Everett MSc / Dennis / Ricketts Physiotherapy in Mental Health

A Practical Approach
1. Auflage 2013
ISBN: 978-1-4831-4183-1
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 440 Seiten

Physiotherapy in Mental Health: A Practical Approach provides a concise discussion of the concept of abnormal behavior. The title also covers the role of physiotherapy in dealing with mental problems. The first part of the text covers the basic aspects of physiotherapy in mental health setting; this part covers psychiatric illness; communication in the clinical mental health setting; and the evaluation of physiotherapy services in the mental health field. Next, the book covers the concerns of the practice of physiotherapy in mental health, such as challenging behaviors, stress management, and relaxation training. The last part covers the various aspects of psychiatric treatment, including child psychiatry, eating disorders, and substance abuse. The text will be of great use to physiotherapists in the mental health care setting. The book will also be interesting to readers who want to know how physiotherapy can be applied to improve the mental and social health of individuals.

Autoren/Hrsg.

Everett MSc, Mcsp

Dennis, Maureen

Ricketts, Eirian

Inhaltsverzeichnis

1;Front Cover;1
2;Physiotherapy in Mental Health: A Practical Approach
;4
3;Copyright Page;5
4;Table of Contents;6
5;Contributors;8
6;Foreword;12
7;Introduction;14
8;Acknowledgements;16
9;Part I;18
9.1;Chapter 1. Psychiatric illnesses;20
9.1.1;Introduction;20
9.1.2;What are psychiatric illnesses?;20
9.1.3;When does a symptom cluster become an illness?;21
9.1.4;What different types of symptom clusters are there?;21
9.1.5;What are the characteristics of psychiatric illnesses?;24
9.1.6;Why do people get psychiatric illnesses?;27
9.1.7;The relevance of an individual's personality;28
9.1.8;How to recognize that someone has psychiatric illness?;29
9.1.9;What help is available for those with psychiatric illness?;31
9.1.10;How to deliver help to those with psychiatric illness;33
9.1.11;Appendix;33
9.2;Chapter 2. Models of mental disorder;35
9.2.1;Introduction;35
9.2.2;Biomedical model;36
9.2.3;Neurophysiological model;37
9.2.4;Genetics and psychiatry;38
9.2.5;Models of social control;41
9.2.6;Psychological models;42
9.2.7;Conclusion;50
9.2.8;References;51
9.3;Chapter 3. Communication in the clinical mental health setting;55
9.3.1;Introduction;55
9.3.2;The clinical interview: doctor and patient communication;55
9.3.3;First encounters with the physiotherapist;59
9.3.4;Non-compliance;60
9.3.5;Communication with the mentally ill;61
9.3.6;Patients within the community;65
9.3.7;Conclusion;67
9.3.8;References;67
9.4;Chapter 4. The multidisciplinary team approach to group practice;68
9.4.1;Introduction;68
9.4.2;Development of group work in physiotherapy;68
9.4.3;The individual counselling process;69
9.4.4;The group process;71
9.4.5;Conclusion;76
9.4.6;References;77
9.5;Chapter 5. Community care and working with carers;78
9.5.1;Introduction;78
9.5.2;Historical perspective;79
9.5.3;The physiotherapeutic role;85
9.5.4;The function of the care programme approach;86
9.5.5;Conclusion;90
9.5.6;Appendix: Useful addresses;91
9.5.7;References and further reading;91
9.6;Chapter 6. Practical guidelines for service evaluation;93
9.6.1;Synopsis;93
9.6.2;The Introduction;94
9.6.3;The Method section;95
9.6.4;The results and analysis section;101
9.6.5;The Discussion section;103
9.6.6;Conclusion;103
9.6.7;References;104
10;Part II;106
10.1;Chapter 7. Touch and handling;108
10.1.1;Introduction;108
10.1.2;Touch as a form of non-verbal communication;109
10.1.3;Sensory healing touch;110
10.1.4;Caring therapeutic touch;111
10.1.5;Touch and quality of life;112
10.1.6;Dementia and communication;113
10.1.7;Boundaries to touch;114
10.1.8;Touch for relaxation;115
10.1.9;Touch and the elderly;116
10.1.10;Conclusion;117
10.1.11;References;117
10.2;Chapter 8. Neuroendocrine-immune network, nociceptive stress and the general adaptive response;119
10.2.1;Introduction;119
10.2.2;Detection of nociceptive information;121
10.2.3;Processing of nociceptive information in the spinal cord;124
10.2.4;Processing of nociceptive information in the brainstem and hypothalamus;128
10.2.5;Neural control of the hypothalamic-pituitary-adrenal axis;135
10.2.6;Dysregulation of the neuroendocrine-immune network: health-related outcomes;137
10.2.7;Conclusion;141
10.2.8;References;141
10.3;Chapter 9. Pain, stress and misdiagnosis;144
