2. Tania Herschdörfer
AEGD
• Classification systems for Mental
Disorders (MD)
• Definition
• DSM-5 diagnostic criteria
• Causes of MD
• Statistics and facts of MD
• History
• Behavior management definition
• Important considerations in
behavior management of patients
with MD
• Conclussions
Outline
“The scream” Edvard Munch
3. ICD-10 International
Classification of Diseases
(ICD-11 2018)
DSM-5 Diagnostic and
Statistical Manual of Mental
Disorders
CLASSIFICATION SYSTEMS FOR
MENTAL DISORDERS
WHO (World Health Organization)
APA (American Psychiatric
Association)
4. WHO: “Mental disorders comprise a broad range
of problems, with different symptoms. However,
they are generally characterized by some
combination of abnormal thoughts, emotions,
behavior and relationships with others. Most of
these disorders can be successfully treated”.
MENTAL DISORDERS
Mental disorders WHO defiintion http://www.who.int/topics/mental_disorders/
5. DSM-5: "A mental disorder is a syndrome
characterized by clinically significant disturbance in
an individual's cognition, emotion regulation or
behavior that reflects a dysfunction in the
psychological, biological or developmental
processes underlying mental functioning”.
Mental disorder WHO defiintion http://www.who.int/topics/mental_disorders/
MENTAL DISORDERS
6. DSM-5 DIAGNOSTIC CRITERIA
• Neurodevelopmental disorders (Autism, CP, ID)
• Schizophrenia spectrum and other psychotic disorders
• Bipolar and related disorders
• Depressive disorders
• Anxiety disorders
• Obsesive-compulsive and related disorders
• Trauma and stressor related disorders
• Feeding and eating disorders
• Elimination disorders
• Medication-induced movement disorders and other adverse efects of medication
Armando Reveron
7. • Sleep-wake disorders
• Sexual disfunctions
• Gender dysphoria
• Disruptive, impulse control and conduct disorders (intermittent explosive disorder,
conduct disorder)
• Substance related and addictive disorders
• Neurocognitive disorders
• Personality disorders
• Paraphilic disorders
• Other mental disorders
• Other conditions that may be a focus of clinical attention
DSM-5 DIAGNOSTIC CRITERIA
9. CAUSES OF MENTAL DISORDERS
• Hereditary (genetics)
• More susceptible
• Multiple genes involved
• Interaction between these genes and
other factors (psychologycal trauma and
environmental stresors)
http://www.mayoclinic.org/diseases-conditions/mental-illness/basics/causes/con-20033813
10. CAUSES OF MENTAL DISORDERS
• Biology
• Abnormal balance of neurotransmitters
• Messages may not make it through the
brain correctly
• Defects or injury to certain areas of the
brain
http://www.mayoclinic.org/diseases-conditions/mental-illness/basics/causes/con-20033813
11. CAUSES OF MENTAL DISORDERS
https://www.bu.edu/cte/about/what-is-cte/
12. CAUSES OF MENTAL DISORDERS
• Psychological trauma (as a child) and
environmental stressors
• Severe emotional, phyical or sexual
abuse
• Significant early loss
• Neglect
• Disfunctional family life
• Changing Jobs or schools
• Substance abuse
http://www.mayoclinic.org/diseases-conditions/mental-illness/basics/causes/con-20033813
13. STATISTICS AND FACTS OF MENTAL
DISORDERS
http://www.mayoclinic.org/diseases-conditions/mental-illness/basics/causes/con-20033813
14. HISTORY
A depiction of trephanning from the painting cutting stone (Circa 1494) by Hieronymus Bosch.
15. HISTORY
Cyber Museum of Neurosurgery http://www.neurosurgery.org/cybermuseum/pre20th/treph
5000 B.C.
Supernatural phenomena
Demonic possession treated
with trephanation
17. HISTORY
Ancient Greece
• Stigma attached to
mental illness
• Divine punishment
• Locked up or put to
die
Foerschner, Allison M. “The History of Mental Illness: From ‘Skull Drills’ to ‘Happy Pills’.”(2010).
