Chapter 58: The Patient with a Mental Disorder

Pharmacotherapy Psychotherapy

2 Treatment options for Bipolar Disorders:

Pharmacotherapy Psychosocial Therapy

2 Treatment options for Schizophrenia:

Restricting type: does not regularly engage in binge-eating or purging behavior (i.e., self-induced vomiting or misuse of laxatives, diuretics, or enemas). Binge-eating/purging type: regularly engages in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

2 Types of Anorexia Nervosa:

Purging type: regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Nonpurging type: uses inappropriate compensatory behaviors such as fasting or excessive exercise, but does not engage in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.

2 Types of Bulimia Nervosa:

Major Depressive Disorder Postpartum Depression

2 Types of Depressive Disorders:

Basic Therapeutic Approach Pharmacologic Treatment Psychotherapy

3 Treatment options for Anxiety Disorders:

Pharmacotherapy Psychotherapy Nutrition Therapy

3 Treatment options for Feeding and Eating Disorders:

Basic Therapeutic Approach Pharmacotherapy Psychotherapy Electroconvulsive Therapy

4 Treatment options for Mood Disorders:

Generalized Anxiety Disorder Obsessive-Compulsive Disorder Panic Disorder Posttraumatic Stress Disorder

4 Types of Anxiety Disorders:

Pica Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Diabulimia Orthorexia Nervosa

6 Types of Feeding and Eating Disorders:

Schizophrenia

A complex, chronic mental disorder. Disturbances in feeling, thinking, and behavior significantly impair function to a level below normal for the individual. Signs and Symptoms Positive symptoms are those that reflect unusual, exaggerated behavior Negative symptoms are associated with disruptions in normal emotions or behaviors and may be mistaken for depression Cognitive symptoms are less obvious and may be difficult to recognize

7%

Anxiety disorders are common with a global prevalence of around ____%. Euro/Anglo countries having prevalence over 10%, suggesting 1 in 10 people have an anxiety disorder.

Women and the average age of onset is mid-20s.

Bipolar disorder is more prevalent in: ON TEST

once a week for 3 months

Bulimia nervosa is a mental disorder marked by recurrent episodes of uncontrollable binge eating that occurs an average of: ON TEST

Anxiety disorders

Dental Hygiene Care: Appointment Interventions for patients with what disorder? - Enhance the patient's sense of control. - Cognitive distraction involves encouraging the patient to think about something besides the dental treatment. - Environmental changes can help reduce anxiety. - Nitrous oxide sedation may be helpful to relax the patient. - Effective pain control is needed. - Appointments are best scheduled in the morning; eliminate unnecessary waiting in the reception area; length of appointment can be minimized and planned to prevent stress. - Be alert to symptoms of a panic attack (Box 58-1), such as sweating or hyperventilation. Allow the patient to sit up and take short breaks.

Feeding and Eating Disorder

Dental Hygiene Care: Appointment Interventions for patients with what disorder? - Recognize that denial of an eating disorder is common. - Be aware answers to medical and personal history questions concerning diet, medications, use of laxatives and diuretics, and weight and weight loss may provide strong suspicions of a feeding or eating disorder. - Assess the nutritional status through use of a dietary assessment. Perimolysis and dental caries prevention strategies include: - Reduction in consumption of cariogenic foods; provide list of suggestions for substitutions. - Improvement in oral self-care. Show use of appropriate brushing and flossing with additional interdental aids if required for biofilm removal. - Clean the tongue. - Avoidance of brushing after vomiting. Demineralization of the tooth surface by the acid from the stomach starts immediately on contact. Brushing may remove additional enamel/dentin. - Remineralization after vomiting with an alkaline rinse of sodium bicarbonate solution to neutralize the acid. Dental hypersensitivity is managed as follows: - Office application of fluoride varnish. - Use fluoride dentifrice at least twice daily. - Daily application of 1.1% neutral sodium fluoride toothpaste or gel. - Avoid acidic foods and beverages. Xerostomia management includes: - Advise sugar-free mints or chewing gum containing xylitol to stimulate saliva flow. - Recommend saliva substitutes. - To reduce problems caused by hypersensitive teeth: choose sugar substitute and acid-free foods and beverages.

Bipolar disorder (BD)

Dental Hygiene Care: Appointment Interventions for patients with what disorder? - Simplify the surroundings; provide a comfortable, calm, and uncluttered environment. - Patient instruction may be difficult due to a short attention span. Use direct, simple instructions.When applicable, help the patient's caregiver to learn procedures for dental caries prevention and periodontal health. - Manage caries and periodontal risk with saliva substitutes, office and home fluoride application, dietary counseling, and sugar-free xylitol gum or mints between meals. >>> Chlorhexidine gluconate mouthrinse may be prescribed for short intervals to reduce caries risk and aid healing after NSPT. - 3-4 month continuing care appointments may be needed.