10.3.1;Introduction;144
10.3.2;The problem;144
10.3.3;Diagnosis or misdiagnosis?;145
10.3.4;Empirical evidence;150
10.3.5;Conclusion;158
10.3.6;References;159
10.4;Chapter 10. Challenging behaviour;160
10.4.1;Introduction;160
10.4.2;Aggression;160
10.4.3;Self-injury;169
10.4.4;Violence to property;171
10.4.5;Inappropriate social behaviour;171
10.4.6;Wandering;172
10.4.7;Institutional behaviour;172
10.4.8;Modifying behaviour;173
10.4.9;References;177
10.5;Chapter 11. Stress management;178
10.5.1;Introduction;178
10.5.2;Effects of stress;179
10.5.3;Stressors;182
10.5.4;Assessment;185
10.5.5;Stress management techniques;190
10.5.6;Behavioural techniques;191
10.5.7;Simple cognitive strategies;194
10.5.8;Body awareness training;196
10.5.9;Alleviating inpatient stress;201
10.5.10;References;202
10.6;Chapter 12. Relaxation training;205
10.6.1;Introduction;205
10.6.2;What is relaxation?;205
10.6.3;Why physiotherapy in relaxation training?;206
10.6.4;Relaxation training;207
10.6.5;Breath control;209
10.6.6;Specific relaxation techniques;210
10.6.7;References;223
10.7;Chapter 13. Exercise and mental health;226
10.7.1;Introduction;226
10.7.2;Rationale for the role of exercise in mental health;227
10.7.3;Exercise and stress, anxiety and depression;229
10.7.4;What kind of exercise?;233
10.7.5;Exercise dosage;234
10.7.6;Exercise adherence;235
10.7.7;Practical implications;235
10.7.8;Evaluation;237
10.7.9;Safe exercising;238
10.7.10;Conclusion;239
10.7.11;References;239
10.8;Chapter 14. Agoraphobia and panic attacks: a physical cause for a psychiatric problem;243
10.8.1;Introduction;243
10.8.2;The primitive reflexes;244
10.8.3;Oculomotor functioning;246
10.8.4;The INPP remedial programme;248
10.8.5;Appendix: Example of a reflex examination: the symmetrical tonic neck reflex (Field and Blythe, 1988);250
10.8.6;References;251
10.9;Chapter 15. Movement therapy: old roots, new profession;252
10.9.1;Introduction;252
10.9.2;Definition;252
10.9.3;The origins of movement therapy;253
10.9.4;Movement and child development;254
10.9.5;Movement and non-verbal communication;256
10.9.6;Movement and psychopathology;256
10.9.7;A common vocabulary;257
10.9.8;Some useful concepts;259
10.9.9;Therapy in action;261
10.9.10;Conclusion;266
10.9.11;Appendix: Useful addresses;266
10.9.12;References;267
10.10;Chapter 16. Complementary medicine;269
10.10.1;A. An introduction to the subject;269
10.10.2;B. Aromatherapy in the mental health setting;272
10.10.3;C. Reflextherapy;281
10.10.4;D. Connective tissue massage;291
11;Part III;298
11.1;Chapter 17. Child psychiatry;300
11.1.1;A. Physiotherapy in a children's psychiatric unit;300
11.1.2;B. A physiotherapist's contribution to a child guidance clinic;305
11.1.3;C. Creative visualization with children;309
11.2;Chapter 18. Eating disorders;313
11.2.1;Introduction;313
11.2.2;Definition;313
11.2.3;Epidemiology;314
11.2.4;Social and cultural context;314
11.2.5;Nature of illness;316
11.2.6;Pattern of illness and movement through it;317
11.2.7;Complications of low weight;319
11.2.8;Therapy in general: principles and aims;321
11.2.9;Physiotherapy techniques;325
11.2.10;Conclusion;328
11.2.11;References and further reading;328
11.3;Chapter 19. Substance misuse;329
11.3.1;A. The medical approach;329
11.3.2;B. The natural health care approach;347
11.4;Chapter 20. Post-traumatic stress disorder;358
11.4.1;History of the Disorder;358
11.4.2;Description of the syndrome;359
11.4.3;Diagnostic issues;360
11.4.4;Events which may lead to PTSD;362
11.4.5;Treatment;366
11.4.6;Conclusion;379
11.4.7;References;380
11.5;Chapter 21. Forensic psychiatry;384
11.5.1;A. Behavioural science in forensic psychiatry;384
11.5.2;B. Physiotherapy in forensic psychiatry;392
11.6;Chapter 22. Dementia;400
11.6.1;Introduction;400
11.6.2;The mobility problems in dementia;400
11.6.3;Influence of environmental stimulation;402
11.6.4;Rehabilitative framework for physiotherapy management;403
11.6.5;Are reservations to the adoption of a rehabilitative approach justified?;404
11.6.6;Physiotherapy assessment;405
11.6.7;Physiotherapy intervention;406
11.6.8;Physiotherapy evaluation;412
11.6.9;Conclusion;413
11.6.10;Acknowledgements;413
11.6.11;Appendix:;414
11.6.12;References;415
11.7;Chapter 23. Mental illness in old age;417
11.7.1;Introduction;417
11.7.2;Changing services;417
11.7.3;Functional psychiatric problems;419
11.7.4;The role of physiotherapy;423
11.7.5;Care in the community;430
11.7.6;Conclusion;431
11.7.7;References and further reading;431
12;Index;434

