Neurologic, Psychiatric and Behavioral Disorders PDF

Neurologic, Psychiatric and Behavioral Disorders DH 352- Idalia Velasco RDH, MS Idalia Velasco RDH, MS LIST OF DISEASES/CONDITIONS  Parkinson’s Disease  Down Syndrome  Cerebral Palsy  Autism Spectrum  Multiple Sclerosis Disorders  P...

Neurologic, Psychiatric and Behavioral Disorders DH 352- Idalia Velasco RDH, MS Idalia Velasco RDH, MS LIST OF DISEASES/CONDITIONS  Parkinson’s Disease  Down Syndrome  Cerebral Palsy  Autism Spectrum  Multiple Sclerosis Disorders  Peripheral Neuropathies 1. Autistic disorder  Facial neuropathy 2. Asperger’s syndrome  Trigeminal neuralgia 3. Rett syndrome  Spinal cord injury 4. Childhood disintegrative disorder  Seizures (Epilepsy) 5. Pervasive development  Dementia disorder not otherwise  Alzheimer’s disease specified  Stroke Idalia Velasco RDH, MS LIST OF DISEASES/CONDITIONS  Alcohol Dependence  Substance/Drug Abuse  Anxiety  Panic disorder  Generalized anxiety disorder  Posttraumatic stress disorder (PTSD)  Eating disorder  Depressive disorders  Bipolar disorders  Somatoform disorders  Schizophrenia Idalia Velasco RDH, MS Student Presentations  Parkinson’s Disease- Geraldine Gomez, Jasmine Monterrosa Idalia Velasco RDH, MS Parkinson’s Disease  Cardinal manifestations of Parkinson’s Disease are rigidity, akinesia (impaired muscle movement), and tremor. P. 969 Darby.  Akinesia or bradykinesia (movement slowness) leads to expressionless face, infrequent blinking and posture and gait disturbances.  One of the first noticeable signs is a lack of facial expression and animation, known as “masked face”. Idalia Velasco RDH, MS Parkinson’s Disease Idalia Velasco RDH, MS Parkinson’s Disease  Later stages of the disease , the muscles used in swallowing may work less efficiently causing dysphagia(impaired swallowing).  Food/saliva can collect in the mouth and the back of the throat causing choking and drooling.  Xerostomia induced by medications (xerostomia therapy protocol Box 62.3 p.970 Darby)  Burning mouth syndrome-pulsating and burning pain of the anterior tongue, hard palate, lips, and alveolar ridge. Idalia Velasco RDH, MS Dental Care Management  Caution when adjusting dental chair possible orthostatic hypotension and dizziness caused by medications.  Increase of tremors and postural instability may lead to difficulty performing own self care.  Ultrasonic use???  https://www.youtube.com/watch?v=s7odyUi4M_E Idalia Velasco RDH, MS Cerebral Palsy Idalia Velasco RDH, MS Cerebral Palsy Idalia Velasco RDH, MS Cerebral Palsy  https://youtu.be/cOfUGUNxEqU Idalia Velasco RDH, MS Cerebral Palsy  Reflex responses of Cerebral Palsy Conditions and their Management (Table 62.3)  Abnormal muscle responses or reflexes are often triggered by changing the patient’s head or neck position in the dental chair.  Inform the patient when lowering, raising or tilting the dental chair to prevent a startled reflex.  Level of dexterity must be assessed to develop self-care plan (specially adapted Toothbrushes.)  Fluoride or chlorohexidine may be recommended –rinsing may have to be monitored.  Written instructions should be given to patients and/or caregivers. Idalia Velasco RDH, MS Student Presentations  Multiple Sclerosis: Sabrina Gonzalez and Gina Meza Idalia Velasco RDH, MS Multiple Sclerosis  From Pfizer News  You Tube Video (5 minutes)  https://www.youtube.com/watch?v=M7O78LvrNSQ Idalia Velasco RDH, MS  Multiple Sclerosis Worldwide, more than 2.3 million people have a diagnosis of MS. In the United States a recently completed prevalence study, funded by the National MS Society, has estimated that nearly 1 million people over the age of 18 live with a diagnosis of MS Appears in young adulthood Gradual disease process Risk of ischemic stroke is higher 90% of the time fatigue Different stages of impairment dictates the management of the patient Short morning appointment is recommended. Idalia Velasco RDH, MS Compare and Contrast Parkinson’s Cerebral Palsy Multiple Sclerosis Disease Chronic, non  Autoimmune CNS  Chronic, progressive disorder progressive starts at 20 to 35 progressive years old. neurodegenerati neuromuscular disorder  Myelin sheath ve disorder of destruction of specific dopamine Starts at childhood axons causing multiple production. or birth defect neurologic symptoms.  