Depressive disorders

Dental Hygiene Care: Appointment Interventions for patients with what disorder? Assessment - Review consultations with medical/psychiatric specialists caring for the patient. - Intraoral/extraoral examination: check for signs of xerostomia. Approach - Provide positive reinforcement and reassurance. Preventive instruction - Dental biofilm control: Teach patient and caregivers the need for daily measures to preserve the teeth and periodontal tissues. Xerostomia: Manage caries risk with dietary counseling, office and home fluorides, saliva substitutes, and xylitol gum between meals. Implementation of care plan - Profound local anesthesia when needed for pain control. - Provide in-office fluoride treatment after instrumentation. - Use care to prevent postural hypotension. Sit the patient up slowly from a reclined position and have the patient remain seated a few moments before standing.

Bipolar disorder (BD)

Dental Hygiene Care: Oral Implications for patients with what disorder? - Oral hygiene needs are often not a priority to the patient. - Gingival tissues may appear abraded and lacerated because of overzealous toothbrushing with excessive pressure. - Side effects of medications with implications for oral health and dental care include: >>> Xerostomia. >>> Dysgeusia and impart a metallic taste in the mouth (lithium). >>> Stomatitis and glossitis. >>> Loss of taste acuity. >>> Dizziness.

Depressive disorders

Dental Hygiene Care: Oral Implications for patients with what disorder? - Side effects of medications: xerostomia along with poor dietary choices encourages growth of dental biofilm and increases the risk for dental caries. - Omission of general health habits and neglect of oral care make the person susceptible to oral diseases. >>> Adults with a diagnosis of depression were at a 64% higher risk for having six or more teeth extracted. >>> Those with depression are at 37% greater risk of being edentulous. - Taste perception changes may contribute to a diet high in cariogenic foods with high levels of sucrose.

Anxiety disorders

Dental Hygiene Care: Oral Implications for patients with what disorder? - Xerostomia related to medications put the patient at high risk for dental caries. - Individuals with a diagnosis of an anxiety disorders are at higher risk of tooth loss - Individuals with mental health disorders have a 25% higher caries risk. - The odds for periodontal disease in a patient with panic disorder is 3x that of someone without the disorder, but it was not higher in other mental health disorders. - A patient with obsessive-compulsive disorder may perform such excessive, vigorous toothbrushing that gingival and dental abrasion may result.

Feeding and Eating Disorder

Dental Hygiene Care: Oral Implications for patients with what disorder? Dental erosion (perimolysis) - The lingual surfaces of the maxillary anterior teeth appear translucent and glasslike - Restorations in posterior teeth may appear raised because of erosion of the enamel around the margins. Dental caries: an increase in caries incidence is found, particularly in cervical caries. - Demineralization results from pH changes in the saliva, from xerostomia, and from the large quantities of cariogenic foods ingested during binges. Mucosal lesions: - Nutrient deficiencies, especially in the B vitamins, may result in angular cheilitis, glossitis, inflammation of pharynx, and a burning sensation. Periodontal manifestations: - Nutritional deficiencies with inadequate control of dental biofilm due to depression may predispose the patient to gingivitis. Saliva: - The decrease in quantity, quality, and pH of the saliva limits its buffering and lubricating properties. - Dehydration of the oral soft tissues occurs. - Xerostomia is also a side effect of antidepressant medication prescribed for patients with bulimia and anorexia. Hypersensitive teeth: - The loss of enamel and the exposure of dentin results in sensitivity, which can be especially noticeable for the maxillary anterior teeth. Trauma: - The soft palate can be traumatized by fingers, comb, pencils, or toothbrush used to induce vomiting. Pharyngeal trauma is caused by a large food bolus that is swallowed or regurgitated. - Callous formation or scars on fingers or knuckles used for self-induced vomiting may be observed. Parotid gland: - Enlargement may occur for 2-6 days after a binge. - The degree of enlargement increases with the frequency of vomiting. - The gland functions normally and is not sensitive to palpation. Bruxism: - Tooth wear is related to stress and tension. Taste: - Taste perception may be impaired. Temporomandibular joint disorders (TMD): - Self-induced vomiting may cause dislocation or subluxation of the mandibular condyle due to excessive opening and result in symptoms of TMD, including headaches, facial pain, and sensitivity to palpation.

