Treatment?
Dental relevance?
Gradual deterioration of intellect, memory and cognitive function in the absence of a disturbance of consciousness
Causes :
Degenerative disease (Alzheimer’s)
Genetic (Huntington’s chorea)
Vascular (multi-infarct dementia)
Metabolic (Wilson’s disease)
Toxic (Alcohol)
Brain lesion – tumour, infection (CJD), inflammation (SLE)
Clinical features:
Impaired intellect, memory & concentration
Difficulty reading, writing, speaking personality change
Treatment = social support
Dental relevance = Poor oral hygiene, poor attenders
Alzheimer’s disease
What is it?
Causes?
Associated with?
Treatment?
Responsible for over 70% cases of dementia
Parts of brain atrophy
Causes :
Unknown
Increased risk with age, family history, previous head injury, smoking, obesity, diabetes, hypertension, hypercholesterolaemia
Associated with :
Depression
Aggressive behaviour
Uncooperation
Treatment
Drugs (donepezil, acetyl choline esterase inhibitors)
Social support
Parkinson’s disease
Clinical features?
Treatment?
Dental relevance?
Tremor - at rest, may affect tongue & jaw
Rigidity – resistance to passive movements
Hypokinesia (slowness of movement)
Degeneration nerve cells in substantia nigra with loss of dopamine (vital role in regulating movement of body)
Other clinical features –
Postural changes , Loss of facial expression, Delayed swallowing, drooling, Weak voice, Depression, insomnia
Treatment:
Social support, physiotherapy
Drugs – levodopa, dopamine agonists
Dental relevance :
Poor oral hygiene
increased risk of aspiration
difficulty sitting in dental chair
drooling
Drug abuse
Examples of common drugs that are socially acceptable?
Paan
Alcohol
Tobacco
Drugs definitions
What is Psychological dependence?
What is Physical dependence?
What is tolerance?
Psychological dependence - drug leads to feeling of satisfaction + want to repeat to gain pleasure/ avoid discomfort
Physical dependence - when amount of drug decreased there are physical disturbances
Tolerance - when increased amount of drug is needed to get the same effect
Misuse of drugs Act 1971
Examples of Class A drugs?
Examples of class B drugs?
Examples of class C drugs?
What is it an offence to do?
Graded broadly 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 drugs
Cannabis, amphetamines, codeine
Class C drugs
Benzodiazepines
It is an offence to:
Possess a controlled substance unlawfully
Possess a controlled substance with intent to supply it
Supply or offer to supply a controlled drug (even where no charge is made for the drug)
Allow premises you occupy or manage to be used for the purpose of drug taking
Drug trafficking attracts serious punishment, including life imprisonment for Class A drugs.
Examples of Drugs
Drug misuse and young adults
Drugs implicated in criminal activity
Aetiology of drug dependance
Environmental - Acceptability + Availability ( eg society attitude )
Constitution - Genetic, personality, illness, education, experience
Drug / substance
Cannabis
What class?
Derived from?
Psychological dependance?
Does it have any therapeutic properties?
Complications?
Class B drug
Derived from cannabis sativa
Psychological dependence – moderate / strong
Therapeutic properties eg Multiple sclerosis
Complications
Respiratory complications inc lung cancer
Other drugs - tobacco, alcohol
Pregnancy – premature labour, transient, mild effect on baby
Social consequences
What are the oral manifestations of cannabis?
Dry mouth
Oral ulceration with chronic use
Cocaine
Derived from?
Mode of use?
Psychological dependance?
Physical dependance?
Tolerance?
Severe intoxication?
derived from leaves of Coca plant
Mode of use – sniffing, smoked, inhaled, ingested, IV
Local anaesthetic and vasoconstrictor properties
Psychological dependence - strong
Little physical dependence (after effects – depression, fatigue)
No tolerance
Feeling of invincibility, euphoria, agitation Tachycardia, hypertension, sweating, hyperthermia Hallucinations, psychosis Perforation of nasal septum
Severe intoxication – arrhythmias, cardiac arrest
What are the oral manifestations of cocaine?
ulceration esp where held in mouth
Oro-nasal fistula
Ecstasy
Acute phase?
Treatment ?
3,4-methylenedioxymetamphetamine (MDMA)
Appetite suppressant Tablets, capsules
Acute phase:
Tachycardia, hypertension, sweating, dilated pupils
Exacerbated by exertion and dehydration
Hyperthermia, acute renal failure
Treatment = rehydration
What are the oral manifestations of ecstasy?
Trismus
temporomandibular disorders
dry mouth
Qat
Where is it found?
Mode of use?
Complications?
Northern Yemen, Ethiopia
Stimulant, euphoria
Chewed, kept in buccal sulcus, juices swallowed
Complications
• Abdominal pain
• Constipation
What are the oral manifestations of qat?
Plasma cell gingivitis
Ulceration
Lichenoid reactions
See slide 26
Complications of IV drug misuse
• Abscesses
• Thrombophlebitis
• Arterial spasm
• Septicaemia, infective endocarditis
• Hepatitis B,C
• HIV
What are signs of drug abuse?
Mood swings
Loss of interest in appearance
Inappropriate wearing of sunglasses
Needle tracks
Unusual tattoos over veins
What are characteristics of drug abuse?
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 patent veins
What is detoxification?
What is rehabilitation?
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 new life
May need residential rehabilitation / community programme
Needs involvement of patient and family
Factual & practical advice
Counselling
Use of help groups
How many grams is one unit of alcohol?
1 unit of alcohol = 8g
What is 1 unit of beer / lager / cider same as?
1 unit of wine same as how many ml?
How many units is one bottle of wine?
1 unit of spirits is same as how many ml?
Beer, lager, cider 1 unit = ½ pint
Wine 1 unit = 125 ml glass of 9% (1 bottle = about 8 units)
Spirits 1 unit = 25 ml
What is the recommended maximum weekly alcohol intake?
Is it the same for men and women?
14 units/ week
Yes
Four factors affecting alcohol consumption
Sex
Race
Occupation
Homelessness
How to recognise problem drinking?
CAGE Questions
Drinking history:
Amount consumed in units
Time of first alcoholic drink in day
Pattern of drinking
Presence of withdrawal symptoms
CAGE Questions
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 ?
Medical presentation of alcohol dependance
GI - Cirrhosis, pancreatitis
CV - hypertension
Obstetrics - Fetal alcohol syndrome
Neurological - Korsakoff’s psychosis
Joints - Gout
Oral - smell of alcohol, Oral cancer
Presentation of alcohol dependance DENTAL FACTORS
Poor attenders
Other drugs, tobacco
Oral cancer
Liver disease - bleeding, drug metabolism
Managing problem drinking / alcohol dependence
Initial intervention
Controlled drinking or abstinence
Detoxification
Support after withdrawal
What are the alcohol withdrawal states?
Withdrawal syndrome - 3-6 hrs after last drink
Delirium tremens - 5% of patients, 48-72 hrs or more after last drink
See slide 38
