Psychiatric Illness &

Physical Therapy
Presented By
Mrs. Mabil Jaison
Assoc. Prof
 Defining Key Terms
• Psychiatric Illness (Mental Illness/Disorder):
• Health conditions involving changes in thinking, emotion, or behaviour (or a combination of
these).
• Associated with distress and/or problems functioning in social, work, or family activities.
• Examples: Depression, anxiety disorders, schizophrenia, bipolar disorder, eating disorders,
PTSD.
• Physical Therapy (Physiotherapy):
• Healthcare profession focused on human movement and function.
• Aims to restore, maintain, and promote optimal physical function and quality of life.
• Utilizes therapeutic exercise, manual therapy, education, and various modalities.
• The Bridge: Recognizing that mental and physical health are inextricably linked.
 The Bio psychosocial Model in
Practice
• Beyond the Biomedical Model: Traditional focus solely on biological factors (e.g., disease,
injury).
• Bio psychosocial Model: A holistic approach that acknowledges the intricate interplay of:
• Biological Factors: Genetics, neurochemistry, physical health status, injury, disease.
• Psychological Factors: Thoughts, emotions, beliefs, coping styles, personality, stress.
• Social Factors: Family support, cultural background, socioeconomic status, environmental
stressors.
• Relevance to PT: Many physical symptoms have psychological or social components, and
psychiatric illnesses often have physical manifestations or impact physical activity.
 Common Psychiatric Illnesses &
Their Relevance to PT
1. Depression (Major Depressive Disorder): 2. Anxiety Disorders (e.g., GAD, Panic
Disorder, Phobias):
• Psychiatric Symptoms: Persistent low mood, • Psychiatric Symptoms: Excessive worry,
loss of pleasure, fatigue, sleep disturbances, fear, restlessness, irritability, difficulty
appetite changes, feelings of worthlessness. concentrating.
• Physical Manifestations: Chronic pain • Physical Manifestations: Muscle tension,
(headaches, back pain, widespread body headaches, palpitations, shortness of breath,
aches), generalized weakness, fatigue, gastrointestinal distress, hyperventilation,
psychomotor retardation (slowed movements), dizziness, sleep disturbances, chronic pain,
altered posture, increased inflammation. motor agitation or freezing.
• PT Relevance: Exercise is a powerful • PT Relevance: Breathing exercises,
antidepressant; addressing pain, fatigue, and relaxation techniques, graded exposure to
deconditioning.
feared movements/situations, reducing
muscle tension.
 Cont….
3. Schizophrenia & Psychotic Disorders: 4. Post-Traumatic Stress Disorder (PTSD):

