Mental Health Disorders DTH22 Student copy PDF

Mental Health Disorders Miss H Rogers GDC ILOs 1.1.3 Explain general and systemic disease and their relevance to oral health 1.1.11 Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases and the success of treatment 1.2.1 Recognise the importanc...

Mental Health Disorders Miss H Rogers GDC ILOs 1.1.3 Explain general and systemic disease and their relevance to oral health 1.1.11 Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases and the success of treatment 1.2.1 Recognise the importance of and carry out an appropriate systematic intra- and extra-oral clinical examination 1.2.3 Recognise the significance of changes in the patient’s reported oral health status and take appropriate action 1.2.4 Recognise abnormalities of the oral cavity and the rest of the patient and raise concerns where appropriate 1.2.6 Assess patients’ levels of anxiety, experience and expectations in respect of dental care 1.5.3 Plan the delivery of, and carry out, care in the best interests of the patient 1.5.4 Identify where patients’ needs may differ from the treatment plan and refer patients for advice when and where appropriate 1.7.1 Treat all patients with equality, respect and dignity 1.7.2 Explain the impact of medical and psychological conditions in the patient 1.7.4 Manage patient anxiety and pain through effective communication, reassurance and relevant behavioural techniques 1.7.7 Refer to other members of the dental team or other health professionals 1.7.8 Recognise the need for and make arrangements for appropriate follow-up care 1.7.9 Recognise local referral networks, local clinical guidelines and policies 1.10.1 Recognise the responsibilities of the dental team as an access point to and from wider healthcare 1.10.2 Provide patients with comprehensive and accurate preventive education and instruction in a manner which encourages self-care and motivation 1.10.3 Underpin all patient care with a preventive approach that contributes to the patient’s long-term oral health and general health 1.10.6 Describe the health risks of diet, drugs and substance misuse, and substances such as tobacco and alcohol on oral and general health and provide appropriate advice, referral and support 1.11.1 Assess and manage the health of periodontal and soft tissues taking into account risk and lifestyle factors 3.2 Recognise the importance of non-verbal communication, including listening skills, and barriers to effective communication 4.1 Communicate effectively with colleagues from dental and other healthcare professions in relation to the direct care of individual patients, including oral health promotion Aim Gain a brief overview of mental health disorders (MHD) and how they may influence the delivery of dental care Learning Outcomes By the end of this session you should be able to: § Recognise the prevalence of MHD in society and its relationship with other health conditions § Name and briefly explain MHD that may present in a medical history § Recognise any oral findings associated with MDH § Explain how MHD may impact on the delivery of dental care, and it’s management Lecture Outline Part 1- Introduction to Mental Health Disorders Part 2- Types of Mental Health Disorders Part 3- Dental Implications and Management Introduction to Mental Health Disorders Mental Health Disorders- what are they? ‘There are many different mental disorders, with different presentations. They are generally characterized by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others’. – World Health Organisation (2019) And what are their contributing factors? ‘Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one's thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support. Stress, genetics, nutrition, perinatal infections and exposure to environmental hazards are also contributing factors to mental disorders’. – World Health Organisation (2019)  Neurodevelopm Schizophrenia ental Disorders Spectrum and Other Disorders Other Psychotic Disorders Bipolar and Paraphilic Related Disorders Disorders Personality Depressive Disorders Disorders Neurocognitive Anxiety Disorders Disorders Substance Use and Addictive Classifications Obsessive- Compulsive Disorders of MHD and Related Disorders Disruptive, Trauma- and Impulse Control Stressor- and Conduct Related Disorders Disorders Gender Dissociative Dysphoria Disorders Somatic Sexual Symptom Dysfunctions Disorders Feeding and Sleep-Wake Eating Disorders Elimination Disorders Disorders MHD Globally Approximately 13% of the global population (around 971 million people) suffer from some kind of mental health disorder10 Anxiety is the most common mental illness in the world, affecting 284 million people11 An estimated 264 million people are affected by depression, with women being the most affected3 MHD in the UK Mixed anxiety & depression is the most common mental disorder in Britain, with 7.8% of people meeting criteria for diagnosis1 1 in 4 people will experience a mental health problem of some kind each year in England Since the COVID-19 pandemic began, depression rates have doubled (Office of National Statistics)12 MHD and Chronic Illness Those who have a physical health problem are at an increased risk of developing mental health problems; the same is true for the opposite (mental health problems increase the risk of physical