Chapter 63: The Patient With a Psychiatric Disorder – Flashcards
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emotion or feeling; tone of reaction to persons and events
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affect
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excessive motor activity, usually not purposeful and associated with internal tension
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agitation
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ability to relieve anxiety or emotional tension, also called antianxiety agent
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anxiolytic medication
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abnormal slowness of movement; sluggish physical and mental responses
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bradykinesia
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no voluntary movement, physical rigidity; fixed position may be maintained for hours
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catatonia
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mental process of comprehension, judgment, memory
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cognitive
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appearance or exacerbation of a mental disorder
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decompensate
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false belief firmly held though contradicted by social reality
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delusion
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loss of cognitive and intellectual functions sufficiently severe to interfere with social and occupational functioning
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dementia
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impairment in uttering words due to diseases that affect oral and pharyngeal muscles
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dysarthria
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electroshock therapy; a form of somatic therapy in which an electric current is used to produce convulsions; primarily used to treat depression
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Electroconvulsive Therapy (ECT)
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feeling of well-being; in psychiatry, abnormal or exaggerated sense of well-being
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euphoria
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false sensory perception in the absence of an actual external stimulus
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hallucination
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a mental impression derived from misinterpretation of an actual sensory stimulus; a false perception
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illusion
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wakefulness; inability to sleep in the absence of noise or other disturbance
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insomnia
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fine, downy hair
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lanugo
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a mental disorder that usually involves the use of unconscious defense mechanisms as a means of coping; individual is not out of touch with reality
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neurosis
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failure to carry out prescribed healthcare plan, for example, failure to take medications as prescribed
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noncompliance
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mental disorder characterized by delusions of persecution
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paranoia
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erosion of enamel and dentin as a result of chemical and mechanical effects
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perimylolysis
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persistent, unrealistic pathologic fear or dread out of proportion to the stimulus from a particular object or situation
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phobia
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a premonitory symptom; a symptom indicating the onset of disease
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prodrome
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a significant major mental disorder that so greatly impairs perception, thinking, emotional response, and/or personal orientation that the individual loses touch with reality
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psychosis
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treatment of emotional, behavioral, personality, and psychiatric disorders by means of individual or group verbal or nonverbal communication with the patient
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psychotherapy
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a medication that alters the mind; the major categories are antipsychotic, antianxiety, antidepressant, and antimanic agents
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psychotropic medication
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involuntary movements of the mouth, lips, tongue, and jaws, usually associated with long-term use of antipsychotic medication
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tardive dyskinesia
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A ______ or _____ disorder is a complex, clinically significant behavioral or psychological syndrome or pattern that is associated with present distress or disability. The causes may be related to behavioral, psychological, or biologic dysfunction in the individual.
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psychiatric mental
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Principles of _____ consent are applied for patients of all ages with mental disorders. Many patients with mental disorders are capable of signing their own consent form.
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informed
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a complex, chronic mental disorder. Disturbances in feeling, thinking, and behavior significantly impair function to a level below normal for the individual
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Schizophrenia
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a major psychotic illness in which the individual may be out of touch with reality. Symptoms include delusions, hallucinations, disorganized thinking, and incoherence
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Schizophrenia
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The onset is usually between the ages of ___ and ___ in males, and 25 and 35 in _____. The onset can be gradual or abrupt. Most people have a slow developing prodromal phase in which there is a gradual appearance of signs and symptoms. Some patients remain chronically ill, while others have periods of remission and recurrence. Although the cause is not understood, genetic factors can make an individual more vulnerable.
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15 and 24 women
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phases of the schizophrenia are described as ____, _____, and _____.
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prodromal, active, and residual
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Rates of alcohol and other drug abuse are _____ among patients with schizophrenia.
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high
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The response to initial treatment of schizophrenia can be a _____ of the long-term prognosis. The prognosis has generally been considered guarded to poor. Evidence shows that although deterioration may occur during the early years, the condition may stabilize with treatment during middle age.
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predictor
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The objectives of treatment are to ____or ______ the delusions, hallucinations, and other symptoms and to enable the patient to function in daily living.