Drake, Robert E., et al. “The History of Community Mental Health Treatment and Rehabilitation for Persons with Severe Mental Illness.”
Community mental health journal 39.5 (2003): 427-40.
HISTORY
18. HISTORY
Ancient egyptians
• Recreational activities
Leeman, Eve. “Mental Illness: Learning from the Foibles of Earlier Generations.” The Lancet” 351.9100 (1998): 457.
HISTORY
19. Hippocrates
Supersticious
Medical
“Four essential fluids”; blood,
phlegm, bile, and black bile.
Imbalances in the body.
Phlebotomies, bloodletting,
purging, and diets
Changing the occupation and/or
environment of the patient
Leeman, Eve. “Mental Illness: Learning from the Foibles of Earlier Generations.” The Lancet” 351.9100 (1998): 457.
HISTORY
20. Middle Age
• Church
• Supernatural causes
(demonic possession).
Dain, Norman, PhD. “The Chronic Mental Patient in 19th-Century America.” Psychiatric Annals 10.9 (1980): 11,15,19,22.
HISTORY
21. Treatment:
• Persuade the demon out
• Insult the demon.
• Torture the possessed so
that demon would not
want to remain there
• Inmersion in hot water or
sulphur
Dain, Norman, PhD. “The Chronic Mental Patient in 19th-Century America.” Psychiatric Annals 10.9 (1980): 11,15,19,22
HISTORY
22. • First Mental Hospital:
Baghdad (729 BC)
• Aleppo and Damascus
• Mass establishment of
asylums and
institutionalization occured
much later
Leeman, Eve. “Mental Illness: Learning from the Foibles of Earlier Generations.” The Lancet” 351.9100 (1998): 457.
HISTORY
23. Asylums
• Not aimed to help the
mentally ill
• Abandoned or
sentenced by the Law
• Inhumane treatment
• Protect ashamed
families and prevent
disturbances in the
community
Leeman, Eve. “Mental Illness: Learning from the Foibles of Earlier Generations.” The Lancet” 351.9100 (1998): 457.
HISTORY
24. • Early XV centhury
• Madhouses or
asylums
HISTORY
31. • State Psychiatric Hospitals
• MHA 1909
• U.S. Community Mental Health
Centers Act of 1963
• Improve the lives of the mentally
ill in the United States
HISTORY
37. • Deinstitutionalization
• Incapable of living
independently
• Homeless (inadequeate
housing and follow up care)
• 1980s: 1/3 of homeless in
America were considered
severely mentally ill
HISTORY
38. BEHAVIOR MANAGEMENT
Process that guides people to change their
actions within a specific context.
American Academy of Pediatric Dentistry Reference Manual. Clinical Practice Guidelines V 37 / NO 6 15 / 16
39. BEHAVIOR MANAGEMENT
Identifying the negative behavior
changing the environment to reduce
negative behavior
offering positive reinforcement to
encourage desired alternatives
American Academy of Pediatric Dentistry Reference Manual. Clinical Practice Guidelines V 37 / NO 6 15 / 16
40. BEHAVIOR MANAGEMENT
• Medical
• Physical
• Psychological
• Social
• Dental
American Academy of Pediatric Dentistry Reference Manual. Clinical Practice Guidelines V 37 / NO 6 15 / 16
42. BEHAVIOR MANAGEMENT
• Nonpharmalogical and pharma-
logical BGT
• Control anxiety
• Encourage positive dental
attitude,
• Perform quality oral health care
safely and efficiently for infants,
children, adolescents, and
persons with special health care
needs.