Leseproben

1

Psychiatric illnesses

Nick Rose

Publisher Summary

This chapter discusses the psychiatric illness and different types of symptom clusters. Individual psychiatric illnesses consist of particular clusters of symptoms that recur in different people at different times and places. These symptoms typically consist of a combination of abnormal thoughts and bodily sensations, usually called cognitive and somatic symptoms. In the psychiatric illness of depression, the cognitive symptoms include thoughts of guilt, worthlessness, and hopelessness, whereas the somatic symptoms include loss of energy, sleep, and appetite disturbance, and tiredness. Similarly, in the illness of anxiety state the cognitive symptoms include fearful thoughts of dying, suffocating, collapsing, or making a fool of oneself, while the somatic symptoms may include palpitations, breathlessness, and sweating. In any one individual, a psychiatric illness and personality disorder may coexist, making the treatment for the psychiatric illness less favorable. Likewise, personality disorder and physical illness or disability may coexist and result in difficulties during the rehabilitation phase of the illness. More commonly, dominant personality traits may influence the clinical picture. These traits are of insufficient severity to cause the level of dysfunction associated with personality disorder, but may present clinical management difficulties, particularly in the diagnosis and care of physical illness.

Introduction

One person in four will suffer from a psychiatric illness at some point in their lives, and the risk is particularly high for those who have chronic physical disability or illness. As a physiotherapist, therefore, you are very likely to be working with patients who have psychiatric illness, although since psychiatric symptoms often go undetected you may not always recognize this.

In physically ill people it is sometimes difficult to distinguish between normal emotional responses to stress, and psychiatric illness. Yet this is important, since psychiatric illnesses are generally treatable, thus making it much easier to help with the underlying physical problem. Correspondingly, failure to recognize and help a patient’s psychiatric problem is likely to slow down their physical recovery, particularly where active participation in therapy is needed.

This chapter will explain what is meant by the term ‘psychiatric illness’, and describe the main types you are likely to encounter as a physiotherapist. It will then highlight the reasons why particular individuals become ill, and how common this is. Finally the recognition of psychiatric illnesses, the awareness of particular risk factors, the importance of personality and ways in which people can be helped are described.

What are psychiatric illnesses?

Individual psychiatric illnesses consist of particular clusters of symptoms that recur in different people at different times and places. These symptoms typically consist of a combination of abnormal thoughts and bodily sensations, usually called cognitive and somatic symptoms. For example, in the psychiatric illness of depression the cognitive symptoms include thoughts of guilt, worthlessness and hopelessness, whereas the somatic symptoms include loss of energy, sleep and appetite disturbance, and tiredness. Similarly in the illness of anxiety state the cognitive symptoms include fearful thoughts of dying, suffocating, collapsing or making a fool of oneself, while the somatic symptoms may include palpitations, breathlessness and sweating.