Anxiety disorders

Dental Hygiene Care: Personal Factors for patients with what disorder? - Each type has its own characteristics. - Relationships with other people can be strained. - Physical complaints, such as rapid heartbeat, hyperventilation, tightness in the throat, and constant fatigue, are common.

Depressive disorders

Dental Hygiene Care: Personal Factors for patients with what disorder? - Self-care impairment and lack of motivation negatively impact oral health. - Symptoms not controlled by medication, such as difficulties with memory, may need to be considered when planning dental hygiene care. - Individuals with depression may have poor diet quality such as higher intakes of energy-dense foods that tend to be higher in sugar, which may increase the risk of dental caries and impact healing after periodontal therapy.

Feeding and Eating Disorder

Dental Hygiene Care: Personal Factors for patients with what disorder? Anorexia nervosa - Individuals with anorexia are frequently engaged in excessive exercise and preoccupied with food and weight loss. - Frequently the person is a high achiever and highly motivated scholastically, but may be socially isolated and withdrawn. - Suicide risk is elevated in anorexia. Bulimia nervosa and binge-eating disorder - The patient is well aware that the eating habits are abnormal, and as a result may suffer low self-esteem and guilt feelings.

Bipolar disorder (BD)

Dental Hygiene Care: Personal Factors for patients with what disorder? In a manic episode: - Many patients talk quickly, jump from thought to thought, and have a short attention span.A tendency to argue and become irritable may be apparent. In a depressive episode: - The patient may not be interested in oral self-care and be unmotivated.

at least 1 month

Diagnostic criteria for Pica include persistent eating of nonfood substances such as dirt, clay, starch, gum, or ice for: ON TEST

6 months

For formal diagnosis of an anxiety disorder, the symptoms must be present for at least __________.

Bipolar disorder (BD)

Formerly known as manic-depressive disorder and involves mood changes from extreme highs (mania) to extreme lows (depression).

1 in 5

In a meta-analysis of 175 studies in 63 countries, _______ respondents met the criteria for a common mental disorder in the previous year. - About 29% of respondents had experienced a mental disorder during their lifetime. - Women had higher rates of mood and anxiety disorders - Men had higher rates of substance abuse disorders. - English-speaking countries had the highest lifetime prevalence of mental disorders with North and Southeast Asia among the lowest reported prevalence.

Suicide risk

In the case of depression, one of the first things assessed is:

Suicide

In those with Bipolar disorder (BD), what is a leading cause of death?

1. Inflated self-esteem. 2. Decreased need for sleep. 3. Irritable. 4. Attention gets focused on unimportant activities. 5. Excessive involvement in risky activities. 6. Extreme changes in energy, activity, sleep, and behavior based on the large swings in mood. **Major depressive episode symptoms are the same as those described for depressive disorders.

Manic episode symptoms with Bipolar disorder (BD) include behaviors that are not consistent with the patient's usual behavior including the following.

Anorexia nervosa and people with bulimia who engage in purging behaviors

Medical complications are primarily associated with:_________ - Problems include dehydration, electrolyte imbalance, protein malnutrition, and cardiac arrhythmia. - Self-medications include abuse of laxatives and diuretics, which contribute to gastrointestinal disturbances. - Esophageal tears. - Amenorrhea or menstrual irregularities.

0.3-0.7%

Prevalence of schizophrenia is ______%. - The onset is usually between the age of 16 and 30 years. - Men tend to develop symptoms at an earlier age than women. - About 10%-13% of people with schizophrenia attempt suicide and 4%-6% die as a result of suicide.

once a week for 3 months

Recurrent episodes of binge eating without compensatory behaviors seen in bulimia nervosa at least:

Negative symptoms

Signs and Symptoms of Schizophrenia: Disruptions in normal emotions or behaviors and may be mistaken for depression. Symptoms include: - The individual may have a "flat affect" meaning the person shows no emotion. - Lack of pleasure in activities once enjoyed. Inability to start and carry out tasks. - Little communication even when forced to interact. - These individuals have difficulty with everyday tasks such as oral self-care.

Cognitive symptoms

Signs and Symptoms of Schizophrenia: Less obvious and may be difficult to recognize. Symptoms include: - Poor executive functioning, meaning difficulty with understanding information and using it to make decisions. - Difficulty paying attention. - Challenges with working memory or the ability to use information immediately after it is learned. Prevalence of substance-use disorder (SUD) is high among patients with schizophrenia. - Prevalence of any SUD was approximately 42% with over 27% using illicit drugs, 26% using cannabis, 24% using alcohol, and 7% using stimulants. - Over 60% of patients with schizophrenia use tobacco.