American Academy of Pediatric Dentistry Reference Manual. Clinical Practice Guidelines V 37 / NO 6 15 / 16
43. BEHAVIOR MANAGEMENT
• Start with the less
stressful procedure
(unless emergency)
• Talk to
parents/caregivers
• Consistensy
• Positive reinforcement
https://sharklearn.nova.edu/webapps/blackboard/execute/content/file?cmd=view&content_id=_4716379_1&course
44. BEHAVIOR MANAGEMENT
• Modeling and shaping
• Voice control
• One voice
• T-S-D
• Count to 5
• Breaks
https://sharklearn.nova.edu/webapps/blackboard/execute/content/file?cmd=view&content_id=_4716379_1&course
45. BEHAVIOR MANAGEMENT
• Use the least restrictive
behavior technique
• Patient stabilizers
(papoose boards)
• Sedation
• OR
https://sharklearn.nova.edu/webapps/blackboard/execute/content/file?cmd=view&content_id=_4716379_1&course
46. • Wide range of behavior guidance techniques
• Tolerant
• Flexible
• Anticipate reactions
49. BEHAVIOR MANAGEMENT OF
PATIENTS WITH MENTAL
DISORDERS
• Mental development
• Past experiences
• Current emotional status
and level of understanding
• Remain attentive to
physical and or emotional
indicatorr of stress
American Academy of Pediatric Dentistry Reference Manual. Clinical Practice Guidelines V 37 / NO 6 15 / 16
Conversations with Dr. Steven Ellen
51. BEHAVIOR MANAGEMENT OF
PATIENTS WITH MENTAL
DISORDERS
GL (F21)
20 yo at the time of the
comprehensive exam
Psychiatric diagnosis
Schizophrenia
(DSM-5: Schizophrenia
spectrum and other
psychotic disorders)
Homestead
No transportation
54. BEHAVIOR MANAGEMENT OF
PATIENTS WITH MENTAL
DISORDERS
Caregivers and
environment influences
American Academy of Pediatric Dentistry Reference Manual. Clinical Practice Guidelines V 37 / NO 6 15 / 16
Conversations with Dr. Steven Ellen
Calkins, Susan D. et al. (2007). Caregiver Influences on Emerging Emotion Regulation: Biological and Environmental Transactions in Early
Development. Handbook of emotion regulation , (pp. 229-248). New York, NY, US: Guilford Press, xvii, 654 pp.
55. Caregivers and environmental influences
CH
54 yo white non hispanic female
Ex husband and caregiver for comprehensive evaluation
Psychiatric history:
Depression ( DSM-5 Depressive disorders)
Anxiety (DSM-5 Anxiety disorders)
BEHAVIOR MANAGEMENT OF
PATIENTS WITH MENTAL
DISORDERS
56. Missing teeth
Gingiva: edematous and inflamed
Fractured #8, multiple arrested and active
caries.
Patient has been in this Group Home for
the last 4 years.
Caregiver was unaware of the existence of
a lower RPD.
Caregivers and environmental
influences
57. Cancer screen not conclussive/ Lower RPD
Bleeding, heavy calculus, tissue overgrowth about 30 mm extending in the lingual surfaces on the
anterior área.
Caregivers and environmental influences
63. BEHAVIOR MANAGEMENT OF
PATIENTS WITH MENTAL
DISORDERSImportance of detailed
notes
DC (M 28)
Psyciatric history
Autism (DSM-5:
Neurodevelopmental
disorder)
Impaired vision and speech
Breaks, negotiation
Document it!
71. BEHAVIOR MANAGEMENT
• Early preventive care
American Academy of Pediatric Dentistry Reference Manual. Clinical Practice Guidelines V 37 / NO 6 15 / 16
Conversations with Dr. Steven Ellen at SNC NSU 2017.
Calkins, Susan D. et al. (2007). Caregiver Influences on Emerging Emotion Regulation: Biological and Environmental Transactions in Early
Development. Handbook of emotion regulation , (pp. 229-248). New York, NY, US: Guilford Press, xvii, 654 pp.
