Severe Mental Illness

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Severe Mental Illness& Oral Health : 

Severe Mental Illness& Oral Health Schizophrenia, Bipolar Disorder & Chronic Depression

Slide 2: 

Fact or Phooey!!

Washington Post 5/19/06 : 

Washington Post 5/19/06

Washington Post 6/12/07 : 

Washington Post 6/12/07

Washington Post 6/12/07 : 

Washington Post 6/12/07

Richmond Times Dispatch 6/10/07 : 

Richmond Times Dispatch 6/10/07

History : 

History

Common IllnessSymptoms : 

Common IllnessSymptoms

Mental IllnessBehaviors : 

Mental IllnessBehaviors

Mental IllnessBehaviors : 

Mental IllnessBehaviors

Slide 11: 

Mental illness takes away…

Major Mental Illnesses : 

Major Mental Illnesses

Schizophrenia is Not… : 

Schizophrenia is Not… A distinct disease Due to flaws in personality A multiple personality From poverty A split personality Demonic Contagious A sociopathic behavior From bad parenting

Schizophrenia is… : 

Schizophrenia is… A chronic, severe & disabling brain disease Characterized by loss of contact with reality Group of symptoms that show wide variations

Prevalence : 

1% percent of the population (20 M people) Prevalence

Prevalence : 

Prevalence More common than MS or MD Males age 17-24 Females age 27-35 Higher percentage in Northern hemisphere born in winter Twice as high in urban areas

Prevalence : 

Prevalence Symptoms universal Better outcome in underdeveloped countries Half of all males hospitalized before age 25 One third of females hospitalized

Family Prevalence : 

Family Prevalence

What Causes Schizophrenia? : 

What Causes Schizophrenia? Genetic/Epigenetic Neurological Environmental

Developmental Origins : 

Developmental Origins

Symptoms : 

Symptoms

Hallucinations : 

Hallucinations

Disorganized Speech &Behavior : 

Disorganized Speech &Behavior

Catatonic Behavior : 

Catatonic Behavior

Negative Symptoms : 

Negative Symptoms 5 A’s Affective flattening Alogia Avolition Autism Anhedonia

Cognitive Impairment : 

Cognitive Impairment

Phases : 

Phases 1st – Prodromal 2nd – Active 3rd – Residual

Prognoses:Better & Poor : 

Prognoses:Better & Poor

Course of Schizophrenia: 10 yrs : 

Course of Schizophrenia: 10 yrs 25% recovered completely 25% much improved 25% improved 15% hospitalized 10% deceased

Course of Schizophrenia: 30 yrs : 

Course of Schizophrenia: 30 yrs 25% recovered completely 35% much improved 15% improved 10% hospitalized 15% deceased

Early ChildhoodOnset : 

Early ChildhoodOnset

Prevention : 

Prevention

Bipolar Disorder : 

Bipolar Disorder Bipolar I Bipolar I mixed Bipolar II Rapid cycling

Bipolar I & Mixed : 

Bipolar I & Mixed

Bipolar II & Rapid Cycling : 

Bipolar II & Rapid Cycling

Prevalence : 

1.2% percent of the population (3 M people) Prevalence

Prevalence : 

Prevalence 6th cause of disability 20-30% first episode before 20 Out of 100,000 teens 2000-3000 have mood disorders; 8-10 teens will commit suicide Recurrent disorder

Family Prevalence : 

Family Prevalence

What Causes Bipolar Disorder? : 

What Causes Bipolar Disorder? Genetic/Epigenetic Biological Neurological Psychological Environmental

Mania : 

Mania

Depression : 

Depression

Prognosis : 

Prognosis ˃ 50% lifelong illness Frequent episodes = future episodes Highest suicide rate Good prognosis = correct diagnosis

Getting a Correct Diagnosis : 

Getting a Correct Diagnosis HIPPA Civil Rights Symptoms overlap Treatment before diagnosis

Bipolar Disorder vs.Psychiatric Disorders : 

Bipolar Disorder vs.Psychiatric Disorders Schizophrenia Anxiety disorders Major depression Asperger’s syndrome ADHD Borderline personality dis. Defiant/conduct disorders Substance abuse disorders

Bipolar vs.Schizophrenia : 

Bipolar vs.Schizophrenia

Treatment: Obstacles : 

Treatment: Obstacles Lack of awareness HIPPA/Civil rights Medical Stigma

Treatment: Hospitalization : 

Treatment: Hospitalization Diagnosis Medication stabilization Personal safety Disorganized behaviors

Treatment: Medication : 

Treatment: Medication Antipsychotics Antiepileptics Mood stabilizers Sleep aids Antidepressants Antihistamines Antianxieties

Treatment: Counseling : 

Treatment: Counseling Cognitive behavioral therapy Psychological therapy Group/family therapy Job coaching

Treatment: Ongoing : 

Treatment: Ongoing Supervised/assisted living Job placement Outpatient care Comorbidity treatment Dual diagnosis programs Nutrition counseling

Treatment: Complementary/Holistic : 

Treatment: Complementary/Holistic

Relapse : 

Relapse

Chronic Depression : 

Chronic Depression

Chronic Depression : 

Chronic Depression

Chronic Depression : 

Chronic Depression

Chronic Depression : 

Chronic Depression

Chronic Depression : 

Chronic Depression

Chronic Depression : 

Chronic Depression

Family Prevalence : 

Family Prevalence

Prevalence : 

Prevalence Major depression rate once in lifetime 40% one episode 60% recurring episode Majority recall symptoms during adolescence Men age 55-70 increased rate

Treatment : 

Treatment Medication Hospitalization Counseling ECT RTMS VNS

Prognosis : 

Prognosis Can have lifelong setbacks Can be well managed with proper medical care and good support system

Severe Mental Illness& Oral Health : 

Severe Mental Illness& Oral Health The Dental Patient

Common OralManifestations : 

Common OralManifestations

Common OralManifestations : 

Common OralManifestations

Lips : 

Lips Herpes lesion Angular chelitis

Buccal Mucosa : 

Buccal Mucosa Friboma Candida albicans

Teeth : 

Teeth erosion decalcification

Tongue : 

Tongue glossitis geographic

Tongue : 

Tongue Black hairy fissured

Slide 73: 

F A C T O R S

Barriers to Dental Care : 

Barriers to Dental Care

MedicationSide Effects : 

MedicationSide Effects

Dental CareConsiderations : 

Dental CareConsiderations

Other CareConsiderations : 

Other CareConsiderations

Saliva:A Precious Body Fluid : 

Saliva:A Precious Body Fluid

Dry MouthProducts : 

Dry MouthProducts

RemineralizationProducts : 

RemineralizationProducts

Prevention &Patient Education : 

Prevention &Patient Education

Dental ServicesNeeded : 

Dental ServicesNeeded State/local govt. Volunteer services Hospital programs

Recovery &Rehabilitation : 

Recovery &Rehabilitation Understanding Acceptance Action

Slide 84: 

National Alliance for the Mentally Ill (NAMI)

Slide 85: 

NAMI 2009 Booth

Slide 86: 

My Goals for Making a Difference

Slide 87: 

What Are Your Goals?

Slide 88: 

In Loving Memory Of Our Beloved Jordan Robert Pence Jan 25, 1984 – Jun 18, 2008

Slide 89: 

Contact info Lisa Knapp, RDH, BS 301-938-5830 lisa91156@aol.com

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