Mental Disorders
Psychiatric Disorders:
Major Depression
Major depression is an affective disorder which is an out ward 
manifestation
of one's feelings or mood. It characterized by prolonged depression of
mood which affects the patient's life.There is a prominent and persistent
loss of interest in and pleasure in daily activities and pastimes.
Major depression is associated with:
- a loss of appetite
- weight loss
- sleep disturbances
- decreased energy
- difficulty with memory
- concentration (easily distracted, indecisive).
- sad appearance
- feelings of worthlessness, hopelessness, and guilt
- thoughts of death or suicide
- poor personal hygiene
Associated oral problems include:
-
poor oral hygiene
-
rampant caries
-
generalized advanced periodontitis
-
oro-facial pain
-
xerostomia
-
poor nutrition, poor diet
Treatment consisits of:
- medications
- psychotherapy
- diet counseling
- exercise
- correction of sleep disturbances
-
electroconvulsive therapy (ECT) occasionally
Psychotropic medications include:
Tricyclic antidepressants:
-
Sinequan (doxepin)
-
Elavil (amitryptiline)
-
Anafranil (clomipramine)
-
Tofranil (imipramine)
-
Etrafon ( perphenazine and amitryptiline)
-
Pamelor (nortryptiline)
MAO inhibitors:
-
Nardil (phenlzine sulfate)
-
parnate ( tranylcypromine sulfate)
Miscellaneous anti-depressants:
-
Prozac (fluoxetine)
-
Desyrel (trazadone)
-
Paxil
Precautions must be taken with patients receiving tricyclic antidepressants.
They may affect the cardiovascular system causing:
- hypotension
- orthostatic hypostension
- tachycardia
- arrythmias
- myocardial infarction
- congestive heart failure
-
xerostomia
Adverse drug interactions may occur between tricyclic antidepressants and;
sedatives, hypnotics, general anesthetics, barbiturates, and narcotics
which could result in severe respiratory depression. There is continuing
debate regarding the use of local anesthetics containing epinephrine; the
pressor effect can be potentiated by tricyclics; always aspirate before
injecting
Precautions must be taken with patients receiving MAO inhibitors; disturbances
in cardiac rate/rhythm may be seen. Do not use a local anesthetic containing
epinephrine or neo-cobefrin this can preceipitate a hypertensive crisis
resulting in CVA, MI or death. Hypotension and xerostomia may be caused
by this drug as well.
Patients undergoing ECT may receive drugs that diminish protective reflexes
that guard against aspiration and should be evaluated for loose teeth,
gross calculus and loose prostheses; a mouthguard may be indicated.
