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a complex, chronic mental disorder
Disturbances in feeling, thinking, and behavior
Major psychotic illness in which the individual may be out of touch with reality
schizophrenia
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Symptoms of schizophrenia
- delusions,
- hallucinations,
- disorganized thinking,
- incoherence
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phases of diseases
- Prodromal: gradual appearance of signs & symptoms
- Active: Positive or negative
- Residual
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marked social isolation ro withdrawal
impairment in role functioning
markedly peculiar behavior
marked impairment in personal hygiene
blunted/inappropriate effect'digressive, vague speech or lack of speech
odd beliefs ro magical thinking
unusual perceptual experiences
lack of initiative, interests, or energy
Prodromal and residual symptoms
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Delusions
hallucinations
disorgaized speech
disorganized or bizarre behavior
catationia
positive symptoms of schizophrenia
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flat affect
lack of voluntary action
speechlessness
no pleasure from events that usually give pleasure
inability to perform goal directed activities
negative symptoms of schizophrenia
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associateed with an excess of dopamine in the brain
schizophrenia
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meds used for schizophrenia do what
block dopamine receptors
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meds don't affect which symptoms much
negative
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types of meds
- Phenothiazines
- butyrophenones
- thioxanthenes
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more effective with negative symptoms
- dibenziazepines
- benzisoxazoles
- olanzapine
- quetiapine
- ziprasidone
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Adverse effects of meds for schizo
- WBC count drops with clozapine
- high risk of agranulocytosis
- dystonia
- dysarthria
- parkinson-like syndrome
- akathisia
- akinesia
- tardive dyskinesia
- anticholinergic effects
- cardiovascular
- sedation
- blood
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Dystonia
- muscle contrations
- laryngeal spasm and coughing
- unable to turn head
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dysarthria
difficult speech
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parkinson-like syndrom
- shuffling gait
- muscular rigidity
- resting tremor
- facial grimacing
- bradykinesia
- cooperation may be difficult
- patient positioning
- insturment positioning; retraction
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akathisia
- restlessness, pacing
- plan short appointments
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akinesia
- loss of voluntary movement
- lethary
- fatigue
- adjust patient positioning
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tardive dyskinesia
- involunatry mouth and jaw movements
- difficulty in instrumentation
- wearing dentures difficult or impossible
- muscle fatigue; may need mouth prop
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anticholinergic effects
- xerostomia
- blurred vision
- dental caries prevention
- fluoride dentifrice
- saliva sub
- difficulty seeing visual aids
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cardiovascular
- postural hypotinsion
- tachycardia
- palpitations
- have patient sit up slowly and wait before standing
- monitor vital signs
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sedation
- drowsiness
- interfere with patien'ts daily routine
- patient may be late; needs reminders
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blood
- reduced leukocytes
- agranulocytosis
- increased suseptibility to infection
- oral candidiasis may be present
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other tx for schizo
psychosocial therapy
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DH care for schizo
- oral implications:
- alcohol/drugs lead to poor periodontal health
- xerostomia leads to rampant caries
- Appt planning: not carried out during exacerbation
- decrease stimulation; create a restful atmosphere, keep music low and soft
- use mouth prop with tartive dyskinesia
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Mood disorders
- Major depressive disorder
- Bipolar
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depressed mood, diminished interest, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation, fatigue, worthlessness, guilt, indecisiveness, lack of concentration, recurring thoughts of death /suicide
major depressive disorder
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tx of major depressive disorder
- – Psychopharmacotherapy
- – Psychotherapy/cognitive behavior therapy
- – Electroconvulsive therapy
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Psychopharmacoherapy
- SSRI (selective serotonin re-putake inhibitors)
- SNRI(serotonin and noradrenergic re-uptake inhibitiors
- tricyclic and heterocyclic antidepressants
- MAOI (monoamine oxidase inhibitors)
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Indications for electroconvulsive therapy
- patient for whom antidepressant meds are contraindicatied
- nonresponsive to meds
- also has delusions
- suicidal/diminished food intake
- need for immediate response (catatonic patient)
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Oral health implications
- Xerostomia,
- high caries risk,
- issues with denture retention,
- infections,
- loss of taste perception
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Appointment interventions
- – Monitor Hx & meds closely, EO/IO, signs of xerostomia
- – Positive reinforcement
- – OHI to patient and caregiver – saliva substitute, fluoride therapy, alcohol free products
- – Use tinted patient eyeware, use local anesthetic,
- be aware of patient and possiblity of hyoptension
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Treatment for bipolar
- –Pharmacotherapy
- –Psychosocial interventions
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meds for bipolar
- benzodiazepine
- anticonvulsants
- antipsychotics
- lithim carbonate (mood stabilizer)
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causes dysgeusia and metallic taste in the mouth
lithium
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Oral health implications
- High risk for caries and perio disease, gingival tissues may appear abraded & lacerated,
- xerostomia,
- dysgeusia (metallic taste),
- stomatitis,
- glossitis, &
- loss of taste.
- Recommend saliva substitutes, daily fluoride therapy, preventive oral care instruction, diet evaluation
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Appointment interventions
- Review Hx and meds,
- simplify surroundings,
- don’t rush patient,
- 3-4 mo. Maintenance appointments,
- use simple instructions
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Postpartum mood disturbances
- postpartum blues
- postpartum depression
- postpartum psychosis
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period of nonpsychotic depression
for a few days after giving birth is not
uncommon. There may be crying, irritability, and mood shifts
blues
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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
Depression
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mood disorder, it may be of a
depressive or manic type
Psychosis
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what is puerperium
6 week period after childbirth when the body undergoes physical and physiologic changes
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risk factors
- Pre-existing mental illness,
- stress,
- conflicts about motherhood,
- marital problems
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Symptoms
- Early:
- Insomnia,
- restlessness,
- tearfulness,
- fatigue,
- emotional instability
- Progressive:
- Confusion,
- irrationality,
- delirium,
- obsessive about baby,
- thoughts of bringing harm to self or baby
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Treatment
- No treatment = risk of suicide or infanticide or both
- Medical care indicated,
- suicidal precautions,
- medications,
- psycohterapy
- extended tx
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Anxiet Disorders
- panic attack
- panic disorder
- posttraumatic stress disorder
- generalized anxiety disorder
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An overwhelming sense of impending doom is the cardinal symptom of the attack
Panic attack
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Recurrent panic attacks that are usually
unexpected
Panic disorder
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An initiating traumatic event has occurred
outside the range of usual human experience
Posttraumatic stress disorder
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is persistent, pervasive anxiety and excessive worry but they are not associated with lifethreatening
fears or “attacks”
Generalized anxiety disorder
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TX of anxiety disorders
- Basic therapeutic approach ( eliminate cafffeine, alcohol and other drugs and add excercise)
- • Cognitive-behavioral therapy
- • Pharmacotherapy
- –Antianxiety medications
- –Antidepressant medication
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antianxiety meds are
benzodiazepines
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side effects of benzodiazepines
- confusion
- dizziness,
- muscle weakness
- difficulty n speaking
- skin rash
- addiction
- withdrawal
- drowsiness
- impaired eye-hand coordination
- xerostomia
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DH care
- Personal Factors:rapid heartbeat, hyperventilation, tightness of throat, constant fatigue
- Oral: hypersensitivity of teeth, xerostomia, caries, biofilm, oral cleanliness may not be present, abrasion from excessive brushing
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Eating disorders
- Anorexia nervosa
- Bulimia nervosa
- Bulimarexia
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