health problems) § More than 15 million people - 30% of the UK population - live with one or more long-term conditions, more than 4 million of these people will also have a mental health problem.1 § People with cancer, diabetes, asthma and high blood pressure are at greater risk of a range of mental health problems such as depression, anxiety and PTSD.1 Mental Health and Chronic Diseases CDC Fact Sheet2 MHD are on a spectrum… Types of Mental Health Disorders Anxiety9 It’s a natural human response we feel when worried, tense or afraid, especially when it is about things that are about to happen, or think could happen in the future It becomes a mental health problem if it impacts on a persons ability to live their life as fully as they want to, for example: Avoidance of Feelings of Worries feeling situations that anxiety are very very distressing may cause strong and last a feelings of anxiety or hard to control long time Regularly Fears or worries Hard to go about experiencing are out of daily life or do symptoms of proportion to the enjoyable things anxiety situation Management9 Self-help workbooks Online Cognitive Behaviour Therapy (CBT) Self- programmes eg apps directed CBT Talking Applied Relaxation Therapy Therapies Anti-depressants (SSRIs) Pregabalin Beta-blockers Medication Benzodiazepine tranquillisers Depression 4-10% of people in England will experience depression in their lifetime.1 Can be long lasting or recurrent Can be characterised by: Loss of Feelings of Sadness interest or guilt or low pleasure self-worth Disturbed Poor sleep or Tiredness concentration appetite Individuals may also experience physical complaints with no apparent cause In some cases it may impact a person’s ability to function at work/school, and cope with daily life Management 3 Talking therapies CBT Mild/ Psychotherapy Moderate Medication Moderate/ Anti-depressants Severe Bipolar Disorder3 Affects about 45 million people worldwide Typically consists of both manic and depressive episodes, separated by periods of normal mood. However, individuals may experience manic attacks without the depressive episodes Manic episodes involve: Elevated or irritable Rapid Over-activity speech mood Decreased Inflated self- need for esteem sleep Management 3 Medication Depressive Psychological treatments eg CBT Episode Medication Manic Episode Talking therapies CBT Interpersonal therapy Long term Enhanced relapse prevention Post-Traumatic Stress Disorder (PTSD)9 PTSD may develop after an individual experiences a traumatic event Traumatic events may involve an event where a person feared for their life, witnessing others being hurt, having a job where distressing things are repeatedly seen/heard or surviving a natural disaster Psychological symptoms can include: Reliving Avoiding Panicking when aspects of what Alertness or feelings or Difficult beliefs reminded of the feeling on edge or feelings happened memories trauma Displaying other Being upset Being jumpy or symptoms of easily or angry easily startled anxiety …which can present alongside physical symptoms: Stomach Headaches Dizziness Chest pains aches PTSD can have an impact on aspects of a person's everyday life such as: Remembering Looking after and making Coping with themselves Keeping a job change decisions And can be associated with other mental health disorders: Dissociative Anxiety Depression disorder Suicidal Substance feelings misuse Management 3 CBT Eye movement desensitisation and Talking reprocessing (EMDR) Therapies Paroxetine Mirtazapine Amitriptyline Medication Phenelzine Schizophrenia A severe mental disorder, affecting 20 million people worldwide Characterised by distortions in: Thinking Perception Emotions Sense of Language self Behaviour Psychotic episodes can include hallucinations and delusions It can make it difficult for those affected to work and study normally Management 9 CBT Psychodynamic therapy Talking Family intervention Therapies Antipsychotics Medication Art Music Arts Dance Therapies Drama Obsessive Compulsive Disorder (OCD)7 Affects around 1-2% of the population8 a common mental health condition where a person has obsessive thoughts and compulsive behaviours. There are three elements of OCD: Obsessions Emotions Compulsions There is no clear cause, but there are many factors that may play a role: Differences in Family history the brain Life events Personality Management 3 CBT Talking therapies Selective Dopamine serotonin reuptake blockers: inhibitors (SSRIs): Risperidone Fluoxetine Aripiprazole Medication Sertraline Olanzapine Citalopram Feeding and Eating Disorders Eating disorders affect approximately 16 million people worldwide11 Defined as: “…conditions that involve abnormal eating or feeding behaviours that are not better accounted for by other health conditions and are not developmentally appropriate or culturally sanctioned.”13 Different types: Other specified Binge eating feeding or eating Anorexia Bulimia disorder disorder (OSFED) Avoidant/restrictive food intake disorder Rumination disorder Pica Orthorexia (ARFID) Anorexia Nervosa6 Some common signs of anorexia include: fear of fatness or pursuit of thinness, preoccupation with body weight a distorted perception of body shape or weight Long term affects may include: Heart Osteoporosis Tooth erosion problems Damage to Weakened organs immune (kidneys/liver) system