defining the impact of defect or trauma on patients with maxillofacial defect

1. Psychology of maxillofacial
patients
Prepared by: Ammar G. Salem
3rd yr candidate of KBMS

2. Psychological disorders
• Anxiety disorder
• Mood disorders (depression and mania)
• Schizophrenia and others psychotic disorders
• Personality disorders
• Cognitive and dissociative disorders
• Somatoform and factitious disorders
• Substance related disorders.
• Eating disorders
• Impulse control disorders

3. Anxiety disorders
• Involve:
• Excessive apprehension, worry and fear.
• Include:
• Panic disorder
• Experience sudden intense terror and physical symptoms (rapid heartbeat and shortness if
breath)
• Obessive compulsive disorder OCD
• Intrusive thoughts or images (obsession) or feel compelled to perform certain behaviors
(compulsions).
• Post-traumatic stress disorder PTSD
• Re-live traumatic events from past and feel extreme anxiety and distress about the event.
• Social phobia
• Fear of specific object, situation, or activity.
• Generalized anxiety disorder
• Constant anxiety about routine events in live.

4. Mood disorders
• Create disturbance in emotional life.
• Include:
• Depression.
• Frequent and serious complication that follow heart attach, stroke, diabetes and cancer.
• Very treatable.
• Symptoms are: sadness, hopelessness, worthlessness, complaints of physical pain and
changes in appetite, sleep and energy level.
• Mania.
• Abnormally elevated mood marked by exaggerated self-importance, irritability, agitation
and decrease need for sleep.
• Bipolar.
• Person’s mood alternate between extreme mania and depression.

5. Schizophrenia and psychotic disorders
• They lose contact with reality.
• Symptoms:
• Delusions, and hallucinations.
• Disorganized thinking and speech.
• Bizzare behavior.
• Diminished range of emotional responsiveness.
• Social withdrawal.

6. Persontality disorders
• Poor perception of themselves or others.
• low self-esteem or overwhelming narcissism.
• Poor impulse control.
• Troubled social relationships.
• Inappropriate emotional respones.

7. Cognitive and dissociative disorders
• Cognitive Include:
• Delirium.
• Dementia.
• Involve:
• Significant loss of mental funcitoning.
• Impaired memory and difficulty in function (speaking).
• Abstract thinking and ability to identify familiar objects.
• Dissociative include:
• Amnesia
• Disturbed consciousness, memories, identity and perception of environment.
• Dissociative personality disorder.
• Two or more distinct personalities.
• Depersonalization disorder.
• Chronic feeling of being detached from one’s body or mental processes.
• Dissociative fugue
• An episode of sudden departure from home or work with an accompanying loss of memory.

8. Somatoform and factitious disorders
• Somatoform characterized by:
• Physical symptoms cannot be explained by a medical condition or other
mental illness.
• Include:
• Conversion disorder (hysteria): an experience of blindness, deafness or
seizures yet a physician can find nothing wrong with the person.
• Hypochondriasis: constant fear that will develop a serious disease and
misinterpret minor physical symptoms as evidence of illness.
• Factitious disorder include:
• Produce or fake a physical or psychological symptoms in order to receive
medical attention and care.

9. Substance related disorders
• Abuse of drugs, side effects of medications or exposure to toxic
substances.
• They are either behavioral or addicitive rather than mental.
• Drugs include:
• Alcohol.
• Caffeine.
• Nicotine.
• Cocaine.
• Heroin.
• Amphetamines.
• Sedatives.

10. Eating disorders
• Anorexia nervosa: an intense fear of gaining weight and refuse to eat
adequately or to maintain a noraml body weight.
• Bulimia nervosa: repeatedly engage in episodes of binge eating,
followed by self-induced vomiting or the use of laxatives, diuretics, or
other meds to prevent weight gain.

