Dentistry and mental illness 2 Flashcards Preview

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Flashcards in Dentistry and mental illness 2 Deck (26):

2 examples of dysphoria

ethnic dysphora
gender dysphoria


physical/ oral manifestations of anorexia/ bulemia

vomiting --> tooth erosion
use vinegar/ lemon to reduce hunger
thickened knuckles (Russells sign)
lanugo hair (baby hair)
pale, cold peripheries


signs of acute scizophrenia

delusions, hallucinations, interrupted thought processes


signs of chronic scizophrenia

-slowness, apathy, lack of drive, social withdrawal
-abnormal use of language (sentences, new words)
-inability to explain abstract ideas eg proverbs
-over-inclusiveness (eg everyone out to get them)
-delusions, hallucinations (auditory, visual)
-incongruous mood, eg laugh at inappropriate times


oral effects of scizophrenia

increased DMFT
tooth brushing not a priority
more likely to be edentulous due to trauma from fights etc


4 treatment options for mental illness

-electro convulsive therapy (electric shock to frontal lobe, now rarely used)
-psychotherapy (councelling, underlying causes)
-behaviour therapy eg CBT (desensitisation, flooding, relaxation, thought processes)


types of drugs used for mental illness

psychotropic: mental symptoms
neuroleptic: antipsychotic, major tranquilisers
-anxiolytic: minor tranquilisers


what % of population have dental phobia



6 factors associated with oral health and access to care

-type, severity, stage of illness
-side effects of medication (xerostomia, dyskenesia/ dystonia)
-mood, motivation, self-esteem (poor compliance)
-lack of perception of OH problems
-habit/ lifestyle (diet, SES, substance abuse)
-lack of information (knowledge/ attitudes)


body dysmorphic disorder and relevance to dentistry

belief in cosmetic defect in someone of ordinary appearance --> not satisfied with surgical outcomes
associated with environmental work/ home stressors


define MUS

medically unexplained symptoms


what to ask when a pt presents with MUS 5

-somatic symptoms of anxiety/ depression (eg weight loss)
-previous history of MUS
-evidence of precipitation by stress
-family/ past psychiatric history
-evidence that symptoms respond to psychological interventions


how to treat unexplained symptoms 8

-admit uncertainty, go through test results
-ask about specific concerns
-give positive explanation of symptoms
-copy clinic letters
-stress potential for recovery, expectations
-discuss stressors
-encourage activity
-reframe and reattribute stress and symptoms


issues with managing MUS 5

-clinical duty of care v patient autonomy
-competent pts can refuse tx (assume capacity unless proven otherwise, best interest checklist)
-lasting powers of attourney (people appointed to act for individual should mental incapacity occur)
-provision of living wills/ advance decisions
-ill tx/ neglect of a person who lacks capacity --> max 5 yr prison sentence


what is included in best interests checklists (MCA sections 4) 5

-consider all relevant circumstances (decision maker is aware)
-regaining capacity: can decision be delayed until then
-permitting and encouraging participation: finding appropriate means of communication or using others to help person participate in decision-making process
-considering person's wishes, feelings, beliefs, values (esp written statements of person when they had capacity)
-taking in to account views of other people (family, informal carers, anyone with an interest in persons welfare/ appointed to act on his/ her behalf


purpose of mental capacity act 2005 and where it covers

framework for people who may not be able to make decisions (learning difficulties/ dementia/ poor mental health --> who can make decisions and how to go about this)
covers england and wales


differences between competency and capacity

competency: ability to consent for yourself (understand/ remember info about clinical circumstances, weigh up choices, believe info applies to you)

capacity: individual (ability to understand, remember, use info to make decisions, communicate decision)


what is needed for consent

competency AND capacity


5 considerations of DCP in dealing with pts with mental health problems

-prevent/ control disease (manage symptoms, maintain oral health, comfort, function)
-environment (staff, waiting time, prep, encouragement, distraction)
-appropriate medical/ social histories (opportunities to disclose, stop masking of symptoms)
-patient control: stop signals, provide/ offer pain relief
-dentist a EDUCATOR: expectations, preconceptions, OH, diet councelling, future appointments


4 models to adapt tx for pts with mental issues

-modelling (pt learns by imitation)
-biofeedback (listening to body response and controlling, eg muscle tension, HR, blood pressure
-token economy: +ve reinforcement. tokens for good behaviour, exchanged for something meaningful
-behaviour contracts: +ve reinforcement, plan of behaviours. often used for schoolchildren


define addiction

physical and psychological dependency
associated with tolerance and withdrawal, relapse


define abuse

pathologic behaviour associated with drugs despite associated social, psychological or physical probs


define dependence

continued substance use due to physical or psychological need
tolerance/ withdrawal


define tolerance

need for increased quantities of a substance to achieve desired results


define withdrawal

psychological/ physiological symptoms developed after drug use is stopped


5 principles of mental capacity act

-person assumed to have capacity unless established otherwise
-person not to be treated as unable to make a decision unless all doable steps to help them have been taken without success
-person not to be treated as unable to make a decision merely because they make an unwise decision
-act/ decision in BEST INTEREST of person
-consideration of less restrictive option