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reduce alleviate
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Conventional antipsychotic drugs are used to block ______ receptors and are effective against positive symptoms with less effect on negative symptoms: phenothiazines (chlorpromazine [Thorazine]); butyrophenones (haloperidol [Haldol]); thioxanthenes (thiothixene [Navane]).
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dopamine
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A side effect of antipsychotic medication that causes involuntary mouth and jaw movements is called what? A) Akathisia B) Dysarthria C) Dystonia D) Tardive dyskinesia
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D) Tardive dyskinesia is the correct answer. Tardive dyskinesia is involuntary mouth and jaw movements, often a side effect associated with antipsychotic medications. All other answers are other possible side effects of antipsychotic medications. Akathisia is restlessness or pacing. Dysarthria is difficult speech. Dystonia is muscle contractions.
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overall degeneration of health factors may have occurred because of neglect of diet, exercise, sleep, general cleanliness, personal grooming, and oral care. Concurrent alcohol and/or other drug abuse, as well as smoking, can influence dental and periodontal health. Xerostomia can lead to an increase in rampant dental caries.
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Oral Implications of Schizophrenia
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Elective dental and dental hygiene treatment is not carried out during an acute exacerbation. Treatment is undertaken when the patient's symptoms are reasonably controlled by medications. If the patient decompensates during a dental or dental hygiene appointment, immediate referral is needed. Telephone numbers of the patient's physicians are kept in an easily accessible location for quick referrals.
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Appointment Planning for Schizophrenia
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Because schizophrenia is often a lifelong disorder, planning for future oral health is essential. Review medical and medication history; analyze drugs for possible side effects, which require appointment modifications. Review consultation notes from the mental health physician relative to medications, alcohol or other substance use, and medical-legal competence for informed consent. Plan a simple routine. For a series of appointments and maintenance, use a familiar, organized routine that is comfortable for the patient. Decrease stimulation; create a restful atmosphere; if background music is present, keep it low and soft. Provide instruction in oral care. Help the patient to improve the level of personal oral care on a daily basis. When applicable, evaluate the patient's personal caregiver for attitude and knowledge and provide information and instruction. Use a mouth prop to assist the patient with tardive dyskinesia. The patient does not have control of mouth movements and can appreciate stability.
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Appointment Interventions
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The primary _____ disorders are major depressive disorder and bipolar disorder.
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mood
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Onset for major depression is usually the mid-20s and is more common in ____ than ____.
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women men
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Bipolar disorder begins about age __ and is equally common in men and women.
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20
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a disturbance marked by apathy, fear, sadness, and loss of mobility and energy
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depression
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Antidepression medications are the primary _______ for individuals with depression. In addition, treatment may include lifestyle changes, correction of sleep disorders, new diet and eating patterns, and exercise, along with counseling and practical psychotherapy. Hospitalization may be indicated when potential danger of suicide or harm to others exists.
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treatment
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Often the initial therapy for depressive illness.
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SSRIs (selective serotonin reuptake inhibitors). Specific products: fluoxetine (Prozac); sertraline (Zoloft); paroxetine (Paxil); fluvoxamine (Luvox)
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____ often a serious side effect of antidepressant drugs.
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Xerostomia
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a major mood disorder in which episodes of varying degrees of mania (elation) and depression occur
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Bipolar disorder
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characterized by excessive elation, hyperactivity, and accelerated thinking and speaking
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Mania
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both pharmacotherapy and psychosocial therapy are used during all phases of the disease
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treatment of bipolar disorder
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Lithium may cause dysgeusia and impart a _____ taste in the mouth.
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metallic
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Dental and dental hygiene appointments usually are _______ until the patient is under medical control.
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postponed
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______- to ______-month maintenance appointments may be needed. Patient instruction may be difficult due to a short attention span. Use direct, simple instructions.
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3 to 4
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A patient with bipolar disorder who takes lithium may complain of: A) bleeding when brushing B) tooth hypersensitivity C) metallic taste in mouth D) sores in the mouth
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C) Metallic taste in mouth is the correct answer. Lithium can cause dysgeusia and impart a metallic taste in the mouth.