To recognize a psychiatric illness one must detect the cluster or pattern of symptoms. Unlike physical medicine there is rarely a laboratory test to confirm the diagnosis. This is because with most psychiatric illnesses we have yet to find any single underlying physical cause such as a virus. Thus, diagnosis of psychiatric illness is usually determined by whether sufficient key symptoms of a recognized cluster are present.

When does a symptom cluster become an illness?

In psychiatry, there is often a continuum between normality and illness. For example, after major loss or trauma it is natural to develop symptoms of sleep and appetite disturbance, features that are also found in depression. How then can one distinguish between the two?

Three things tend to point towards a diagnosis of illness. First, the presence of a full cluster of symptoms. Therefore, in someone coping with a major loss, a diagnosis of depression would need the presence of symptoms of guilt or hopelessness, together with a number of the somatic symptoms summarized in Table 1.1. Secondly, symptoms would normally be persistent, often over a period of weeks if not months. Thirdly, the intensity of symptoms is likely to impair daily living to some degree.

Table 1.1

Diagnosis of psychiatric illness

Thus, where an individual is experiencing psychiatric symptoms, the diagnosis of mental illness depends on whether there is a sufficient clustering of individual symptoms, and on the duration and intensity of these symptoms. If a psychiatric illness is thought to be present this is likely to have specific treatment implications.

What different types of symptom clusters are there?

Broadly speaking there are two groups of psychiatric illnesses. The first comprises those with symptoms which represent a gross exaggeration of experiences that many of us are familiar with; examples include depression, anxiety and obsessional illness. These are sometimes called The second comprises those with symptoms totally different from normal experience; examples include schizophrenia and bipolar affective disorder (manic depression). These are sometimes called

Less frequently, psychiatric illness can be caused by physical factors such as in drug or alcohol withdrawal, endocrine disorders or steroid use. These are usually called

In addition to psychiatric illnesses some people suffer from abnormalities of behaviour and personality. If these abnormalities are enough to cause serious persistent disruption in relationships and in employment, then a may be present. People with personality disorders are often distressed and needy, are more likely to seek medical attention, and may pose particular difficulties during treatment.

In any one individual, a psychiatric illness and personality disorder may coexist, making the treatment, for the psychiatric illness less favourable. Likewise, personality disorder and physical illness or disability may coexist and result in difficulties during the rehabilitation phase of the illness.

More commonly, dominant may influence the clinical picture. These traits are of insufficient severity to cause the level of dysfunction associated with personality disorder, but may nevertheless present clinical management difficulties, particularly in the diagnosis and care of physical illness.

Thus, influential personality characteristics may vary across a spectrum from mild (personality trait) to severe (personality disorder). Some of the more commonly encountered personality characteristics likely to be encountered in physical medicine are described later in this chapter.

What are the characteristics of psychiatric illnesses?

Eight important characteristics of psychiatric illnesses are described below.

Common

Psychiatric illnesses are particularly common among general hospital inpatients and general practice and hospital outpatient clinic attenders. Up to a third of attenders have significant psychiatric symptoms, while up to a fifth have a specific psychiatric illness, most commonly depression or anxiety. This is 10 times what one would expect from a general population sample, and in part reflects the stressful nature of physical illness.

Those at particularly high risk of developing psychiatric disorders include people with chronic physical disability or pain, people who have life-threatening illnesses, and people who have lost a significant part of their bodily functioning, for example after a stroke, an amputation or a mastectomy. (In contrast, women undergoing hysterectomy appear to have a particularly low risk of developing psychiatric disorder after surgery.)

Recurrence

Once a person has suffered from a psychiatric illness the risk of recurrence is greater than if they had never had that illness. For example, the risk of a psychotic illness after childbirth increases from 1 in 500 to 1 in 5 if the mother has had a previous psychotic illness. Likewise, a man who has had a history of depression during his life is at particular risk of developing depression following a major health problem such as a heart attack.

Hidden

The presence of a psychiatric illness is often missed, even by experienced clinicians. At least a half of depressive illnesses are missed in hospital and GP clinics, for example. Alcohol dependence and eating disorders, particularly bulimia, are also likely to be missed.

The reasons why certain common psychiatric disorders are so readily missed are various: Depressed patients may fail to recognize their illness, may...