Positive symptoms

Signs and Symptoms of Schizophrenia: Reflect unusual, exaggerated behavior and include: - Hallucinations that may include hearing voices. - Delusions. - Disorganized thinking characterized by the person having difficulty organizing thoughts or connecting them logically. - Movement disorders such as agitated body movements. - May "lose touch" with reality and the symptoms may come and go.

1. Shortness of breath 2. Dizziness, unsteady feelings, or faintness 3. Palpitations or accelerated heart rate 4. Trembling or shaking 5. Sweating (clammy hands) 6. Choking 7. Nausea or abdominal stress 8. Paresthesia (numbness or tingling sensation) 9. Flushes (hot flashes) or chills 10. Chest pain or discomfort 11. Fear of dying 12. Fear of losing control

Symptoms of Panic Attack

1. Depressed mood or loss of interest or pleasure in activities present for at least 2 weeks. 2. Feelings of hopelessness, worthlessness, or guilt. 3. Fatigue and lack of energy. 4. Difficulty with memory and concentration. 5. Appetite disturbance. 6. Insomnia, early-morning wakefulness. 7. Thoughts of suicide.

Symptoms vary between individuals, but common symptoms of a mood disorder include

True

T or F: Anxiety is a normal reaction to stress.

True

T or F: Each disorder has characteristic signs and symptoms.

True

T or F: Individuals with anxiety disorders often have comorbid conditions, including other mental health disorders, hypertension, gastrointestinal issues, thyroid disease, cardiovascular conditions, migraine headaches, allergies, and/or a respiratory disease.

False

T or F: With the current policies of deinstitutionalization, more individuals with mental disorders are NOT seeking dental and dental hygiene care in dental offices and clinics.

200

The American Psychiatric Association has classified more than ______ types of mental disorders in the document Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

4%

The lifetime prevalence of Bipolar Disorder in the United States is approximately _____%. - It is more prevalent in women and the average age of onset is mid-20s. - In those with BD, suicide is a leading cause of death, so they need frequent monitoring by a mental health professional.

0.9%; 0.3%

The lifetime prevalence of Feeding and Eating Disorders range from _____% for women and _____% for men for anorexia nervosa to 1% for bulimia to 2.8% for binge-eating disorder. - Prevalence of other feeding disorders such as pica and rumination disorder is unclear.

Bipolar disorder (BD)

The most costly behavioral health issue in part because of high rates of comorbidities such as anxiety disorder, metabolic syndrome, substance abuse, and attention-deficit disorder.

10-20%

The prevalence of Postpartum Depression is estimated to be _____%.

7.1%; 31%

The prevalence of mood disorders for adults is ______% in the previous 12 months with a lifetime prevalence of nearly _____% in the United States. - Women are more likely to experience mood disorders. - Onset is usually in the mid-20s, but it can occur at any age. - Depression is the leading cause of disability worldwide.

Basic Therapeutic Approach

Treatment for Anxiety & Mood Disorders: Lifestyle modifications include regular physical activity, adequate sleep, and avoidance of drugs and alcohol. - Diagnose and treat other medical and psychiatric problems.

Pharmacologic Treatment

Treatment for Anxiety Disorders: Antidepressants: antidepressants preferred as an initial treatment of anxiety disorders. - Examples include fluoxetine (Prozac), paroxetine (Paxel), and sertraline (Zoloft). Side effects: headache, weight gain, tremor, irritability, and xerostomia. Anxiolytics: These are used only short term because of the risk of dependency. - Examples include benzodiazepines (Valium, lorazepam). These are highly addictive and must be carefully monitored. Side effects: confusion, dizziness, muscle memory impairment, weakness, difficulty in speaking, skin rash, and xerostomia. Beta-blockers: taken on a short-term basis for anxiety, these medication help to relieve the physical symptoms of anxiety such as trembling, shaking, and rapid heartbeat.

Psychotherapy

Treatment for Anxiety Disorders: Cognitive behavioral therapy (CBT) - CBT is a combination of strategies to address the cognitive, behavioral, and emotional components of the anxiety disorder. - May be conducted in individual or group sessions. - Support groups are also helpful. Prolonged exposure (PE) therapy - PE therapy is used in treatment of PTSD and gradually exposes an individual to the traumatic event in a safe way and helps them to cope with their feelings. Cognitive processing therapy (CPT) - CPT is also used to treat PTSD and helps people to make sense of the traumatic event they experienced.

