Friedlander Arthur H, Marder Stephen R
VA Greater Los Angeles Healthcare System, Calif 90073, USA.
J Am Dent Assoc. 2002 May;133(5):603-10; quiz 624-5. doi: 10.14219/jada.archive.2002.0236.
Schizophrenia is a psychiatric illness characterized by thought disturbances, bizarre behaviors and cognitive impairments that may diminish a person's abilities in the areas of social relations, school or work and self-care. The onset of the disorder typically occurs between the late teens and mid-30s. Advanced dental disease is seen frequently in patients with schizophrenia for several reasons: the disease impairs these patients' ability to plan and perform oral hygiene procedures; some of the antipsychotic medications they take have adverse orofacial effects such as xerostomia; and these patients sometimes have limited access to treatment because of a paucity of financial resources and adequate number of dentists comfortable in providing care. The recent introduction of more effective medications has permitted the majority of patients to receive their psychiatric care from community-based providers rather than in the hospital. Consequently, dentists in the private sector also are being called on more frequently to care for these people.
Dentists cognizant of the signs and symptoms of schizophrenia are likely to feel more secure in treating patients with schizophrenia and more confident when obtaining consultative advice from the patients' psychiatrists. Dentists usually can provide a full range of services to such patients, can enhance these patients' self-esteem and can contribute to the psychotherapeutic aspect of management.
To effectively provide treatment to patients with schizophrenia, dentists must be familiar with the disease process so that they can communicate effectively with the patient, the treating psychiatrist and family members who serve as caregivers. In addition, dental treatment may need to be modified because of the patient's impaired ability to think logically, the local and systemic effects of psychiatric medications, and adverse interactions between these drugs and medications used in dentistry.
精神分裂症是一种精神疾病，其特征为思维紊乱、怪异行为和认知障碍，这些可能会削弱一个人在社交、学校或工作以及自我照料方面的能力。该疾病通常在青少年晚期至35岁中期发病。精神分裂症患者经常出现严重的牙齿疾病，原因有以下几点：这种疾病损害了这些患者计划和执行口腔卫生程序的能力；他们服用的一些抗精神病药物有不良的口腔面部影响，如口干；而且由于资金匮乏以及缺乏足够数量愿意提供治疗的牙医，这些患者有时难以获得治疗。最近更有效的药物的引入使大多数患者能够从社区医疗服务提供者那里接受精神科护理，而不是在医院。因此，私营部门的牙医也越来越频繁地被要求为这些人提供治疗。
认识到精神分裂症体征和症状的牙医在治疗精神分裂症患者时可能会感觉更安心，并且在向患者的精神科医生寻求咨询建议时会更有信心。牙医通常可以为这类患者提供全方位的服务，可以增强这些患者的自尊心，并且可以在治疗管理的心理治疗方面做出贡献。
为了有效地为精神分裂症患者提供治疗，牙医必须熟悉疾病过程，以便他们能够与患者、主治精神科医生以及作为照料者的家庭成员进行有效沟通。此外，由于患者逻辑思维能力受损、精神科药物的局部和全身影响以及这些药物与牙科使用的药物之间的不良相互作用，可能需要对牙科治疗进行调整。
