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*Complex Patient - Physiotherapy > Week 5- Mental Health > Flashcards

Week 5- Mental Health Flashcards

1
Q

What is mental health

A

According to WHO, mental health is “a state of well- being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

  • a wellness rather than illness
  • thoughts, feelings and behaviours
  • we all have it
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2
Q

What is mental illness?

A

• Mental health problems and mental illnesses are conditions that significantly and adversely affects a person’s thoughts, feelings or behaviours
• Diagnosis is made with standardized criteria, e.g. DSM5 – Symptoms: +ve, -ve, cognitive
– Organic and nonorganic origins, drug induced
• Different types and degrees of severity
– Positive Mental wellbeing > mental health condition > mental illness

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3
Q

What are positive mental illness symptoms

A

Positive symptoms add. Can include hallucinations, delusions and repetitive movements that are hard to control.

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4
Q

What are negative mental illness symptoms

A

Negative symptoms take away. Can include the inability to show emotions, apathy, difficulties talking and withdrawing from social situations and relationships.

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5
Q

What are cognitive symptoms

A

The third group

Anything related to thinking, such as disorganised thoughts, memory problems and difficulties with focus and attention

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6
Q

How many Australians are experience mental illness

A

Aged 18-65, approx 1 in 5

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7
Q

What are common mental illness presentations

A

• Schizophrenia
• Psychosis including drug induced psychosis
• Addictions
• Suicide
• Bipolar disorder
• Major depression/anxiety
– Depression very common in men, anxiety very common in women
• PTSD
• Behavioural/emotional disorders, e.g. ADHD
• OCD

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8
Q

How is mental health typically managed

A

Medications and counselling

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9
Q

What is the influence of mental health on physical health outcomes

A

Mortality is higher in those with a mental illness

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10
Q

Why is mortality higher in the population with a mental illness

A

Higher incidence of cardiovascular disease and metabolic syndrome in people living with mental illness. Likely due to low levels of physical activity (especially moderate and vigorous) and higher levels of sedentary behaviour

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11
Q

What are the average sendentary time (hours per day) for depression, bipolar and schizophrenia?

A

Approximately:
Depression- 8.25hrs
Bipolar- 10ths
Schizophrenia- 12.25hrs

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12
Q

What is Australia’s biggest killer according to the APA?

A

Sitting in your house= sedentary time

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13
Q

What are the guidelines around exercise

A

Moderate- 150mins
Vigorous- 75mins
Strength- 2x week

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14
Q

What are other drivers of CVD, MS and comorbidity?

A

• Main= low levels of exercise/ high levels of sedentary behaviour
• Other drivers
– Symptoms of illness
– Medication side effects: anti-psychotics (especially atypical variety), sedatives (Cardiomyopathy, EPSE, falls and movement problems)
– MSK pain/somatic complaints (prevalent)
– Socioeconomic/patient factors/lifestyle behaviours (Substance use; Diet, sleep, smoking; Motivation and behaviour change)
– Not accessing/receiving appropriate treatment? Diagnostic overshadowing?

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15
Q

What is the sum effect

A

Sum effect: poor physical health outcomes as a whole for people living with mental illness, increased morbidity and mortality from preventable diseases

The physical health of those living with mental illness has traditionally received little attention

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16
Q

What is the simplified overview of the relationship between the mental health and physical health

A
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17
Q

What is the influence of physical activity on mental health/ affect

A

• Physiological basis
• Neurochemical/neuroplastic/neuroendocrine and vascular effects of exercise/physical activity:
– Increased circulating levels of dopamine, endorphins, serotonin, BDNF
– Increased circulation to brain
– Influence on hypothalamic pituitary axis and physiologic reactivity to stress
• Inflammation
– Reduced systemic inflammation with regular exercise

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18
Q

What are the physiological effects of physical activity and exercise linked to

A

– Improved mood and concentration
– Improved cognition (especially in elderly)
– Pain relief and improved physical functioning – Feelings of reward/pleasure
• Physiological effects may last several hours after acute bout of exercise and seem to be more significant with > moderate intensity aerobic exercise

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19
Q

What effects does the HPA ( Hypothalamic pituitary adrenal) have?