Psychotherapy

Treatment for Bipolar Disorder: Cognitive behavioral therapy helps patients to learn to change harmful or negative thought patterns and behaviors. Family-focused therapy improves communication and coping strategies to aid in early recognition of manic or depressive episodes. Interpersonal and social rhythm therapy (IPSRT) is typically used in conjunction with other psychotherapies and is helpful in the maintenance phase of BD. IPSRT focuses on helping individuals to maintain consistent daily routines to promote stability in mood. - If a patient was undergoing IPSRT, inclusion of oral hygiene procedures in the daily routines may be helpful in encouraging regular oral self-care. Psychoeducation educates the patient and family about BD and coping strategies.

Pharmacotherapy

Treatment for Bipolar Disorder: Mood stabilizers Example: lithium. Side effects: xerostomia, restlessness, joint and muscle pain, salivary gland swelling, indigestion, and bloating. Atypical antipsychotics Sometimes used in conjunction with antidepressants. Examples: quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa), and aripiprazole (Abilify). Side effects: dizziness, blurred vision, rapid heartbeat, skin rashes, and drowsiness. Antidepressants Usually taken with a mood stabilizer. Example: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin).

Pharmacotherapy

Treatment for Depressive Disorders: Antidepressants are preferred as an initial treatment. However, they take 2-4 weeks to reach therapeutic levels. Selective serotonin reuptake inhibitors - Advantages: tolerability better than earlier drugs; better compliance; safety in overdose. Examples: fluoxetine (Prozac), paroxetine (Paxel), and sertraline (Zoloft). Serotonin and noradrenergic reuptake inhibitors Examples: duloxetine (Cymbalta) and venlafaxine (Effexor). Dopamine norepinephrine reuptake inhibitor Example: bupropion (Wellbutrin). Monoamine oxidase inhibitors - Use is restricted to patients who do not respond to other medications due to drug-drug and drug-food interactions. Example: phenelzine and tranylcypromine. Alternative therapies St. John's Wart may be used by some patients, but the evidence is not strong for its effectiveness and there are potential drug interactions, so patients should be encouraged to consult with their mental health provider.

Psychotherapy

Treatment for Depressive Disorders: Combined with pharmacotherapy is more effective than either one alone for treating depressive disorders. Cognitive behavioral therapy (CBT) Problem-solving therapy Psychodynamic therapy Interpersonal psychotherapy

Electroconvulsive Therapy

Treatment for Depressive Disorders: Used in severe major depression disorder when pharmacologic therapy and psychotherapy have not been effective. It is also indicated in situations where an immediate response is needed, such as for someone who is suicidal. - Patient may experience confusion and short-term memory loss. - May have cardiovascular side effect and is contraindicated in patients with a history of cardiac arrhythmia or recent myocardial infarction.

Pharmacotherapy

Treatment for Feeding and Eating Disorders: Antidepressants (primarily in bulimia nervosa) Example: fluoxetine (Prozac). Side effects: - Headache - Weight gain - Tremor _ Irritability - Xerostomia

Nutrition Therapy

Treatment for Feeding and Eating Disorders: Registered dietitian nutritionists with advanced training in eating disorders work as part of the interprofessional team to conduct a full nutrition assessment, diagnosis, and individualize a plan for medical nutrition therapy in collaboration with the team. - This in-depth type of nutrition counseling is beyond the scope of practice for dental professionals.

Psychotherapy

Treatment for Feeding and Eating Disorders: The goal of therapy is to help the individual discover the underlying causes of the problems and source of the disordered eating behavior. Cognitive behavioral therapy is the first line of treatment in bulimia nervosa and diabulimia. Interpersonal therapy. Family-based therapy is recommended for younger patients.

Pharmacotherapy

Treatment for Schizophrenia: Typical antipsychotics Used to block dopamine receptors and are effective against positive symptoms with less effect on negative symptoms. Examples: chlorpromazine (Thorazine), haloperidol (Haldol), and perphenazine (Etrafon, Trilafon) Side effects: - Xerostomia - Persistent muscle spasms - Tremors, and restlessness - Long-term use can lead to tardive dyskinesia (uncontrolled muscle movements), which commonly happens around the mouth. Atypical antipsychotics Developed in the 1990s and are second-generation antipsychotics: Examples: clozapine (Clozaril), quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa), and aripiprazole (Abilify). Side effects: - Xerostomia - Dizziness - Blurred vision - Rapid heartbeat - Skin rashes - Drowsiness.

