Schizophrenia and Antipsychotic Drugs: Relevance to the Dental Practice

Dr. Aviv Ouanounou returns to Oasis Discussions to give us a brief overview of schizophrenia.

Highlights

Schizophrenia affects ~1% of the Canadian and American population and the disease onset is mainly in the late teens and early twenties. This can have a devastating effect, not only, on the patient but, on his/her family as well because of its many social impacts. There is a strong genetic predisposition associate with this disease.

The “dopamine hypothesis” suggests that symptoms of schizophrenia are cause by the overactivity of dopaminergic synapses and prolonged activation of the post-synaptic receptors, but it does not completely explain the disorder as anti-psychotics, which block dopamine quickly, do not offer immediate relief of the symptoms. Instead, the symptoms may take several weeks to subside. As a result, other neurotransmitters such as serotonin, GABA and glutamine may be involved.

Studies involving brain dissections of deceased patients has shown structural and functional abnormalities in areas of the brain associated with mood and thought processes. These include enlarged cerebral ventricles and atrophy of the cortex.

Symptoms of schizophrenia include:
• Hallucinations and delusions
• Severe anxiety, agitation and emotional problems
• Thought disorders
• Insomnia
• Asocial behaviour
• Apathy

Several anti-psychotic medications are used to treat schizophrenia: clozapine, olanzapine and risperidone. Their mechanism of action is primarily to block dopamine and serotonin receptors and they may all lead to different side-effects. The most common side-effect in patients taking these medications for long periods of time is tardive kinesia. A more rare and potentially lethal side-effect is neuroleptic malignant syndrome as a result of excessive blockade of post-synaptic dopamine receptors which is reversed with the administration of anti-Parkinsonian drugs.

Oral Health Impacts of Schizophrenia:
• Increased neglect of oral health and higher incidence of dental caries and periodontal disease
• Poor nutrition
• Drug-induced xerostomia
• Avoidance of dental care, except in emergency situations
• Atypical facial pain
• Burning sensation of the oral mucosa
• TMJ orofacial dyskinesia
• Sialorrhea
• Toothaches as a side-effect of taking risperidone

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