Usually after age Caused by damage  Impaired vision 50. (maybe the first sign to motor areas of of symptoms)  Motor brain  May have facial pain, disturbances TMJ problem Abnormal muscle (Trigeminal neuralgia)  Resting tremor responses or  Levels of motor  Muscular rigidity reflexes often are impairment will  Bradykinesia determine how to triggered by manage patient in the  Postural changing the chair. instability Morning appointment client’s head or   Morning is advised due to neck position. afternoon fatigue. appointment is advised. Idalia Velasco RDH, MS Amyotrophic Lateral Sclerosis (ALS)  Also known as Lou Gehrig’s disease  Progressive neurodegenerative disease, particularly motor neurons of the brain  Muscle atrophy  Affects speech, eating, movement of limbs, swallowing, and walking.  Ultimately lead to loss of breathing and resultant death.  A person with ALS retains intellectual ability (reasoning, remembering, understanding and problem solving)  Sialorrhea (excessive saliva) – can not control swallowing or closing lips  Need assistance oral care at home as the disease progress for poor dexterity. Idalia Velasco RDH, MS Huntington Disease (HD)  Rare, neurodegenerative disorder within basal ganglia, which controls movement. It also affects the cortex of the brain, which controls thought, perception, cognition, and memory.  Initial recognition by decline of intellectual capacity, emotional disturbances, and rapid, jerky involuntary movements (chorea)  Inheritance due to a genetic mutation. 50 % of chance if a parent with HD.  Symptoms often begins at age 30 to 50  Early, middle and late stages characteristics are different.  No cure available.  Xerostomia common  May need assistance with transfer to dental chair  Upright position  Limit the use ultrasonic scaler due to poor swallowing.  Need assistance oral care at home as the disease progress for poor dexterity. Idalia Velasco RDH, MS Seizures (Epilepsy)Little, p. 535  From Pfizer News  You Tube Video (4 minutes video)  https://www.youtube.com/watch?v=ZdX8vUZB7dc Idalia Velasco RDH, MS Types of Seizures Tonic-Clonic Absence Status Seizures(Grand Mal) Seizures Epilepticus  Most common type Occurs in  Single seizure  Vague prodromal childhood lasting for at symptoms (aura) between 3 and least 20 occurs days before minutes convulsion. 12 years old.  Patient emits “epileptic Brief, 10 to 30  Or Recurrent cry” (caused by spasm seconds generalized of the diaphragmatic seizures muscles.) episodes of without  Tonic (stiffing) altered states of regaining of contractions begins consciousness consciousness first, then the clonic (convulsion) phase Child has no between begins. recollection of seizures.  Loss of bowel and the seizure.  Life threatening bladder control often medical occurs  Does not last more emergency. than few minutes. Idalia Velasco RDH, MS Dental Management  Review Medical History and discuss with the patient or family members.  Seizure history must be discussed: 1) Type of seizure 2) Age and onset of seizure 3) Current and regular use of medications 4) Frequency of physician visits 5) Frequency and date of last seizure 6) Precipitating factors ❖ Review page 535 for managing a seizure within the dental office. 536 Box 27.8 Idalia Velasco RDH, MS DOWN SYNDROME  Chromosomal abnormality occurs 1 out of approximately every 700 births.  Small head and eyes have upward slant and prominent epicanthic folds (the folds of skin that extend from the root of the nose to the median end of eyebrow.  Often has congenital heart disease – may need prophylactic antibiotic premedication for unrepaired congenital heart disease or residual defects. Consult physician!  May have other medical concerns: seizures, autoimmune disorder, diabetes etc.