Panic Disorder

Types of Anxiety Disorders: Characterized by sudden and repeated episodes of extreme fear. Symptoms center on panic attacks: - May be unexpected (uncued) or "situationally bound" (cued). A situationally bound panic attack invariably results from exposure to a specific trigger, such as the dental office. - Fear of being out of control during a panic attack. - Physical symptoms during an attack may include pounding or racing heart, sweating, difficulty breathing, chest pain, or dizziness

Posttraumatic Stress Disorder

Types of Anxiety Disorders: Develops after a terrifying ordeal involving physical harm or threat of physical harm. - Onset may be triggered by destruction to the home or family or may result from a manmade disaster, such as war, imprisonment, torture, rape, physical or sexual abuse, or other exposure associated with intense fear or serious threat to life. Signs and symptoms include: - Flashbacks of the traumatic experience and terror may be triggered by a stimulus that can be readily associated with the original event. - Dreams or recollections may cause the individual to feel they are reliving the event. - Avoidance of places, events, or objects that are reminders of the triggering event.Loss of interest in activities that were enjoyable in the past. - Hyperarousal symptoms including feeling tense, difficulty sleeping, angry outbursts, and may be easily startled. - In children, symptoms may be slightly different and include bedwetting, acting out the scary event during playtime, or being unusually clingy to a parent or other adult. Risk factors may include: - Living through a dangerous or traumatic event. - A history of mental illness or substance abuse. Resilience factors include: - Seeking out support either formal or informal from family and friends. - A positive coping strategy. - Ability to function despite feelings of fear.

Obsessive-Compulsive Disorder

Types of Anxiety Disorders: Frequent upsetting thoughts (obsessions), and when the individual tries to control them, there is an overwhelming urge (compulsion) to repeat routines or rituals over and over. Symptoms include: - Spend at least 1 hour a day with obsessive thoughts and rituals that cause distress and interfere with normal daily functioning. - Thoughts or obsessions might include fear of germs, dirt, or intruders. - Rituals might include washing hands, locking and unlocking doors, or keeping unneeded items (hoarding).

Generalized Anxiety Disorder

Types of Anxiety Disorders: Persistent, pervasive anxiety and excessive worry, but are not associated with life-threatening fears or "attacks." - May be complicated by depression, alcohol abuse, or anxiety related to a general medical condition. Symptoms include: - Feeling restless, on-edge, irritable. - Difficulty falling and staying asleep. - Difficulty concentrating. - Muscle tension.

Postpartum Depression

Types of Depressive Disorders Many physiologic and psychologic stresses are related to the changes taking place in the mother's life. Moderate-to-severe depression within the first month postpartum Postpartum depression (PPD) tends to peak at 2-6 months after delivery. The prevalence of PPD is estimated to be 10%-20%. Recent research suggests that fathers can also experience paternal PPD in the first 6 months after birth of the baby with prevalence rates of about 10%. It is critical to identify women with PPD because it can lead to negative mother-infant bonding and interactions that include maternal withdrawal, disengagement, and abuse. - The mother may be less likely to engage in preventive care and is less responsive to providing care to the infant; this may include engaging in appropriate feeding practices and oral health care for the infant/children. PPD may impact developmental milestones such as cognitive scores and nonverbal communication of the infant/toddler. Infants may also exhibit increased dysregulation of sleep and feeding. - Negative infant behaviors are also typical including excessive infant crying and fusiness.

Major Depressive Disorder

Types of Depressive Disorders Transient depressed moods occur in the lives of most people. - Interferes with daily life. - Sadness over unforeseen tragic events, illnesses, death, or disappointments in career or other life plans can cause depressed feelings. Some individuals experience only one episode in their lifetime, but it is more common to have multiple episodes.

Bulimia Nervosa

Types of Feeding and Eating Disorders: A mental disorder marked by recurrent episodes of uncontrollable binge eating that occurs an average of once a week for 3 months. - Two types of compensatory behaviors are seen in individuals known as the purging type and the nonpurging type Purging type: regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Nonpurging type: uses inappropriate compensatory behaviors such as fasting or excessive exercise, but does not engage in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Characteristics 1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: >> Eating, within any 2-hour period, an amount of food larger than most people would eat in a similar period of time. >> A sense of lack of control over eating during the episode, for example, a feeling that one cannot stop eating or control what or how much one is eating. 2. Recurrent inappropriate behavior to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas; fasting; or excessive exercise. 3. Self-evaluation is unduly influenced by body shape and weight. Signs and symptoms include - Normal body weight or slightly overweight is typical, in contrast to the thin anorectic person. - Comorbidity with other mental disorders is common, especially depression and BDs. - Lifetime prevalence of alcohol or substance abuse is 30% for people. - Chronically inflamed and sore throat. - Swollen salivary glands. - Enamel erosion and dentin hypersensitivity due to frequent exposure to acid gastric fluids. - Severe dehydration may result from purging. - Food consumed during a binge include 65% breads/pasta, 56% sweets, and 40% salty snacks, which may be more cariogenic.