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The puerperium is the 6-week period after childbirth when the body undergoes physical and physiologic changes. During the entire ______ period, many physiologic and psychological stresses are related to the changes taking place in the mother's life.
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postpartum
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A period of nonpsychotic depression for a few days after giving birth is not uncommon. There may be crying, irritability, and mood shifts.
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Postpartum Blues
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A moderate to severe depression may begin by the second to third week postpartum. Symptoms include excessive fatigue, insomnia, loss of appetite, and loss of interest and enthusiasm.
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Postpartum Depression
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Postpartum or puerperal psychosis is a mood disorder. It may be of a depressive or manic type.
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Postpartum Psychosis
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Pre-existing mental illness, such as bipolar disorder or schizophrenia. Stress. Conflicts about motherhood, such as unwanted pregnancy; fears about mothering; marital problems.
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Risk Factors for Postpartum Depression
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Early. Complaints of insomnia, restlessness, tearfulness, fatigue, and emotional unsteadiness. Progressive. Confusion, irrationality, delirium, and obsessive concerns about the baby. Thoughts of bringing harm to the baby or oneself are not unusual.
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Symptoms of Postpartum Depression
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experienced as apprehension, tension, or dread that results from the anticipation of danger, the source of which is unknown or unrecognized; the result of feeling a threat to the person's being, self-esteem, or identity
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Anxiety
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an emotional or physiologic response to a recognized source of danger
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fear
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True or False? In normal life, some mild anxiety provides an effective stimulus to improved performance. As a psychiatric symptom, anxiety can be excessive, irrational, and beyond the control of the individual.
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True
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characterized by recurrent panic attacks that are usually unexpected
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Panic disorder
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the fear of being in places or situations from which escape might be difficult or embarrassing or in which help might not be available in the event of a panic attack; the fear is of open spaces, of crowds, or of going outside the home alone and away from a safe place
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Agoraphobia
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An initiating traumatic event has occurred outside the range of usual human experience. It may be destruction to the home or family or may result from a manmade disaster, such as war, imprisonment, torture, rape, or other exposure associated with intense horror, fear, or serious threat to life.
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Posttraumatic stress disorder.
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There is persistent, pervasive anxiety and excessive worry but they are not associated with life-threatening fears or "attacks." It may be complicated by depression, alcohol abuse, or anxiety related to a general medical condition.
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Generalized anxiety disorder.
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Treatment of Anxiety Disorders:
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Basic therapeutic approach Cognitive-behavioral therapy Pharmacotherapy -Antianxiety medications -Antidepressant medication
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Antianxiety medications.
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Benzodiazepines. Adverse effects: potential for addiction, withdrawal symptoms, diminished alertness (drowsiness), impaired eye-hand coordination, xerostomia.
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Oral Implications of Anxiety Disorders
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hypersensitivity of the teeth, related to patient's general tenseness and irritability, may be present
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Question regarding ______ ______ ______ for patients with panic disorder.
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mitral valve prolapse
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Anorexia Nervosa Bulimia Nervosa Bulimarexia
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Eating Disorders
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characterized by a refusal of the individual to maintain body weight over the minimal normal weight for age and height. The aversion to eating results in life-threatening weight loss; involves self-imposed starvation that results from an obsessive desire to be thin and a marked fear of gaining weight.
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anorexia nervosa
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a psychiatric compulsive disorder marked by recurrent episodes of uncontrollable binge eating
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Bulimia nervosa
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The individual with bulimia nervosa tends to be socially ________ and more outgoing in contrast to the person with anorexia.
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extroverted
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the chemical erosion of the tooth surfaces by acid from the regurgitation of stomach contents
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Perimylolysis
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Enlargement may occur for 2 to 6 days after a binge.
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Parotid gland.
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True or False? Do not brush after vomiting. Demineralization of the tooth surface by the acid from the stomach starts immediately on contact. Brushing may abrade the demineralized areas.
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True
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Factors to Teach the Patient
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Significance of daily personal oral care Dental caries prevention Salivary substitutes for xerostomia Causes and effects of enamel erosion Need for fluoride therapies