Psychiatric Disorders

Iwan Arijanto, dr., SpKJ, MKes

Psychiatric Disorder Classification PPDGJ III / 1994-2004

Multiaxial Diagnosis
Axis I : Clinical disorders, other conditions that may be a focus of clinical attention Axis II : Personality disorders, mental retardation Axis III: General medical condition Axis IV: Psychosocial & environmental problems Axis V : Global Assessment of Functioning Scale

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

Axis I
F 20 29
Schizophrenia, Schizotipal disorder (axis II), delusional disorder, schizoaffective disorder Psychotic disorder

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

Axis I
F 40 48
Neurotic disorder, Somatoform & Stress related disorder

F 50 59
Behavior syndrome related to physiological disorder & physical factor Psychosomatic disorder

F 99

Unclassified mental disorders

Axis I
F 80 89
Psychological developmental disorder autism

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

Axis II
F 60 - 69
Personality disorder

F 70 - 79
Mental retardation

Schizophrenia
Thought / perceptional distortion Inappropiate/dull affect Clear 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

Schizophrenia Diagnosis
- One or more symptoms :
a. Thought echo, Thought insertion / withdrawl, Thought broadcasting b. Bizzare delusions c. Auditory hallucinations talking about patients behavior

Schizophrenia
- Two or more symptoms within interval
more than 1 month : d. Other hallucinations e. disorganized speech (eg, frequent derailment or incoherence) f. grossly disorganized or catatonic behavior g. negative symptoms, i.e, affective flattening, alogia, or avolition

 Prodromal (weeks months):

Decrease academic / work achievement Decrease social activity Decrease personal hygiene Anxiety Depression Paranoid type Hebephrenic (Disorganised) type Catatonic type Redidual type Undifferentiated type

Schizophrenia

Type :

Delusional Disorder
Nonbizarre delusions of at least 1 month's
duration that cannot be attributed to other psychiatric disorders. With or without auditory hallucination Onset at middle age.

Acute and Transient Psychotic Disorders

Acute 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 Disorder
The 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 Disorder

Criteria 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 / Conversion

Partial / 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 Disorder
recurrent somatic complaints + asking for physical examination even theres no abnormality Somatisation 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. Chest pain, torturing, persistent, without organic / physiologic disorders Psychic stressor background (+)

Somatoform Pain Disorder ( Psychalgia )

-

Mood Disorder Principal symptoms : mood changes

(depression/elation) + appropriate behavior, +/psychotic symptom Chronic relapsing disease Depression : - 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 Health

Patient dental treatment & nursery emotional factors (conscious - unconsious, realistic/unrealistic, rational/irational) related to teeth reflection of fear, anxiety & prejudice to figure of authority attitude 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 gingivitis

Resistency 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 (family support) Sense of well being, Self worth, self care (-) Guilty feeling, anger (rejection, family punishment)

self blame
Self destructive behavior

Adult
Loss of old friend
Morphologic abnormality heavy emotional consequence for the patient (low self-esteem antisocial behavior) therapy : recovered self-esteem Anxiety pratherapy evaluation

Psychiatric Aspects of Some Oral and Dental Pathology

1. Resistency to treatment of oral hygiene
Kebiasaan & didikan higiene oral Symbol of anti authority & rejection of
sexual activity Mental disorder: psychotic, depression, MR, acute anxiety Rationalisation : other lack in self that cause socialization difficulties.

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

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

4. Thumb sucking

Related 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 biting Therapy: 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 abnormality
Social stigma impulsive and asocial behavior corrective action could help patients personality development (decrease anxiety, and low self esteem)

8. Bruxism

Separation
movement in tongue jaw movement of breatfeeding in infant Anxiety contact / pressure within teeth self confidence Anger displacement of restrained anger

9. TMJ (Temporo-mandibular-joint) syndrome

Severe pain change places jaw, teeth,

tongue feel like burning, paraesthesia / electric shock in jaw and head, bad taste, shaky teeth. Previous depression due to threat separation with someone who was very important in patients life.

 The use of symptoms :

- escape from problems. - way to find substitution of missing person

10. Oral pain Patient with complaint of pain without organic origin : a. repression & anger denial emerged from doctor-patient relationship. b. Displacement / escape from certain problem pain : - family support - doctor-patient relationship substitution - disturbed real relationship

c. Fail to control anger / aggresivity to another person hyposensitive to self inflicted pain but hypersensitive to pain caused by other person (dentist)