Anorexia Nervosa

Types of Feeding and Eating Disorders: 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. - Has the highest mortality rate of any mental disorder. Commonly begins in adolescence or young adulthood. Types: Restricting type: does not regularly engage in binge-eating or purging behavior (i.e., self-induced vomiting or misuse of laxatives, diuretics, or enemas). Binge-eating/purging type: regularly engages in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Signs and symptoms include: - Refusal to maintain body weight over a minimally normal weight for age and height. - Intense fear of gaining weight or becoming fat, even though underweight. - Disturbance in the way in which one's body weight or shape is experienced. - Denies the seriousness of the current low body weight. - Amenorrhea (missed menstrual periods). - Restriction of energy intake resulting in severe weight loss with emaciation; "waiflike" appearance. - Body image distortion - Purging by vomiting, laxatives, and excessive exercise. - Malnutrition can have long-term impact on bone mineral density (osteopenia or osteoporosis). - Vital signs: low pulse rate, hypotension, decreased respiratory rate, and low body temperature. - Metabolic changes: gastrointestinal, cardiovascular, hematologic, and renal system disturbances.

Orthorexia Nervosa

Types of Feeding and Eating Disorders: Characterized by pathologic or disordered healthy eating with a focus on the quality of food choices resulting in negative effects on health. - This condition is not recognized by the American Psychiatric Association in the DSM-5 and did not appear in the peer-reviewed literature until 2004. Proposed diagnostic criteria include: - Compulsive behavior or preoccupation with restrictive dietary practices believed to promote health. - Dietary restriction tends to escalate over time with elimination of entire food groups and may engage in "cleanses" (partial fasts) to detoxify. - Violation of dietary restriction causes anxiety and shame. - Malnutrition or medical complications from the restricted diet. - Impairment of social, academic, and/or vocational functioning.

Pica

Types of Feeding and Eating Disorders: Consumption of nonfood items typically occurs in children, but it also common in adults, particularly those with mental disorders and/or intellectual disabilities. Diagnostic criteria include: - Persistent eating of nonfood substances such as dirt, clay, starch, gum, or ice for at least 1 month. - Consumption of nonfood items may replace healthy foods and lead to nutrient deficiencies that can impact immune response and healing.

Diabulimia

Types of Feeding and Eating Disorders: Defined as the restriction or omission of insulin in an individual with type 1 diabetes mellitus (T1DM) in order to lose or prevent weight gain. - This condition has been documented since the 1970s, but there are no recognized diagnostic criteria in the DSM-5. - Most often seen in adolescent and young women. - These individuals are at increased risk of microvascular complications such as renal failure, neuropathy, heart attack, stroke, and death. Signs and symptoms include: - Rapid weight loss. - Obsession with body size and shape and dissatisfaction with body image. - Ketone or "fruity" smell. - Persistent high hemoglobin A1c. - Eating behaviors similar to bulimia nervosa. - Frequent emergency rooms visits or admission for diabetic ketoacidosis.

Binge-Eating Disorder

Types of Feeding and Eating Disorders: Recurrent episodes of binge eating without compensatory behaviors seen in bulimia nervosa at least once a week for 3 months. Signs and symptoms include: - Occurs in normal weight, overweight, and obese individuals. - Associated with feeling embarrassed or guilty about how much one is eating. - Comorbid disorders include mental health disorders such as bipolar, depressive, and anxiety disorders. - Eating large amounts of food quickly in a short time. - Eating alone or in secret. - Frequent dieting.

Person-first language

Used to refer to someone with a mental disorder, chronic disease, or disability. The person is emphasized first and not the disorder, disease, or disability. For example, refer to the patient as "an individual with schizophrenia," not as "a schizophrenic."

Cognitive behavioral therapy (CBT) Prolonged exposure (PE) therapy Cognitive processing therapy (CPT)

What 3 Psychotherapy tx is rec. for Anxiety Disorders?

Cognitive behavioral therapy Family-focused therapy Interpersonal and social rhythm therapy (IPSRT) Psychoeducation

What 4 Psychotherapy tx is rec. for Bipolar Disorders?

Cognitive behavioral therapy (CBT) Problem-solving therapy Psychodynamic therapy Interpersonal psychotherapy

What 4 Psychotherapy tx is rec. for Depressive Disorders?

Cognitive behavioral therapy is the first line of treatment in bulimia nervosa and diabulimia. Interpersonal therapy. Family-based therapy is recommended for younger patients.

