Psychiatric Disorder

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  • Psychiatric DisordersIwan Arijanto, dr., SpKJ, MKes

  • Psychiatric Disorder ClassificationPPDGJ III / 1994-2004Multiaxial DiagnosisAxis I : Clinical disorders, other conditions that may be a focus of clinical attentionAxis II : Personality disorders, mental retardationAxis III: General medical conditionAxis IV: Psychosocial & environmental problemsAxis V : Global Assessment of Functioning Scale

  • Axis IF 00 09Organic mental disorder behavior & mental disorder due to general medical conditions, head trauma, neoplasm brain dysfuntionF 10 - 19Behavior & mental disorder due to psychoactive substance use

  • Axis IF 20 29Schizophrenia, Schizotipal disorder (axis II), delusional disorder, schizoaffective disorder Psychotic disorder

    F 30 39Mood disorder depression / elation with or without psychotic symptom

  • Axis IF 40 48Neurotic disorder, Somatoform & Stress related disorderF 50 59Behavior syndrome related to physiological disorder & physical factor Psychosomatic disorderF 99 Unclassified mental disorders

  • Axis IF 80 89Psychological developmental disorder autism

    F 90 98Behavior & emotional disorder with onset at child and adolescent

  • Axis IIF 60 - 69 Personality disorderF 70 - 79Mental retardation

  • SchizophreniaThought / perceptional distortionInappropiate/dull affectClear consciousness, intelectual capacity within normal limit. Prevalence 1-1,5% in family, 8% in sibling, 47% identic twins (US)=; highest onset 15-25 years, 25-35 years

  • SchizophreniaDiagnosisOne or more symptoms :a. Thought echo, Thought insertion / withdrawl, Thought broadcastingb. Bizzare delusionsc. Auditory hallucinations talking about patients behavior

  • SchizophreniaTwo or more symptoms within interval more than 1 month : d. Other hallucinationse. disorganized speech (eg, frequent derailment or incoherence)f. grossly disorganized or catatonic behaviorg. negative symptoms, i.e, affective flattening, alogia, or avolition

  • SchizophreniaProdromal (weeks months):

    Decrease academic / work achievementDecrease social activityDecrease personal hygiene AnxietyDepressionType :

    Paranoid typeHebephrenic (Disorganised) typeCatatonic typeRedidual typeUndifferentiated type

  • Delusional DisorderNonbizarre delusions of at least 1 month's duration that cannot be attributed to other psychiatric disorders. With or without auditory hallucinationOnset at middle age.

  • Acute and Transient Psychotic DisordersAcute stressor / 2 mg psychotic symptoms; complete remission within 2-3 months; schizophrenia like 1 month

    1. An acute onset (less than 2 weeks) as the key criterion for the whole group. Acute onset denotes a change within 2 weeks or less from a state without psychotic features to a clearly abnormal psychotic state (not necessarily at its peak severity).2. The presence of typical syndromes. Those include, first, a rapidly changing and variable state called polymorphic, prominent in acute psychoses described in several countries, and, second, the presence of typical schizophrenic symptoms.3. The presence or absence of associated acute stress (within 2 weeks of the first psychotic symptoms).

  • Panic DisorderThe occurrence of three or more panic attacks within a 3-week period. These attacks cannot be precipitated only by exposure to a feared situation, cannot be due to a physical disorder. These attacks must be accompanied by at least four of the following symptoms: dyspnea, palpitations, chest pain, smothering or choking, dizziness, feelings of unreality, paresthesias, hot and cold flashes, sweating, faintness, trembling or shaking.Genetik factor (+)

  • Generalized Anxiety DisorderCriteria for generalized anxiety disorder require the presence of unrealistic or excessive anxiety and worry, accompanied by symptoms from three of four categories:

    (1) motor tension, (2) autonomic hyperactivity, (3) vigilance and scanning, and (4) apprehensive expectation. The anxious mood must continue for at least a month.The diagnosis is not made if phobias, panic disorder, or obsessive-compulsive disorder are present or if the disturbance is due to another physical or mental disorder such as hyperthyroidism, major depression, or schizophrenia. Etiology chronic stress, >

  • Dissociative disorder / ConversionPartial / full loss of normal integration between past memory, identity awareness, & body movement control.Psychogenic related to psychic trauma, unsolved problems. Sudden onset & end, last within weeks months.Dissociative amnesia, dissociative fugue, dissociative stupor, trance, motoric dissociative, dissociative konvulsion, anaesthesia dissociative, sensoric dissociative.

