Psycho PART ONE *1: Anxiety, Phobias, and OCD

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Questions and Answers

Which of the following best describes generalized anxiety disorder (GAD)?

  • A short-lived episode of intense fear triggered by a specific object or situation.
  • Recurring, unwanted thoughts that lead to repetitive behaviors.
  • A long-term condition characterized by persistent and excessive worry about various situations. (correct)
  • Intense anxiety caused by a past traumatic event.

A patient reports dizziness, tachycardia, and diarrhea. While these can be symptoms of many conditions, which psychiatric disorder are they MOST closely associated with?

  • Depression
  • Generalized Anxiety Disorder (correct)
  • Bipolar disorder
  • Schizophrenia

Irritability, poor concentration, and restlessness are psychological features associated with which condition?

  • Generalized anxiety disorder (correct)
  • Obsessive-compulsive disorder
  • Phobias
  • Panic disorder

A patient describes an overwhelming and irrational fear of spiders. This best describes which of the following?

<p>Phobia (D)</p> Signup and view all the answers

Which condition involves recurring thoughts that lead to the need to repeatedly perform certain actions?

<p>Obsessive-compulsive disorder (OCD) (D)</p> Signup and view all the answers

Anxiety can be a normal response to certain situations. In what circumstance, would classifying anxiety as a 'psychiatric condition' be MOST appropriate?

<p>When it becomes excessive, persistent, and impairs daily functioning. (D)</p> Signup and view all the answers

Which of the following physiological responses is LEAST likely to be a risk factor for anxiety?

<p>Hypothyroidism (C)</p> Signup and view all the answers

Considering dental treatment, what is a potential consequence of increased anxiety?

<p>Bruxism (B)</p> Signup and view all the answers

Which of the following is the MOST appropriate initial approach to managing a patient experiencing anxiety in a dental setting?

<p>Providing empathy and reassurance (A)</p> Signup and view all the answers

A patient reports a persistent low mood, loss of interest in activities, and changes in sleep patterns. These are MOST indicative of which condition?

<p>Depression (C)</p> Signup and view all the answers

How does depression typically affect a person's daily life?

<p>Lowers mood and impacts eating, sleeping, feelings, and emotions. (C)</p> Signup and view all the answers

Which of the following is a significant dental consideration when treating a patient with depression?

<p>Potential for xerostomia due to antidepressant medication (A)</p> Signup and view all the answers

Alternating episodes of depression and heightened mood are characteristic of which disorder?

<p>Bipolar disorder (C)</p> Signup and view all the answers

Which of the following behaviors is MOST indicative of the manic phase of bipolar disorder?

<p>Increased risk-taking behavior (D)</p> Signup and view all the answers

What is the PRIMARY characteristic of schizophrenia?

<p>Loss of contact with reality. (C)</p> Signup and view all the answers

Which biological factor is MOST implicated in the etiology of schizophrenia?

<p>Excessive dopamine levels (B)</p> Signup and view all the answers

A patient reports hearing voices and believes that others are plotting against them. This is MOST characteristic of which condition?

<p>Schizophrenia (D)</p> Signup and view all the answers

Which of the following is a potential dental management consideration for patients with schizophrenia?

<p>Difficulty obtaining informed consent and potential communication barriers (A)</p> Signup and view all the answers

Why might providing a complete denture to a patient with schizophrenia be approached with caution?

<p>Dentures may affect speech and swallowing and can be distrusted by the patient. (A)</p> Signup and view all the answers

A patient with schizophrenia is taking anti-psychotic medication. What is a common oral side effect of this medication?

<p>Xerostomia (B)</p> Signup and view all the answers

Flashcards

Generalised Anxiety Disorder (GAD)

A long-term condition characterized by persistent anxiety about a wide range of situations, experienced on most days.

Physical Clinical Features of GAD

Dizziness, Tachycardia, Palpitations, Diarrhoea, Dry mouth, Headaches, Insomnia.

Psychological Features of GAD

Aggression, Lack of concentration, Poor memory, Loss of sleep, Irritability, Feeling restless, Worried, On edge.

Phobia

An irrational and intense fear of a specific object or situation, leading to significant anxiety and avoidance.

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Panic Disorder

Sudden episodes of intense fear or discomfort, accompanied by physical symptoms such as palpitations, sweating, and shortness of breath.

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OCD

Obsessive Compulsive Disorder; Recurring, unwanted thoughts (obsessions) that lead to repetitive behaviors (compulsions).

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Post-Traumatic Stress Disorder (PTSD)

Anxiety disorder that develops after exposure to a traumatic event, involving intrusive memories, avoidance, negative thoughts/feelings, and hyperarousal.

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Anxiety (as a Response)

A normal reaction to perceived threats or changes. A non specific symptom.

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Risk Factors for Anxiety

Include life events, drug misuse, hyper/hypoglycemia, dysrhythmias, increased adrenaline.

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Clinical Features of Anxiety

Tachycardia, Dizziness, Diarrhoea, Dry mouth, Bruxism, Dysphagia, Aggression, Irritation, Poor concentration, Reduced pain threshold, Sleep loss

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Possible Outcomes of untreated Anxiety

Phobias, Obsessive disorders, Panic disorders, Generalised anxiety disorder

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Treatments for Anxiety

Sympathy, Empathy, Reassurance, restoring Patient's control, Sedation, Beta blockers

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Social Anxiety Disorder

Fear of social situations, often leading to avoidance.

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Depression

A mood disorder characterized by a sustained lowering of mood that affects eating, sleeping, feelings, and emotions.

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Clinical Features of Depression

Sustained lowering of mood, Early morning waking, Loss of concentration, Anhedonia, Suicidal thoughts, Loss of appetite, Lack of energy, Reduced libido

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Bipolar Disorder

A mood disorder characterized by alternating episodes of depression and mania (euphoria).

