Psycho-Social I&II: Common Psychiatric Disorders & Dementia

• 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 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 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 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, gustatoryDelusions(belief in something untrue)- persecutory, grandiose, delusions of referenceThought disorders- insertion, broadcasting, withdrawalOthers- 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 the prevalence of anorexia nervosa?

  2% schoolgirls and affects F>M 20:1

  Peak incidence 10-19
• 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 are the signs associated with anorexia nervosa?

  Low self-esteem, depression, anxietyLight-headed, dizziness, amenorrhoeaRisk of suicide 10%May take several years to fully recover
• 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 are the clinical features of dementia?

  Impaired intellect, memory & concentration

  Difficulty reading, writing, speaking

  Personality change
• What does treatment for dementia include?

  Social support
• 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 are some features of Parkinson's disease?

  Tremor- at rest, may affect tongue & jaw

  Rigidity- resistance to passive movements

  Hypokinesia (slowness of movement)
• 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 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