  • Somatoform Disorderrecurrent somatic complaints + asking for physical examination even theres no abnormalitySomatisation Disorder:

    - > , onset young adult age.- family history- Several somatic complaints, change of origin, chronic ( 2 years), fluctuative

  • Hypochondric Disorder

    - = - Preoccupation with the fear of developing a serious disease or the belief that one has a serious disease.Somatoform Pain Disorder ( Psychalgia )

    - Chest pain, torturing, persistent, without organic / physiologic disorders - Psychic stressor background (+)

  • Mood DisorderPrincipal symptoms : mood changes (depression/elation) + appropriate behavior, +/- psychotic symptomChronic relapsing diseaseDepression :

    - Bipolar I,II- Depressive episode- Repeated depressive disorder- Persistant mood disorders (cyclothymic, dysthymic)

  • depressive mood, retardation in thinking, speech and behavior, retardate / agitate psychomotor

    personal hygiene health problem, including dental health

    suicide attempt, dyssomnia (mid and terminal insomnia), decreased weight 5% in a month, negative thought / pessimistic, etc

  • Psychiatric Problems in Dental HealthPatient dental treatment & nursery emotional factors (conscious - unconsious, realistic/unrealistic, rational/irational) related to teeth reflection of fear, anxiety & prejudice to figure of authorityattitude to tooth ache / dentist the influence of psychic factor in oral and dental health aware in therapeutic process

  • Influence of Emotional Factors Saliva

    a.anxiety, fear saliva dry mouth, swallowing problem, taste, cavity risk b.emotional expression (tense, angry) salivation c. emotional inhibition, salivation b & c : fine singer sutherland

  • Endocrine

    emotional conflict pituitary gland metabolism of Ca++, carbohydrate gingivitisResistency to infection

    emotional / psychic problem resistency to infection (depression, weak, fatigue, tense, restlestness,stress) oral infection oral flora

  • Blood circulation

    - anxiety, tense blood flow bleeding tendency- depression blood flow gingival condition

    Chewing & Swallowing

    - final phase of swallowing conscious / unconscious swallowing disorder (globus hystericus etc), nausea, vomitting with psychiatrical background (tense, rejection, aggressivity, hostility)

  • The Psychologic Meaning of Teeth :

    - Related to oral hygiene - Threat of loss of teeth

  • Children

    (+)(-)Oral hygiene awareness Guilty feeling, anger(family support) (rejection, family punishment)Sense of well being,Self worth, self careself blameSelf destructive behavior

  • AdultLoss of old friend

    Morphologic abnormality heavy emotional consequence for the patient (low self-esteem antisocial behavior) therapy : recovered self-esteemAnxiety pratherapy evaluation

  • Psychiatric Aspects of Some Oral and Dental PathologyResistency to treatment of oral hygiene Kebiasaan & didikan higiene oralSymbol of anti authority & rejection of sexual activityMental disorder: psychotic, depression, MR, acute anxietyRationalisation : other lack in self that cause socialization difficulties.

  • 2. Phantom teeth- unable to receive reality lost of teeth and senility process.

    3. Implanted teethcould stimulate the wish to go back to infant phase (regression)

  • 4. Thumb suckingRelated to unsatisfactory oral phase (less experience of breastfeeding, less pleasure)

    sucking time = infants right too early discontinuation of breastfeeding : excessive optimism, narcissism, pessimism, envy, jealousy, excessively dependent and require others to give to them and to look after them

  • Last till age > 4 years bad early rearing.Early intervension, strong, suddenly stuttering, delinquency, enuresis, sticking out the tounge, nail bitingTherapy: the child talk about his/her feeling, good rearing, chewing training (food, drink), social contact & better attention (for lonely child)Residue in adult : smoking, candy chewing, mustache playing.

  • 5. Caries- stress increase of intake (carbohydrate)6. Gingivitis- Need of oral dependency >> + anxiety precipitation : acute anxiety

  • 7. Morphologic abnormalitySocial stigma impulsive and asocial behavior corrective action could help patients personality development (decrease anxiety, and low self esteem)

  • 8. BruxismSeparation

    movement in tongue jaw movement of breatfeeding in infantAnxiety

    contact / pressure within teeth self confidenceAnger

    displacement of restrained anger

  • 9. TMJ (Temporo-mandibular-jo

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