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Clinical Features of Mania in Bipolar Disorder

Episodes of elevation of mood associated with mental and physical overactivity, Bright clothes, Over familiar, Disinhibition, Pressure of speech, Flight of ideas, Grandiose ideas, Risk taking.

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Schizophrenia

A mental disorder characterized by a loss of contact with reality, often involving hallucinations and delusions.

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Clinical Features of Schizophrenia

Hallucinations, Delusions, Thought disorders, Paranoid beliefs, social withdrawal

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Treatment for Schizophrenia

Anti-psychotic medication, Therapy (e.g. CBT), Hospitalisation (if self harm).

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Study Notes

  • Psycho-social conditions include common psychiatric disorders such as anxiety, depression, bipolar disorder, and schizophrenia.

Generalised Anxiety Disorder (GAD)

  • GAD is a long-term condition characterized by persistent anxiousness about a wide range of situations, experienced most days.

Physical Clinical Features of GAD

  • Dizziness
  • Tachycardia (rapid heart rate)
  • Palpitations (heart fluttering or pounding)
  • Diarrhoea
  • Dry mouth
  • Headaches
  • Insomnia

Psychological Features of GAD

  • Aggression
  • Lack of concentration
  • Poor memory
  • Sleep loss
  • Irritability
  • Restlessness
  • Excessive worry
  • Feeling "on edge"

Phobias

  • Characterized by irrational fears of specific objects or situations, triggering severe anxiety.

Panic Disorder

  • Involves episodes of intense anxiety or panic.

Obsessive-Compulsive Disorder (OCD)

  • Defined by recurring, intrusive thoughts that lead to the need to repeatedly perform certain acts.

Post-Traumatic Stress Disorder (PTSD)

  • Anxiety disorder caused by a stressful, frightening, or distressing event.

Anxiety: General Points

  • Anxiety is a psychiatric condition.
  • It is a normal response to threat or unpredictable change in the environment and can manifest as a non-specific symptom.

Risk Factors for Anxiety

  • Positive or negative life events
  • Drug misuse
  • Hyperthyroidism
  • Hypoglycemia
  • Dysrhythmias
  • Increased adrenaline levels

Clinical Features of Anxiety

  • Tachycardia
  • Dizziness
  • Diarrhoea
  • Dry mouth
  • Bruxism (teeth grinding)
  • Dysphagia (difficulty swallowing)
  • Aggression
  • Irritation
  • Poor concentration
  • Reduced pain threshold
  • Sleep loss

Potential Outcomes of Anxiety

  • Phobias
  • Obsessive disorders
  • Panic disorders
  • Generalised anxiety disorder

Treatments for Anxiety

  • Sympathy
  • Empathy
  • Reassurance to patient
  • Giving the patient control
  • Sedation (for very anxious patients)
  • Beta-blockers (muscle relaxants)

Social Anxiety Disorder

  • Fear of social situations.

Depression

  • Sustained depression of mood (a unipolar mood disorder).
  • Lowers mood, affecting eating, sleeping, feelings, and emotions.
  • Prevalence: 400 per 100,000 per year
  • Lifetime expectancy: 10-20%
  • Sex ratio: F:M = 2:1

Clinical Features of Depression

  • Sustained lowering of mood
  • Early morning waking
  • Loss of concentration
  • Anhedonia (inability to experience pleasure)
  • Suicidal thoughts
  • Loss of appetite
  • Lack of energy
  • Reduced libido

Dental Relevance of Depression

  • Alcohol & drug abuse (e.g., paracetamol overdose leading to liver damage)
  • Lowered mood
  • Neglect of oral hygiene, leading to caries and periodontal disease
  • Hallucinations
  • Reduced sexual activity
  • Atypical facial pain
  • Xerostomia (dry mouth) as a side effect of tricyclic antidepressant (TCA) medication

Bipolar Disorder

  • Alternating episodes of depression and euphoria.
  • Onset typically between 20-40 years old.
  • Prevalence: 20 per 100,000 per year
  • Lifetime expectancy: 1%
  • Sex ratio: F:M = 1.3:1

Clinical Features of Bipolar Disorder

  • Episodes of elevated mood associated with mental and physical overactivity
  • Bright clothing
  • Over-familiarity
  • Disinhibition
  • Pressure of speech
  • Flight of ideas
  • Grandiose ideas
  • Risk-taking behaviour

Schizophrenia

  • Psychosis involving a loss of contact with reality.
  • Psychosis characterized by hallucinations, thought disorders, and delusions.
  • Lifetime risk: 1%

Aetiologies of Schizophrenia

  • Genetic factors
  • Imbalance of brain chemicals (dopamine)
  • Brain damage (viral or drug-induced)
  • Structural brain abnormalities

Age of Onset for Schizophrenia

  • 15-35 years old.

Clinical Features of Schizophrenia

  • Hallucinations: perception in the absence of reality (auditory, visual, tactile, gustatory)
  • Delusions: belief in something untrue (persecutory, grandiose, delusions of reference)
  • Thought disorders: insertion, broadcasting, withdrawal
  • Paranoid beliefs, social withdrawal

Treatments for Schizophrenia

  • Anti-psychotic medication
  • Therapy (e.g., CBT)
  • Hospitalization (if self-harm is a risk)

Dental Relevance for Schizophrenia

  • Tranquilizers (anti-psychotics) can cause xerostomia
  • Increased oral hygiene problems = caries and perio
  • Patients might be hard to communicate with
  • Patients might not trust you
  • Oral hygiene instruction may not be effective due to trust issues
  • Treatment is relatively safe
  • Informed consent may be difficult to obtain
  • Dentures might affect speech and swallowing
  • Possible uncontrollable facial movements

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