Article Type : Editorials
Authors : Stathopoulos S
Keywords : Mental Health, Paediatric Psychiatry
Dear colleagues, at the beginning were an international network of physical therapists working in the field of psychiatry and mental health with the origin at Leuven University (Belgium) from in 2006. The International Organization of Physical Therapy in Mental Health (I.O.P.T.M.H) was accepted as a W.C.P.T subgroup at the 17th General Meeting, in 2011 and reconfirmed in 2015 and 2019, including 21 member countries, Australia, Austria, Belgium, Colombia, Denmark, Estonia, Finland, Greece, Iceland, Japan, Latvia, Mexico, The Netherlands, Norway, Poland, Spain, South Africa, Sweden, Switzerland, Turkey, UK, but within I.O.P.T.M.H, there is a network of individual physical therapists, representing 59 nations from 6 continents. The I.O.P.T.M.H provides a consensus statement on the role of qualified physical therapists within mental health. This policy statement has been developed by the Executive Committee and physical therapists with expertise in mental health (2019).
It is implemented in different health and mental health
settings, psychiatry and psychosomatic medicine. Physical therapy in mental
health is person-centered and aimed at children, adolescents, adults and elderly
with mild, moderate and severe, acute and chronic mental health problems, in
primary and community care, inpatients and outpatients. Physical therapists in
mental health provide health promotion, preventive health care, treatment and
rehabilitation for individuals and groups. Physical therapists in mental health
create a therapeutic relationship to provide assessment and services
specifically related to the complexity of mental health within a supportive
environment applying a bio-psycho-social model. The core of physical therapy in
mental health is to optimize wellbeing and empowering the individual by
promoting functional movement, movement awareness and physical activity,
exercise, bringing together physical and mental aspects. Physical therapists in
mental health play a key part in the integrated multidisciplinary
team/interprofessional care. Physical therapy in mental health is based on the
available scientific and best clinical evidence.
Observation &
Evaluation Tools
It based on:
·
observation of the
person's behavior or physical characteristics, in movement or posture
(recording information)
·
self-observation and
self-esteem of the individual (completion of questionnaires)
It applicable at the beginning, in between & at
the end of the physiotherapy session
Design and implementation of individual
and group therapeutic exercise programs
Exercise as a means of treatment, either supervised or
guided:
·
Protects against the
onset of depression
·
Prevents the development
of mental illness
·
Patients with depression
and schizophrenia are less likely to stop exercising when monitored by a
physiotherapist
·
It improves the quality
of life and self-esteem of people experiencing mental health issues
·
It has a large and
significant antidepressant effect in people with pre-existing depression
·
It helps to better manage
anxiety disorders
·
Reduces food symptoms in
food intake & improves body image
·
Prevents weight gain
& deteriorates mental health in patients of psychiatric prison structures
·
It protects against dementia
but also slows the progression of the disease.
Closeness/Touch/Massage
Since ancient times it has been a valuable therapeutic
and preventive measure, keeping pace with the mental and psychosomatic
evolution of the human species.
By contacting and manipulating, it transmits the
feeling of a wave of euphoria, relaxation and calm.
It is not an individual technique
but is a functional part of the broader therapeutic intervention
The physiotherapist is responsible for the delicate
balance between positive and negative reactions related to contact and
immediacy.
Biofeedback
According the international references for biofeedback
and the guidelines of the International Society of Applied Psychophysiology and
Biofeedback is indicated with a high-level score (4/5) in:
·
Anxiety disorders
·
Headaches and especially
tension type
·
Phobias
·
Somatoform disorders
Relaxation and
breathing techniques
Prevents the growth of harmful effects on the physical
and mental health, reduces the respiratory rate by improving the way of breathing,
normalizes the process of ventilation and restores the normal
cardio-respiratory parameters.
It is demanding and need:
·
Explaining and
understanding how to execute and act.
·
Repetitions and precise
guidance from a physiotherapist.