• Psychiatric Symptoms: Delusions, • Psychiatric Symptoms: Re-experiencing

hallucinations, disorganized (flashbacks), avoidance, negative
thinking/behaviour, negative symptoms (e.g., alterations in cognition/mood, hyper
apathy, social withdrawal, lack of motivation). arousal (exaggerated startle response, hyper
• Physical Manifestations: Sedentary lifestyle, vigilance).
obesity, cardiovascular disease (often due to • Physical Manifestations: Chronic pain,
medication side effects), metabolic syndrome,
poor coordination, abnormal gait, tardive
muscle tension, sleep disturbances, fatigue,
dyskinesia (involuntary movements), poor somatic symptoms (e.g., irritable bowel),
self-care, smoking-related respiratory issues. hyper vigilance leading to guarded
movement patterns, restricted breathing.
• PT Relevance: Promoting physical activity,
addressing gait/balance issues, managing • PT Relevance: Trauma-informed care,
medication side effects, improving functional graded exposure, movement to regain sense
capacity, health promotion. of control, pain management, grounding
techniques.
 Cont….
5. Eating Disorders (e.g., Anorexia Nervosa, 6. Substance Use Disorders (Drug
Bulimia Nervosa): Dependence & Alcoholism):
• Psychiatric Symptoms: Distorted body • Psychiatric Symptoms: Compulsive drug-
image, extreme fear of weight gain, seeking, cravings, impaired control over use,
restrictive eating, binging/purging negative consequences, withdrawal
behaviours, intense anxiety around symptoms. Often co-occurs with other mental
food/weight. health disorders.
• Physical Manifestations: Muscle weakness, • Physical Manifestations: Liver damage,
fatigue, osteoporosis, electrolyte imbalances, heart problems, neurological damage (e.g.,
cardiac issues, dental erosion (bulimia), Wernicke-Korsakoff), peripheral neuropathy,
peripheral neuropathy, poor balance, low muscle weakness (myopathy), increased fall
bone density leading to fractures. risk, nutritional deficiencies, chronic pain.
• PT Relevance: Safe re-introduction to • PT Relevance: Addressing physical
physical activity, restoring muscle complications, rebuilding strength/endurance,
strength/bone density (under medical improving balance/gait, pain management,
guidance), improving body image/awareness promoting exercise as a healthy coping
mechanism.
 General Physical Manifestations
of Psychiatric Illness
• Chronic Pain: Very common across many psychiatric conditions (e.g., tension headaches,
fibromyalgia-like symptoms, back pain, generalized aches).
• Fatigue & Low Energy: A hallmark symptom of depression and many chronic illnesses.
• Sleep Disturbances: Insomnia, hypersomnia, disrupted sleep cycles.
• Muscle Tension & Guarding: Response to anxiety, stress, or trauma, leading to
musculoskeletal pain and restricted movement.
• Gait & Balance Impairments: Can result from medication side effects, neurological changes,
or deconditioning.
• Obesity & Metabolic Syndrome: Often due to sedentary lifestyle, poor diet, and side effects
of psychotropic medications.
• Cardiovascular Issues: Increased risk of heart disease due to lifestyle, stress, and medication.
• Poor Posture & Body Mechanics: Can be a reflection of mood, pain, or low self-esteem.
 The Role of Physiotherapy in
Psychiatric Care
• Symptom Management:
• Pain Relief: Utilizing modalities, manual therapy, and therapeutic exercise.
• Fatigue Management: Graded exercise programs, energy conservation techniques.
• Sleep Improvement: Promoting physical activity, addressing pain that disrupts sleep.
• Reducing Muscle Tension: Relaxation techniques, stretching, and manual therapy.
• Functional Restoration & Improvement:
• Improving strength, endurance, balance, and coordination.
• Enhancing activities of daily living (ADLs) and instrumental ADLs (IADLs).
• Facilitating return to work, social participation, and hobbies.
• Promoting Physical Activity & Healthy Lifestyles:
• Prescribing tailored exercise programs.
• Educating on the benefits of physical activity for mental health.
• Encouraging consistent engagement.
 Cont…
• Mind-Body Connection & Grounding:
• Body Awareness: Helping patients reconnect with their bodies in a safe and positive way.
• Breathing Exercises: Teaching diaphragmatic breathing for anxiety, stress management,
and pain reduction.
• Mindful Movement: Incorporating techniques like yoga, Tai Chi, or mindful walking to
improve present-moment awareness and self-regulation.
• Education & Self-Management:
• Educating patients on their condition, the benefits of exercise, and pain science.
• Empowering them with self-management strategies for physical and emotional well-being.
• Fall Prevention: Addressing fall risk often heightened by medication side effects,
deconditioning, or cognitive impairments.
• Addressing Medication Side Effects: Counteracting physical side effects (e.g.,
weight gain, stiffness, tremors, sedation) through exercise and movement.
 Benefits of Physical Therapy for
Mental Health
• Neurobiological:
• Increases neurotransmitters (serotonin, dopamine, norepinephrine).
• Reduces cortisol (stress hormone).
• Promotes neurogenesis (growth of new brain cells).
• Reduces inflammation.
• Psychological:
• Improves mood and reduces symptoms of depression and anxiety.
• Enhances self-esteem and self-efficacy.
• Provides a sense of accomplishment and control.
• Reduces rumination and negative thought patterns.
• Improves body image.
• Social:
• Increases social interaction (group exercise).
• Reduces social isolation.
 Challenges & Considerations for
Physiotherapists
• Stigma: Patients may be reluctant to discuss mental health or engage in PT due to stigma.
• Motivation & Adherence: Low motivation, anhedonia (inability to feel pleasure), and fatigue can
hinder exercise adherence.
• Medication Side Effects: Sedation, weight gain, tremors, and orthostatic hypotension can impact
exercise tolerance and safety.
• Safety Concerns: Risk of self-harm, aggression, or unpredictable behaviour (rare, but awareness is
key).
• Cognitive Impairment: May affect understanding of instructions and adherence to home exercise
programs.
• Trauma-Informed Care: Essential for patients with a history of trauma; requires sensitivity to
triggers and empowering choices.
• Communication: Adapting communication styles for varying cognitive abilities and emotional
states.