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R. Reti, D. Findlay (eds.)Oral Board Review for Oral and Maxillofacial Surgeryhttps://doi.org/10.1007/978-3-030-48880-2_21
21. Psychiatric Disease
Major depression disorderSchizophreniaSerotonin syndromeNeurolepticMalignant syndromeBipolar disorderAnorexia nervosaBulimia nervosa
Mood Disorders
Major Depressive Disorder (MDD)
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Depressed mood that lasts at least 2 weeks with a constellation of associated symptoms.
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Signs and symptoms (SIGECAPS mnemonic for remembering associated symptoms):
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Sleep (increased sleep during the day or decreased sleep at night)
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Interest (loss of interest)
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Guilt (feeling of worthlessness)
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Energy (lack of energy – fatigue)
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Cognition/concentration (reduced cognition or difficulty in concentration)
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Appetite (increased or decreased appetite)
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Psychomotor (anxiety or lethargy)
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Suicide (ideation)
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Treatment for MDD
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Psychotherapy – cognitive behavioral therapy.
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Electroconvulsive therapy.
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Antidepressants:
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Selective serotonin reuptake inhibitors (SSRIs) – prevent reuptake of serotonin in the synaptic cleft that increases the amount of serotonin, which enhances neurotransmission, e.g., citalopram, escitalopram, fluoxetine, paroxetine, and sertraline.
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Selective serotonin – norepinephrine reuptake inhibitors (SNRIs) – prevent reuptake of serotonin and norepinephrine in the synaptic cleft that increases the amount of serotonin and norepinephrine, which enhances neurotransmission, e.g., duloxetine, venlafaxine, desvenlafaxine, milnacipran and levomilnacipran.
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Tricyclic antidepressants (TCAs) – prevent reuptake of serotonin and norepinephrine in the synaptic cleft that increases the amount of serotonin and norepinephrine, which enhances neurotransmission, e.g., clomipramine, imipramine, amitriptyline, nortriptyline, and protriptyline.
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Monoamine oxidase inhibitors (MAOIs) – inhibit the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters such as serotonin, epinephrine, and norepinephrine, e.g., isocarboxazid, nialamide, phenelzine, tranylcypromine, bifemelane, moclobemide, pirlindole, rasagiline, and selegiline.
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Bipolar Disorder (aka Manic Depression)
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Mental disorder with periods of depression and mania (elevated mood).
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Signs and symptoms of mania:
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Inflated self-esteem/grandiosity.
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Insomnia.
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Pressured speech.
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Engaging in risky behavior despite consequences (e.g., exuberant shopping, gambling, and engaging in risky sexual behavior).
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Racing thoughts.
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Treatment for Bipolar Disorder
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Patients are usually on an antidepressant and a mood stabilizer.
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Mood stabilizers include lithium, anticonvulsants, and antipsychotics.
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Lithium – alkali metal used for manic management. Lithium may cause diabetes insipidus. Lithium toxicity can manifest as cardiac toxicity (AV blocks, sinus bradycardia, ventricular irritability), seizures, and hypotension. Narrow therapeutic index (0.6–1.2 mmol/L). Avoid steroids and ibuprofen in these patients as these may increase lithium bioavailability.
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Anticonvulsant mood stabilizers
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Carbamazepine
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Valproic acid
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Lamotrigine
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Topiramate
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Antipsychotic mood stabilizers
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Olanzapine
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Serotonin Syndrome
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An adverse drug reaction producing excess serotonergic effects of the central nervous system [1, 2].
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Serotonin syndrome typically occurs shortly after an increase in the dose of a serotonin agonist (a MOI or an SSRI inhibitor) or after the addition of a second serotonergic agent, such as tramadol or dextromethorphan [3, 4].
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Occurs rapidly, normally within 24 hours.
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It is typically characterized by a triad of changes in mental status, neuromuscular activity, and autonomic function.
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It is a clinical diagnosis, as there is no lab test that is confirmatory. Serotonin blood levels do not correlate with clinical symptoms [1].
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Important to rule out infections, cocaine or MDMA abuse, lithium or anticholinergic overdose.
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Symptoms include hypertension, diarrhea, tachycardia, hyperthermia, diaphoresis, ataxia, myoclonus, mydriasis, hallucinations, and confusion.
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Concern for rhabdomyolysis, ventricular arrhythmia, respiratory arrest, and coma.
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