What 4 Psychotherapy tx is rec. for Feeding and Eating Disorders?

Typical antipsychotics Atypical antipsychotics

What are the 2 Pharmacologic Treatment options for Schizophrenia?

Antidepressants (fluoxetine (Prozac), paroxetine (Paxel), and sertraline (Zoloft)). Anxiolytics (benzodiazepines (Valium, lorazepam)). Beta-blockers

What are the 3 Pharmacologic Treatment options for an anxiety disorder?

Mood stabilizers (lithium) Atypical antipsychotics (quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa), and aripiprazole (Abilify). Antidepressants (fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin).

What are the 3 Pharmacologic Treatment options for an bipolar disorder?

Selective serotonin reuptake inhibitors (fluoxetine (Prozac), paroxetine (Paxel), and sertraline (Zoloft). Serotonin and noradrenergic reuptake inhibitors (duloxetine (Cymbalta) and venlafaxine (Effexor). Dopamine norepinephrine reuptake inhibitor (bupropion (Wellbutrin). Monoamine oxidase inhibitors (phenelzine and tranylcypromine.)

What are the 4 Pharmacologic Treatment options for a depressive disorder?

Anxiety disorders

What are the most common class of mental disorders in the general population?

Genetic

What factor are strong contributors to risk for schizophrenia?

Depression

What is the leading cause of disability worldwide?

Antidepressants

Which Pharmacologic Treatment option for Feeding and Eating Disorders? (primarily in bulimia nervosa) Example: fluoxetine (Prozac). Side effects: - Headache - Weight gain - Tremor _ Irritability - Xerostomia

Typical antipsychotics

Which Pharmacologic Treatment option for Schizophrenia? Used to block dopamine receptors and are effective against positive symptoms with less effect on negative symptoms. Examples: chlorpromazine (Thorazine), haloperidol (Haldol), and perphenazine (Etrafon, Trilafon) Side effects: - Xerostomia - Persistent muscle spasms - Tremors, and restlessness - Long-term use can lead to tardive dyskinesia (uncontrolled muscle movements), which commonly happens around the mouth.

Mood stabilizers

Which Pharmacologic Treatment option for a Bipolar disorder (BD)? Example: lithium. Side effects: - Xerostomia, - Restlessness - Joint and muscle pain - Salivary gland swelling - Indigestion - Bloating

Atypical antipsychotics

Which Pharmacologic Treatment option for a Bipolar disorder (BD)? Sometimes used in conjunction with antidepressants. Examples: quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa), and aripiprazole (Abilify). Side effects: - Dizziness - Dlurred vision - Rapid heartbeat - Skin rashes, and drowsiness.

Antidepressants

Which Pharmacologic Treatment option for a Bipolar disorder (BD)? Usually taken with a mood stabilizer. Example: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin).

Selective serotonin reuptake inhibitors

Which Pharmacologic Treatment option for a Depressive Disorder? Advantages: tolerability better than earlier drugs; better compliance; safety in overdose. Examples: fluoxetine (Prozac), paroxetine (Paxel), and sertraline (Zoloft).

Dopamine norepinephrine reuptake inhibitor

Which Pharmacologic Treatment option for a Depressive Disorder? Example: bupropion (Wellbutrin).

Serotonin and noradrenergic reuptake inhibitors

Which Pharmacologic Treatment option for a Depressive Disorder? Examples: duloxetine (Cymbalta) and venlafaxine (Effexor).

Monoamine oxidase inhibitors

Which Pharmacologic Treatment option for a Depressive Disorder? Use is restricted to patients who do not respond to other medications due to drug-drug and drug-food interactions. Example: phenelzine and tranylcypromine.

Antidepressants

Which Pharmacologic Treatment option for an anxiety disorder? Preferred as an initial treatment of anxiety disorders. - Examples include fluoxetine (Prozac), paroxetine (Paxel), and sertraline (Zoloft). Side effects: - Headache - Weight gain - Tremor - Irritability - Xerostomia

Beta-blockers

Which Pharmacologic Treatment option for an anxiety disorder? Taken on a short-term basis for anxiety, these medication help to relieve the physical symptoms of anxiety such as trembling, shaking, and rapid heartbeat.

Anxiolytics

Which Pharmacologic Treatment option for an anxiety disorder? These are used only short term because of the risk of dependency. - Examples include benzodiazepines (Valium, lorazepam). ***These are highly addictive and must be carefully monitored. Side effects: - Confusion - Dizziness - Muscle memory impairment - Weakness - Difficulty in speaking - Skin rash - Xerostomia

Anorexia Nervosa

Which mental disorder has the highest mortality rate?