11. Impulse control disorders
• Cannot control an impulse to engage in harmful behavior (explosive
anger, stealing, setting fire, gambling, or pulling out their own hair.
• Mania, schizophrenia and antisocial personality may include
symptoms of impulsive behavior.

12. Psychological changes in maxillofacial patients
• Acquired.
• Congenital.
• Developmental.

13. Acquired defects
• Those who have had ablative cancer surgery or severe trauma.
• A person might express “why me?” and is often faced with possibility
of recurrence, more surgery, chemotherapy or radiotherapy and the
futility of the process.
• Those with smaller defects frequently will be more demanding and
have higher expectations that patients with larger more debilitating
defects.

14. Congenital defects
• They are intuitively understand that they are different from the norm
and may believe that they are genetically damaged or subhuman.
• Might result in family lose their unity due to self-blame and difficulty
to accept the child.
• Person might face multiple sequential surgeries, orthodontics, and
prosthetic procedures over several years in attempt to correct their
defects.

15. Developmental defects
• May not appear readily apparent at first but will ultimately become
so.
• May display emotional responses similar to those with congenital
defects.
• but due to their overtime changing, the patient may or may not learn
to deal with the evolving process.

16. Loss and Grief in MF defects
• A cancer patient or those who have experienced some debilitating
crisis creating a loss.
• This loss can manifest in the form of anxiety, depression, PTSD.
• In any event a cycle of loss, grief and reintegration by the patient and
should be understood by the prosthodontist.

17. Loss
• A state of being deprived of or being without something one has had
and valued.
• Peretz divides loss into four categories:
• Loss of significant person.
• Loss of a part of the self.
• Loss of material objects.
• Developmental loss.

18. Grief
• Involve stages:
• Shock and denial: changes in sleeping, eating, depression, idealized past, risk of suicide if
depression is severe.
• Guilt, anger, and search to find ways to discharge emotional pain: anger is secondary to the
driving feeling of fear of the unknown and unfamiliar, and may abuse some substances.
• Adjustment, acceptance and growth: realize the past had its faults, the future may not be so
bad, acceptance of loss, healthy adjestment, and new life patterns (this stage integration of
the prosthesis is possible.
• It can causse physical illness, poor judgment, weakened inhibition, clouded
intellect, and blurred perception.
• Children grieve their losses openly and a dominant emotion toward loss is anger.
• Due to egocentricity, children can often blame themselves for losses and feel
guilty.

19. Impact of psychological impairments
• Health care provider may focus on the precision of the treatment, the
patient may be more interested in acceptance and reintegration into
society.
• The prosthodontist may sense the patient’s presentation (attitude,
demeanor, appearance, emotional state, mood, manner of speech,
and cognitive processes) the nature of the psychological impairment
and then make the appropriate referral for definitve evaluation.

20. Clinical referral
• Family support
• Support from family and friends can be a great help due to sense of isolation and loneliness
of the patients.
• Patient-centered treatment planning
• The individual will direct the planning process with a focus on what he or she wants and
needs.
• It is highly individualized process according to needs and desires of the individual.
• The person’s choices and preferences should always be considered if not always granted.
• Mental health services
• Before referral, the practitioner should know if their patient at a stage of acceptance of the
MF deficiencies.
• Psychologists are more psychodynamic or individually focused than social worders.
• Psychiatrists are specialized physicians and are the only mental health provider that prescribe
medication.
• Patient support groups

21. Level of care (table)
• Support groups
• Support those who experience trauma.
• Educational groups
• Educate on the trauma or problem area by a trained prof. no tx intention.
• Outpatient therapy
• Psychotherapy to decrease symptoms and coping with life change. Regular appointments.
• Home based treatment
• Psychotherapy for chronic individuals by trained prof. at any time including 24h emergency care.
• Day treatment
• Daily psychotherapy
• Partial hospitalization
• Daily psychotherapy within hospital setting
• Inpatient hospitalization
• Psychiatric for those who are in danger of hurting themselves.