Osteopathic Psychiatry Flashcards
Osteopathic Medicine
The preferred term for a complete system of medical care practiced by physicians with an unlimited license that is represented by a philosophy that combines the needs of the patient with the current practice of medicine, surgery and obstetrics. Emphasizes the interrelationship between structure and function, and has an appreciation of the body’s ability to heal itself.
Psychiatry
The medical specialty concerned with the prevention, diagnosis, and treatment of mental illness.
Osteopathic Psychiatry
The field of psychiatry as approached through the lens of the osteopathic philosophy.
Osteopathic Philosophy
a concept of health care supported by expanding scientific knowledge that embraces the concept of the unity of the living organism’s structure (anatomy) and function (physiology).
Osteopathic philosophy emphasizes the following principles: 1. The human being is a dynamic unit of function. 2. The body possesses self-regulatory mechanisms that are self-healing in nature. 3. Structure and function are interrelated at all levels. 4. Rational treatment is based on these principles.
Body Unity
The human being is a dynamic unit of function.
The person is a unit of body, mind and spirit.
Elements
Body: Anatomy & Physiology Mind: Interface Spirit: Animation Reciprocally interrelated Whole greater than sum of its parts- Synergy
Somatic Dysfunction in Psychiatry
Occipital sites in schizophrenia, SBS in manic depressives, Frontosphenoid in “involutional dementias”
50 of 1000 psychiatric patients have somatic dysfunction at C2 and T4-6 regions
2,288 psychiatric patients had altered CRI compared to controls
Body Unity in Psychiatry
Biopsychosocial Assessment
Non-reductionism
Psychoneuroimmunology
- Allostasis
- SNS & HPA
- —Somatic, Visceral & Emotional sequelae
Neuroendocrineimmune :
- Cortisol
- Hippocampal formation
- –> Memory loss
Pediatric and Adult patients with Asthma
- Relaxation training
- > ↓Asthma attacks
- > ↓Bronchodilators
Post MI patients develop depression
- Exercise and nutrition improve depression
— Emotions effecting disease course
Placebo effect
Meditation improving mood and immune system functioning
Religiousness reducing suicide attempts
S & F in Psychiatry
Thyroid Hormone
- Synthesis
- Transport
- Action
Thyroid hormone synthesis, transport, MOA as great example for structure and function. Thyroid hormone synthesized and covalently linked to thyroglobulin to reserve it for later active state use.
Lysosymes take up the molecule and proteolysis of the thyroglobulin molecule frees the active thyroid hormone, which subsequently freely diffuses across the cell membrane to enter the blood stream.
The thyroid hormone circulates indiscriminately throughout the body via transport proteins. However, only certain tissues respond to the hormone.
This exquisite hormonal process is determined by the structure and function of the originating gland, hormone itself, transport modalities and target organ.
Wide Dynamic Range Neurons (WDR)
Spinal Segmentation Fiction
Convergence: Dermatome, Myotome, Sclerotome
Primary Afferents release inflammatory polypeptides locally ↑ Self-stimulating
WDR: Interneurons, root of “facilitated segments”
Structure changes Function
Function changes Structure
pathologic structure–> change in function
Down regulation of serotonin receptors leads to decreased serotonergic transmission
Genotype determining phenotype in Down’s Syndrome or Huntington’s Disease
pathologic function–> pathological structure:
Purging via vomiting results in dental & esophageal erosions
Negative thinking predisposes depression and subsequent changes in neurobiology
S & F of Treatment Modalities in Psychiatry
Psychotherapy & Pharmacotherapy induced neurobiology changes
Pharmacology
- Pharmacodynamics
- Pharmacokinetics
OMM in Psychiatry
Touch is often considered contraindicated in psychiatric patients.
It is well known that Dr. Freud experienced significant distress when encountering patients. His personal means of coping involved not facing the patient and avoiding physical contact with the patient. As psychoanalysis demonstrated success, a major component of its efficacy was considered to come from this form of aphysical interaction.
Rhesus monkey studies as well as orphanage studies have clearly demonstrated the fundamental need of human beings to be touched. Non-sexual, affirming touch is vital to our health.
As osteopathic psychiatrists we possess a potential skill set that can be of great benefit to our patients–OMT.
OMT is not the only expression of osteopathic medicine, it is just the most visible/tangible one.
uses of OMM in psychiatry
Evaluate the whole patient Autonomics Cranial strain patterns C2, T4-6 HVLA less effective >24 hrs AFTER ECT
↓Psychotic Inpatient days Paxil + Adjunct OMT Cannabimimetic effects Reduces anxiety Reduces depression
Self-Healing Self-Regulating
Health and healing come from within. It is the patient who gets well not the physician or treatment that makes them well.