·
Effort, perseverance and
patience for the right way of execution
Psychomotor
therapy
It is based on the unity of mind and body. Uses
physical awareness and various motor activities, to positively affect the motor
and emotional development of individuals
A non-invasive, painless technique in which a pulsed
magnetic field exerts an effect on electroencephalogram activity with general
indications with strong based evidence in chronic neuropathic pain & major
depression but possible efficacy in depression & schizophrenia
Virtual reality
application techniques
Research findings that it can cause significant
behavioral changes in real-life situations and so its application is mainly
supported in the treatment of phobias & stressful events.
Paediatric
Psychiatry Specific Elements
Though physical therapy in mental health for children
and adolescents is currently well embedded in different setting (such as child
psychiatry, rehabilitations centers, private practices, etc.), it is a relatively
young domain. The field of physical therapy in mental health in children and
adolescents encompasses different approaches and therapeutic techniques,
ranging from assessment and observation to body awareness techniques,
relaxation, experienced oriented family therapy, physical activity, etc.
(Simons, 2018).
Geriatric Psychiatry
Specific Elements
The cornerstones are to improve the quality of life of
the elderly with mental health problems (e.g. dementia and functional
psychiatric disorders)
The goals are:
·
Slowing down the
reduction of daily activities
·
Improving cardiovascular
function
·
Strength, coordination
and balance improvement
·
Reduction of the risks of
falling due to the psycho-pharmaceutical treatment but also the weakening of
the possibilities of vision and gait
Adapted therapeutic exercise and body-oriented
approaches such as yoga-, tai chi-, mindfulness-derived exercises or massage
have a positive influence on cognition, communication, social behavior, sleep,
depression and anxiety.
Incorporating physical therapy into mental health will
lead to improve both physical and mental health as well as experiencing
feelings of well-being from our patients.
Let’s bring the contribution of physical therapists in
mental health into the spotlight, starting from completing the application as
an interested physiotherapist (http://www.ioptmh.org/Colleagues.html)
and participating en masse at the 8th international conference of
physiotherapy in psychiatry and mental health (February 8-10, 2021 due
Covid19), Helsinki, Finland and at the 9th in Athens, Greece, in
2022.
COVID-19 is an infectious disease caused by the
SARS-CoV-2 virus. In addition to the physical medical effects through
contracting the disease, the psychological or mental impact of the pandemic
could be significant, even in people who have not got the disease. Factors such
as loss of job / income, separation from family, isolation, fear of the disease
etc. can lead to negative psychological conditions. It was in this background
that the study reported in this paper was carried out to analyse the psychological
state of people during the pandemic period.
The COVID-19 pandemic will contribute to a negative
mental state for majority of people, which will also be influenced by some of
their characteristics.
Kontoangelos K, et al. opined that extensive
stressors will emerge or become worsened due to the COVID-19 pandemic [1]. AL-Omiri
MK, et al. reported that COVID-19 was associated with feelings of stress,
depression, sadness, and loneliness [2]. Elements such as separation from loved
ones, loss of freedom, uncertainty about the advancement of the disease, and
the feeling of helplessness due to the pandemic affect people more [3,4].
The study was undertaken by WEDO (NGO), Kozhikode,
Kerala, India using an on-line questionnaire among a sample of 300 respondents
from various parts of India using the snow ball sampling technique. 15
psychological traits were considered to analyse the psychological state of the
respondents during the COVID-19 pandemic period (Table 1). The responses to the
level of experience of the traits (on an average during the pandemic period)
were: Felt very strongly, felt strongly, felt moderately, felt slightly, did
not feel with scores of 1, 2, 3, 4 and 5 respectively. The sum of scores of the
traits was considered as the psychological state score of the respondents
during the pandemic period. A higher score indicates a more positive
psychological state and vice versa. The data was analysed as proportion / score
and through statistical techniques such as Random Forest technique, Chi-square
test and Odds Ratio.
Table 1 shows the proportion of respondents
reporting the experience of various psychological traits during the COVID-19
pandemic period.
Table 2 gives details of respondents attributing the
experience of psychological traits to the pandemic.
Table 3 shows the responses reading the effect of
pre-COVID tension on post COVID tension.