Bulimia/Bulimia Nervosa6 Involves cycles of bingeing and purging Long term affects may include: Damage of Damage of Tooth erosion vocal chords the stomach and throat and intestines Increased risk of heart Kidney damage problems Management6 CBT/CBT-BN Cognitive analytic therapy (CAT) Interpersonal psychotherapy (IPT) Talking Focal psychodynamic therapy (FPT) Therapies Family interventions Evidence based self-help Self- Support groups directed  Autism There are around 700,000 people in the UK with a diagnosis of autistic spectrum disorder Characteristics may include: Finding it hard to Seeming blunt, understand what Anxious about rube or not Finding it hard to Taking things very others are thinking social situations interested in others describe feelings literally and feeling without meaning to Having the same daily routine and Disliking being Noticing smells Avoiding eye touched or close and sounds others feeling anxious if it contact changes contact may not May also experience other conditions such as: Attention deficit Dyslexia and hyperactivity Anxiety Depression disorder (ADHD) dyspraxia Epilepsy Insomnia Management 4 Epilepsy ADHD Anxiety Treatment for Depression associated OCD conditions Dental Implications and Management How do you know? Patient Management Patients should be assessed at each visit, therefore there is no ‘blanket’ management but should be tailored on an individual and appointment basis Build a rapport and trust: Consider the language we use Delivery of message Non-judgemental environment Empathy Support Avoid pre-conceived ideas/stereotyping May be the first person that notices or the first person the patient has confided in – not our job to diagnose but to recognise and raise concern/refer as appropriate Considerations for autistic patients Book appointments at the start or end of the day Consider making a double appointment Offer a visit before the appointment Suggest bringing someone else along with them Have a designated quiet space in the waiting area Ask how you can make things easier 4 Helpful Resources Dental Care and Autism- a guide for dentists Dentistry and autism: parental experiences Going to the dentist – a guide for parents and families Making dental practices more autism-friendly Medical History Medication Side Effects Common medication side effects that may require management: Dry Mouth Altered Taste Vomiting Activity: Have a look on the BNF for the medications below. What side effects can you identify that may have an impact on the oral cavity or on the delivery of dental care? Medication Side Effect Amitriptyline Fluoxetine Risperidone Carbamazepine Lithium Carbonate Additional considerations and their management Smoking, alcohol, substance misuse Tooth wear Oral appearance Caries Reduced Side effects of Self neglect motivation Avoidance medications Nail Biting Bruxism Toothbrush Abrasion Barriers to accessing care Stigma and discrimination Avoidance Socioeconomically disadvantage Isolation Raising concerns If you have concerns regarding your patient, or a patient discloses information to you and you are unsure how to respond, speak with a senior colleague or your safeguarding lead. Summary Don’t forget that MHD may not always present alone but alongside other chronic illnesses which may present their own challenges in patient management MHD can present on a spectrum and their presentation can vary, not only person to person but for one person across time Endeavour to create a non-judgemental safe environment Dental management should be tailored to the patient, not the condition If you have a concern, find out who to speak to in your practice Resources If there are additional resources you think would help with any of the issues covered within this lecture, or wider MHD, then please post in this weeks forum on Moodle. Further Reading UCLH Trust training on mental health- looks at the causes, signs and symptoms of anxiety, depression and stress. https://learning.uclh.nhs.uk/totara/program/required.php?id=1361&useri d=12485 Mental Illness and Oral Health https://www.dentalhealth.org/mental-illness-and-oral-health Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014. https://digital.nhs.uk/data-and-information/publications/statistical/adult- psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of- mental-health-and-wellbeing-england-2014 Caring for dental patients with eating disorders https://www.nature.com/articles/bdjteam20159.pdf?proof=t References 1. https://www.mentalhealth.org.uk/ 2. https://equallywell.co.uk/wp-content/uploads/2018/09/Mental-health-and- chronic-disease.pdf 3. https://www.who.int/news-room/fact-sheets/detail/mental-disorders 4. https://www.nhs.uk/conditions/autism/ 5. https://www.autism.org.uk/ 6. https://www.beateatingdisorders.org.uk/ 7. https://www.nhs.uk/mental-health/conditions/obsessive-compulsive- disorder-ocd/ 8. https://ocdaction.org.uk/ 9. https://www.mind.org.uk/ 10. https://www.theguardian.com/society/2019/jun/03/mental-illness-is-there- really-a-global-epidemic 11. https://www.singlecare.com/blog/news/mental-health-statistics/ 12. https://www.health.org.uk/news-and-comment/news/latest-data-highlights- a-growing-mental-health-crisis-in-the-uk 13. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019- 1327-4 14. https://www.nationaleatingdisorders.org/dental-complications-eating- disorders