…  High incidence of periodontal disease.  Poor OHI  If the patient is unmanageable, special consideration like general anesthesia may be necessary. Idalia Velasco RDH, MS Autism Spectrum Disorders  Maybe high risk for caries – dental sealants are recommended.  Psychotropic medications may cause xerostomia  Difficulty adjusting new environment and people – may need multiple visit to familiarize the patient to the dental office  Telling- Showing – Doing  Frequent positive reinforcement  Short, clear commands  Caregivers are encouraged to be present  Pharmacologic therapies like nitrous-oxide/oxygen sedation or other medications maybe used. Idalia Velasco RDH, MS  ALZHEIMER’S DISEASE (Young Onset)  Young-onset (also called early-onset) Alzheimer's is an uncommon form of dementia that affects people younger than age 65. About 5% to 6% of people with Alzheimer's disease develop symptoms before age 65. So. if 6 million Americans have Alzheimer's, around 300,000 to 360,000 people have the young-onset form of the disease.  Initial Symptoms ◦ Diminished energy and enthusiasm ◦ Show less interest in subject they previously cherished ◦ May show emotional instability and heightened anxiety levels because the awareness of failing mental functions.  Patient Management ◦ A frightened and frustrated patient may be uncooperative, even combative ◦ Schedule morning appointment ◦ Caregiver should accompany the patient Idalia Velasco RDH, MS Management of Patients with Intellectual Disabilities (Down Syndrome, ASD, Alzheimer Disease)  Determine the mental age vs. chronologic age  Familiarize the patient with their surroundings  Keep the first appointment short  Give explanations slowly.  Tell-Show-Do frequently.  Validate patient’s understanding  Reward the patient with positive behavior  Involve care giver as part of oral hygiene education  Use more visual instruction than auditory instruction Idalia Velasco RDH, MS ANXIETY DISORDERS  Phobias  Panic Attack  Generalized Anxiety Disorders  Posttraumatic Stress Disorders (PTSD) Idalia Velasco RDH, MS Panic Attacks Panic Attack Syndrome  Dr. Phil  YouTube video (6 minutes)  https://www.youtube.com/watch?v=ri_xk2Mw91U Idalia Velasco RDH, MS MOOD DISORDERS. (Chapter 29 Little)  Depressive Disorders ◦ Major depression  Symptoms of depression at least 2 weeks period.  Dysthymia (Chronic depression) ◦ Symptoms lasts at least over 2 years.  Bipolar Disorders ◦ Manic state – euphoric, high and cheerful ◦ Depressed state  Cyclothymia ◦ Rare mood disorder of milder and chronic bipolar disorders Idalia Velasco RDH, MS Schizophrenia  Management  No known etiology ◦ Consultation with the  Typical symptoms: physicians recommended ◦ Hallucinations ◦ Patient’s current status ◦ Delusions ◦ Medications ◦ Disorganized speech ◦ Ability of the patient to ◦ Grossly disorganized or give a valid consent for catatonic (unresponsive) treatment behavior ◦ An attendant or family ◦ Lack of desire and member should accompany motivation the patient. ◦ Social and occupational ◦ Epinephrine must be used functioning is deteriorated with caution in patients taking antipsychotic drugs, it may cause hypotension. Idalia Velasco RDH, MS Management of Neurologic Disorders During Dental Hygiene Appointment  If patient recognize or reveals their medical condition, ask how they manage it (medication? Psychotherapy?)  The mood and anxiety can change anytime during the appointment, and they may be unpredictable, so treat the patient the best you can.  Never take their response or reaction as personal attack. Take them as their conditions.  If their mood, anger, frustrations or fear interferes with the appointment, re-schedule the appointment.  Document their behaviors accurately in the progress notes (SOAP notes). Idalia Velasco RDH, MS REFERENCE  Chapter 60, & 62 of Darby and Walsh, Dental Hygiene Theory and Practice 5th edition, Elsevier 2020  Chapter 27, 28, & 29 Little and Falace’s Dental Management of the Medically Compromised Patient, Elsevier 2018 Idalia Velasco RDH, MS