11 - Depression, psychoses and personality disorders

Question 1

What is cyclothymia?

Answer 1

• normal mood spectrum
• elation, normal mood and dysthymia

Question 2

What is depressive disorder?

Answer 2

• unipolar disorder
• mild depression, moderate depression, severe depression, severe depression with psychosis

Question 3

What is recurrent depressive disorder?

Answer 3

Normal mood, dysthymia, mild depression, moderate depression, severe depression, severe depression with psychosis

Question 4

What is bipolar affective disorder?

Answer 4

Ranges from mania with psychosis to severe depression with psychosis

Question 5

What is bipolar type I?

Answer 5

Experiences full range of emotions at their extremes

Question 6

What is bipolar type II?

Answer 6

Experiences severe depression ± psychosis to hypomania

Question 7

Give examples of depressive mood disorders.

Answer 7

• major depressive disorder
• persistent depressive disorder
• bipolar depression
• postpartum depression
• premenstrual dysphoric disorder
• seasonal affective disorder
• atypical depression

Question 8

What are common symptoms of depression?

Answer 8

• low mood
• reduced motivation/interest
• lethargy
• sleep disturbance
• appetite disturbance
• poor concentration
• loss of confidence
• suicidal thoughts
• unreasonable guilt
• anxiety

Question 9

What are common signs of mania and hypomania?

Answer 9

• increased productivity and feeling of wellbeing
• reduced need for sleep
• gradual reduction in social functioning and occupational functioning
• increase in reckless behaviour
• commonly followed by period of depression

Question 10

What are the different treatment options for mood disorders?

Answer 10

• psychological
• drug therapy
• physical

Question 11

Give examples of psychological treatment of mood disorders.

Answer 11

• CBT
• interpersonal pscyhotherapies

Question 12

Describe the drug therapy regime for mood disorders.

Answer 12

• usually 2 year treatment
• antidepressant
• mood stabilising

Question 13

Give examples of physical treatment of mood disorders.

Answer 13

• exercise
• phototherapy (SAD)
• ECT (post-partum)

Question 14

What are acute phase antidepressants?

Answer 14

• SSRI (selective serotonin reuptake inhibitor)
• mirtazepine
• tricyclic antidepressant
• monoamine oxidase inhibitor

Question 15

What are examples of mood stabilising drugs?

Answer 15

• lithium
• carbamazepine
• valproate
• lamotrigine

Question 16

What can antidepressants be prescribed for?

Answer 16

• depression
• anxiety disorders
• pain relief
• aid psychological treatments

Question 17

Give examples of TCAs.

Answer 17

• amitriptyline
• doxepin

Question 18

What are side effects of TCAs?

Answer 18

• xerostomia
• sedation
• weight gain

Question 19

Who should TCA be use with caution?

Answer 19

• glaucoma
• prostatism

Question 20

Give examples of SSRIs.

Answer 20

• fluoxetine
• citalopram
• sertraline

Question 21

What are side effects of SSRIs?

Answer 21

• acute anxiety disorders
• sedation
• xerostomia
• GI upset

Question 22

Give examples of MAOIs.

Answer 22

• phenelzine
• selegeline

Question 23

What are interactions associated with MAOIs?

Answer 23

• indirectly act on sympathomimetic amines which gives an enhanced vasoconstrictor effect
• interacts with some foodstuffs including alcohol, cheese and beans

Question 24

What drugs are used to treat bipolar disorder?

Answer 24

• lithium
• carbamazepine or valproate
• aripiprazole/risperidone (antipsychotic drugs to treat mania)

Question 25

What should you avoid when taking lithium?

Answer 25

- NSAIDs - metronidazole

Question 26

How can antidepressants affect dentistry?

Answer 26

- xerostomia - caries (severe xerostomia when taking lithium) - sedation - facial dyskinesias (twitching) - drug interactions

Question 27

What are psychoses?

Answer 27

- perceptual abnormalities - include manic depression, schizophrenia, Korsakoff's psychosis

Question 28

What is Korsakoff's psychosis?

Answer 28

Alcohol induced brain degeneration

Question 29

What is schizophrenia?

Answer 29

- thought disorder - distortions of thinking and perception - can have bizarre delusions that are "normal" to the patient - can have auditory/visual hallucinations which can be threatening or derogatory

Question 30

What causes schizophrenia?

Answer 30

- genetic - perinatal factors can influence - drug abuse (!!!) including cocaine, amphetamine, ecstasy, opiates and cannabis

Question 31

How do you manage schizophrenia?

Answer 31

- CBT - family intervention - drug therapy

Question 32

What drugs are used to treat schizophrenia?

Answer 32

- often IM injection due to problems with compliance - dopamine antagonists - atypical antipsychotics

Question 33

What is an example of a dopamine antagonists?

Answer 33

Doperidol

Question 34

What are examples of atypical antipsychotics?

Answer 34

- respiridone - clozapine

Question 35

What are extrapyramidal side effects that can be experienced when taking antipsychotics?

Answer 35

- akathisia (restlessness, tapping fingers etc) - dystonia (involuntary contractions) - Parkinsonism - tardive dyskinesia (uncontrollable fiscal movements including lip smacking, do not stop when medication is stopped)

Question 36

How do you treat extrapyramidal side effects?

Answer 36

- use atypical antipsychotics instead - non-selective beta blockers (eg propranolol) - anticholinergics (eg benztropine)

Question 37

What is anorexia nervosa?

Answer 37

- altered body perception - avoids eating - presents in the oral cavity with ulcers, dry mouth, infections and bleeding due to malnutrition

Question 38

What is bulimia?

Answer 38

- patient maintains a normal weight - patient comfort eats as a reaction to stimuli (ie stress) and vomits food back up - presents in the oral cavity with dental erosion on palatal surfaces and oesophageal strictures

Question 39

What is a personality disorder?

Answer 39

- chronic peculiarities of character - maladaptation to life - often present with antisocial behaviour