A

– Communication of HPA with several regions of brain
including limbic system (motivation and mood), amygdala (fear generation in response to stress), hippocampus (memory formulation, mood + motivation)
– Aerobic exercise appears to increase hippocampal volume

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20
Q

What are overall potential impacts of exercise and physical activity (psychosocial aspects)

A
  • Distraction
  • Self efficacy and behaviour reward, autonomous motivation
  • Social interaction and overcome negative symptoms
  • Improved self esteem and body awareness
  • Improved general cognitive function
  • Sensory modulation, relaxation and stress relief
  • ‘Keystone Habit’ – regular physical activity and structured exercise could help with forming other habits, behaviour change, diet regulation
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21
Q

What are general physiology effects of exercise and physical activity?

A

– Improved strength, balance, BMD, endurance and cardiorespiratory function, weight loss, reduced cholesterol and BP, etc.
– Better ‘HRQOL’, Disease specific QOL, physical functioning measures, etc.
– Happier people

22
Q

What are the known associations with exercise, physical activity and physical health

A
  • Lower physical activity is associated with mood disorders and depression
  • Higher physical activity is associated with a decreased risk of future depression (all ages, genders, continents)
  • Physical activity levels and physical health are consistent modifiable risk factors for depression
23
Q

How does sedentary behaviour impact mood and physical activity

A

Increased sedentary behaviour could increase negative mood, independent of physical activity

24
Q

What are links between poor physical health/ medical conditions and mental health problems

A

– Parkinson’s and MS: high rates of depression
– COPD patients and elderly patients experiencing falls: both high risk of developing anxiety disorder
– Women’s health: post natal depression
– Chronic pain disorders: associations with anxiety, depression, affective disorders, PTSD

25
Q

What are the two perspectives for evidence for physical activity in treating mental illness

A

– Reducing chronic disease risk and improving physical health outcomes for people with mental illness/mental health problems
– Managing symptoms of mental illness

26
Q

What does resistance training help with

A

Reducing depression symptoms

27
Q

What can help with symptoms of schizophrenia

A
  • cardiovascular exercise
  • strength training
  • yoga

These can also help with general mental health, mood, cognition and brain

28
Q

What are considerations for exercise/ physical activity

A

• Intensity of exercise
– May be an inverse relationship between intensity and affect (Ekkekakis 2011); affective response predicts future
physical activity
– Lower intensity better for fatigue and anxiety
– Higher intensity could help more with depressive symptoms, schizophrenia (e.g. HIIT) and yield better effects for physical health (Wu 2015)
– Avoid exacerbating mania or psychosis
• What is the aim: general health vs. managing symptoms
• Timing and efficiency of exercise/physical activity – AM vs. PM
– Formal/informal/structured/self-directed
– Engagement
• Medications
– Side effects and titration, timing, precautions
• Who delivers it
– Physical health interventions delivered by a qualified exercise professional yield better outcomes and have better compliance

29
Q

What does low-intensity exercises lead to

A

Cognitive control/ attentional processing

30
Q

What does high-intensity exercises lead to

A

Affective processing

Fatigue

31
Q

What are key factors to consider for certain presentations

A 
– Anxiety
• De-threaten, safe context – Depression
• Small initial goals – Bipolar
• Avoid exacerbating manic phase – Eating disorders
• Extreme caution given medical status
32
Q

Remember exercise is not the only treatment, what are some other options

A
  • MDT
  • medications
  • therapies

May need to treat symptoms first (general physio) before doing exercise

33
Q

What should be implemented in regards to optimal prescription

A

• Anything is better than nothing
• Structured exercise may be good for serious mental illness,
but overall lifestyle changes focusing on accumulating moderate intensity physical activity on any day most likely the best for most
• Exercise is an important part of lifestyle modification for better mental health and for management of mental illness
• Aim to meet or exceed minimum physical activity guidelines as starting point – this applies in all other disease cohorts, same for mental health/illness

34
Q

What is the optimal exercise program fir people with mental illness

A

– Individualised
– Involve aerobic exercise > 12 weeks at moderate to high intensity
– Involve resistance training
• 2-3 sessions / week supervised aerobic +/- resistance training, 45-60 mins; associated with optimal physical and mental health benefits (Maudsley Physical Health guidelines)
– Be supervised by recognised physical health professional

35
Q

What does the European Psychiatric Association suggest in regards to optimal prescription

