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IHD Part 2 306 > Psychiatry > Flashcards

Flashcards in Psychiatry Deck (37)
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1

Psychiatry: What is psychiatry?

Psychiatry is the medical specialty concerned with the recognition and treatment of disorders of the mind

2

Psychiatry: When does anxiety become pathological?

when it becomes too intense, frequent or persistent, and as a consequence interferes with the functioning of the individual

3

Psychiatry: What is anxiety?

Anxiety is a normal experience to a perceived threat or danger

It serves to mobilise energy reserves for action and enhances performance by increasing arousal

4

Psychiatry: What are the symptoms of anxiety?

Psychological:
Sense of dread
Irritability
Fear of loss of control
Avoidance
Panic

Physical:
Palpitations
Shortness of breath
Chest pain
‘Butterflies’
Sweating
Dry mouth
Nausea

5

Psychiatry: What is generalised anxiety disorder?

The anxiety experienced is not confined to a specific situation but is pervasive

Anxiety is experienced more days than not

Understandably, whilst frequently anxious, anxiety levels typically rise in stressful situations

May result in panic attacks

6

Psychiatry: What are phobic disorders? and what are the types?

In common these are situational, predictable, with anticipatory anxiety and avoidance

Types:
Simple phobias
specific animal phobias
Social phobia
Agoraphobia

Common in general population but only 2% considered “severely disabling

7

Psychiatry: What are possible presentations of odontophobia?

Delayed presentation
Looking anxious
Cancel appointments at short notice / fail to attend

8

Psychiatry: What are possible reasons for odontophobia?

Specific phobia (e.g. drills, needles, sounds, smells)
Anxiety about somatic reactions (gagging, injection)
Generalized anxiety disorder
Social phobia.

9

Psychiatry: How can you manage dental anxiety?

Prevention:
Dental health education
Calm, sympathetic paced approach
Honest and tactful explanation of procedures
Relaxed, welcoming atmosphere
Confident and professional manner

Treatment:
Education regarding anxiety
Relaxation techniques
Desensitisation (graded exposure)
Short term pharmacological anxiolytics (e.g. diazepam)
Long term pharmacological antidepressants

10

Psychiatry: What is body dysmorphic disorder?

The affected person is excessively concerned about a perceived defect in his or her physical features

may present to the dentist

11

Psychiatry: What is hypochondriasis?

Abnormal preoccupation about the presence of an underlying serious physical disease

Patients can place an abnormal interpretation upon a normal sensation (e.g. transient dry mouth is proof of oral cancer).

It is often very difficult to persuade patients that their symptoms might have a largely psychological component.

12

Psychiatry: What is somatoform pain? What are the key characteristics?

The cause is psychological rather than organic/physical

Absence of organic pathology
Evidence of a psychological cause

Inconsistent with anatomical landmarks
May be continuous and bilateral
May prevent sleep but does not wake patient
Repeated negative investigations
Analgesia ineffective
Associated with emotional factors and may have symbolic meaning.

13

Psychiatry: What are affective disorders?

Extremes of mood, if accompanied by associated symptoms and impaired function can be delineated into ‘illnesses’

Mood can go up as well as down


Unipolar affective disorder
Bipolar affective disorder

14

Psychiatry: how is depression diagnosed?

Depressed mood

2 weeks or more
Lack of energy
Loss of enjoyment
Poor appetite/ Weight loss
Sleep disturbance
Loss of libido
Psychomotor retardation
Poor concentration
Guilt and worthlessness
Hopelessness / Suicidal ideation
Delusions / hallucinations

15

Psychiatry: What is bipolar affective disorder?

Elevated mood may be a normal experience
Most patients with mania also experience depression
Bipolar disorder is a very disruptive condition
Men and women are at equal risk
1% of the population

16

Psychiatry: What is mania?

Elated or irritable mood

For more than 1 week
Or
Resulting in admission

Over-activity
Disinhibition
Risk taking activity
Distractibility
Reduced need for sleep
Inflated self esteem
Rapid, loud speech
Racing thoughts
Delusions/ Hallucinations - psychotic symptoms

17

Psychiatry: What is schizophrenia?

Not “Split personality”
Schizophrenia is a serious psychiatric condition:
Abnormal thoughts and experiences

Reduction in drive, social function and alteration in personality and emotion
The age of onset is usually in early/mid adulthood
Male=Female

18

Psychiatry: What are the positive symptoms of schizophrenia?

Delusions
Hallucinations
Passivity Phenomena
Thought disorder

19

Psychiatry: What are the negative symptoms schizophrenia?

Social withdrawal
Emotional blunting
Apathy: A lack of drive, motivation and volition

20

Psychiatry: how is anorexia nervosa diagnosed?

Body weight <15% expected
BMI < 17.5
self induced weight loss
body image distortion
widespread endocrine disorder
arrest of puberty

21

Psychiatry: What are the problems with eating disorders and dental problems?

Erosion of dental enamel
Thermal hypersensitivity (cold/hot sensitive)
Salivary gland enlargement
Dryness of the mouth and decreased salivary flow
Redness of the throat and palate
Reddened, dry, and cracked lips and fissures at angles to the lips

22

Psychiatry: How do you screen for alcohol misuse?

CAGE

C “Have you ever felt you should cut down?”
A “Are you annoyed if people comment on your drinking?”
G “Do you feel guilty about the amount you drink?”
E “Have you ever drunk early in the morning as an eye-opener?”

23

Psychiatry: What are personality disorders?

Severe disturbance in the characterological constitution and behavioural tendencies of the individual
Associated with considerable personal and social disruption
Appear in late childhood/adolescence
Persist into adulthood.

24

Psychiatry: What is dementia?

An acquired impairment of global cognitive function which is progressive & irreversible

Alzheimer’s Dementia
Vascular Dementia
Frontotemporal Dementia
Other

25

Psychiatry: What is delirium?

A reversible state characterised by:
Impairment of consciousness
Disturbed attention
Perceptual abnormalities
Emotional disturbances
Disturbed sleep wake cycle

Fast onset

Causes:
Infection
Drugs
Systemic illness

26

Psychiatry pharmacology: What types of antidepressants exist?

Tricyclic Antidepressants (TCAs) - psychiatrists very rarely use, GPs use more often for other benefits such as neurological pain, dentists use etc
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
Noradrenaline and Specific Serotonin Antagonist (NaSSA)

27

Psychiatry pharmacology: What do tricyclic antidepressants do?

E.g. amitriptyline, lofepramine

Inhibit 5-HT and NA uptake
Produces therapeutic effect

Block of M1, H1, alpha1 receptors produces side effects

28

Psychiatry pharmacology: What do SSRIS do?

E.g. fluoxetine, sertraline, citalopram.
Inhibit 5-HT uptake

Produces therapeutic benefit
- depression
- OCD, Panic, anxiety

Produces side effects
- Nausea
- Early increased anxiety (continue to take before desired effect seen)

Well tolerated and good first line treatments

29

Psychiatry pharmacology: What are SNRIS?

Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)

E.g. venlafaxine

Inhibit 5-HT and NA (and DA) uptake
Produces therapeutic effect
Produces side effects
Similar to SSRI

Better tolerated than TCAs and ? more effective than SSRIs for severe depression.

30

Psychiatry pharmacology: What are NASSAS?

Noradrenaline and Specific Serotonin Antagonist

e.g. mirtazapine
Blocks alpha2 receptors
- Produces antidepressant effect (Increases 5-HT release)

Blocks 5-HT2 receptors
- Produces decreased anxiety

Blocks H1 receptors
- Produces sedation

Lacks sexual side effects but may cause weight gain.

doesn't usually cause nausea