A

– Physical activity should be used as a frontline treatment for depressive symptoms (high evidence, A)
– Physical activity should be used as an adjunct treatment for schizophrenia-spectrum disorders, to improve symptoms, cognition and QOL (good evidence, B)
– Physical activity should be used to improve physical health in people with severe mental illness (some evidence, C)
– People with severe mental illness should be screened for physical activity habits in primary and secondary care (expert opinion, D)

36
Q

What is the current focus of treatment in SMI 🤯(severe mental illness)

A

Psychotropic medication, psychological therapy, lifestyle interventions however physical activity is growing in importance but seen as luxury/ secondary

37
Q

What are the two reasons to consider Physiotherapy in relation to mental health

A
  1. The broad consideration
    – You will be managing patients in your clinical practice with current or past mental disorders, or mental disorders/considerations related to comorbidity/presentation
    – This may not be in the mental health setting
    – Therefore awareness is important
  2. Physiotherapy is well positioned to provide tailored interventions in mental health setting
    – Physical health and physical activity/exercise interventions are important in the treatment of mental illness, and physiotherapists are well positioned to meet this need
38
Q

What are examples of the broad consideration for Physiotherapy in mental health

A
  • Rehab of MSK injuries from suicide attempts
  • Chronic pain, work cover, insurance
  • Women’s health
  • COPD
  • Parkinson’s
  • Patient with abuse or trauma history
  • Psychiatric medications may cause weight gain, MS or MSK conditions you need to manage

+

  • May be no association at all, e.g. schizophrenic consults for sports injury
  • Appropriate management of condition could help mental health
  • We need to appreciate and understand mental disorders just like any other comorbidity, and screen, assess and manage accordingly through our physical health lens as physiotherapists
  • Being able to have the conversation is great
39
Q

Will you be only work with mental health in specific mental health settings

A

No, all settings and many patients. In general population 1 in 5 have a mental illness

40
Q

What are physiotherapists skilled in

A

– Exercise prescription
– Musculoskeletal assessment and treatment
– Management of cardiorespiratory and neurological conditions
– Lifestyle modification (remember probably most important for all)
– Nonpharmacological management of pain
– Facilitation of independent self management

41
Q

How is Physiotherapy important in mental health setting in regards to age groups

A

– Younger adults: substantial amount of MSK and pain complaints
– Elderly mental health: high falls rates, polypharmacy and comorbidity

42
Q

What are the big challenges in practice

A
  1. Behaviour change of consumers
    – Motivational interviewing
  2. Integration of physical health interventions into care
    – Long term adherence of consumers
    – Facility level, service level, staff acceptance/culture – identify and address barriers, facilitators, enablers
43
Q

Explain behaviour changes of consumers: motivation

A

Feeling tired, lacking motivation, being distracted and worried, stress – these are common symptoms of mental illness that can make exercise feel like the last thing you want to do and make habits difficult to form

44
Q

What are critical components to motivation

A
  • willingness: is it important?
  • confidence: do I have the ability?
  • readiness: is it an immediate priority?
45
Q

Explain practitioner tasks behaviour change: precontemplation (not ready)

A

Raised doubt and increase the patients perception of the risks and problems with their current behaviour. Provide harm reduction strategies

46
Q

Explain practitioner tasks behaviour change: contemplation (getting ready)

A

Weigh up pros and cons of change with the patient and work on helping them tip the balance by:

  • exploring ambivalence and alternatives
  • identifying reasons for change/ risks of not changing
  • increasing the patient’s confidence in their ability to change
47
Q

Explain practitioner tasks behaviour change: preparation action (ready)

A

Clear goal setting- help the patient to develop a realistic plan for making a change and to take steps toward change

48
Q

Explain practitioner tasks behaviour change: maintenance (sticking to it)

A

Help the patient to identify and use strategies to prevent relapse

49
Q

Explain practitioner tasks behaviour change: relapse (learning)

A

Help the patient renew the processes of contemplation and action without becoming stuck or demoralised

50
Q

What are barriers/ facilitators/ enablers to integration of physical health interventions

A
  • local are, facility, health service, organisation

- advocacy

51
Q

What are factors of integration of physical health interventions into care

A
  • staffing/ funding
  • resources
  • operating procedures
  • workplace culture and awareness
52
Q

What are benefits of physical activity/ exercise that should be reinforced by mental health professionals

A

Improved sleep, libido, endurance, stress relief, mood, increased energy and stamina, reduced tiredness, weight loss, reduced cholesterol and improved cardiovascular fitness

*Complex Patient - Physiotherapy (13 decks)

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