In order to identify the psychological traits, which
influence the psychological state score, the Random Forest technique based on
Inc Node purity values was attempted. The results are presented in Table 4.
Table 5 shows the distribution of psychological
state score into low, medium and high groups based on quartile method.
Table 6 shows the results of the Chi square test of
psychological state score with respect to the score of various characteristics
of the respondents such as age, gender, qualification etc.
Table 7 shows the psychological state score under
various categories of the characteristics of respondents, which was worked out
based on the quartile method.
Odds ratio comparing high and low categories of the
psychological state score was attempted. The ratios shown in Table 8 indicate
the chance of exposure of an individual to a high score, implying a better
psychological state of the respondents during the pandemic period.
It can be made out from Table 1 that 50 % and more of the respondents have not at all experienced and experienced only slightly the positive traits such as happiness, feeling lively, satisfied, energetic, enthusiastic and peaceful during the COVID-19 pandemic period. Similarly, more than 50 % and more of the respondents have experienced the negative personality traits, namely, sadness, tiredness, anger and uneasiness moderately during the pandemic period (Table 1). These results indicate that the pandemic has influenced the psychology of the respondents in a negative manner. It can be observed from Table 2 that respondents in the range of 60 to 80 % attribute less experience (indicating the responses, namely, did not feel at all, and felt slightly only) of six out of the seven positive psychological traits to the COVID-19 pandemic. Similarly, 66.7 to 100 % respondents have attributed more experience (indicating the responses, namely, felt strongly, and felt very strongly) of five out of six negative psychological traits to the occurrence of the pandemic (Table 2).
These results also indicate the negative influence of the pandemic on the psychology of the respondents. 60 % of the respondents reported that pre-COVID tension has affected the tension experienced by them after the pandemic (Table 3). It can also be made out from Table 3 that a comparatively higher proportion of people having moderate and high pre-COVID tension mention that it has affected their post COVID tension, when compared to those who reported less and very less pre-COVID tension. These results indicate the influence of existing tension of people in creating more tension during the pandemic period. The pandemic induced uncertainty, individual health threat and quarantine measures may exacerbate pre-existing conditions such as depression, anxiety etc. Inc Node purity values above 300 obtained through random Forest technique only were considered for analysis. Accordingly, as per Table 4, the traits, namely, Enthusiasm, Satisfaction, Loving nature and Peacefulness are the main ones, which influence the personality state score. These traits can be considered to contribute to a positive mental state for people under the conditions such as fear of contracting the disease, isolation, loss of job/income etc. existing during the COVID-19 pandemic. All the other traits showed Inc Node purity values in the range of 12.6 to 271.8 only.
More or less equal proportion of respondents are
there under the high, medium and low personality state groups, implying that the
more respondents were not able to maintain a better level of psychological
status due to the pandemic (Table 5). Except sex, the other characteristics of
the respondents, namely, age, qualifications, level of pre COVID tension and
pre COVID tension affecting post COVID tension are influencing the
psychological state score significantly through Chi square test (Table 6). As
per data shown in Table 7, 52 % of the middle-aged respondents and 14 % in the
young age group fall in the high and medium psychological state categories
together, while nobody in the old age group falls under these two categories.
While 46 % of males fall in the high plus medium psychological state groups,
the figure is only 20 % for females, implying that males were able to maintain a
better psychological state than females during the pandemic period. None of the
respondents with Degree and PG qualifications have low psychological state
score, when compared to 22 % and 12 % respectively under the up to 10th and
plus two educational categories (Table 7).
The results of the
study prove the hypothesis that the pandemic has influenced the psychology of
the respondents in a negative manner, and that the characteristics of people
will influence their psychological state during the COVID-19 pandemic period.
Less experience of positive psychological traits and more experience of
negative traits have been attributed to the COVID-19 pandemic by 60 % and more
of the respondents. The influence of existing tension of people in creating
more tension during the pandemic period is evident from the study. Random
Forest technique results show that Enthusiasm, Satisfaction, Loving nature and
Peacefulness are the main psychological traits, which influence the personality
state score. These traits could contribute to a positive mental state for
people under the conditions such as fear of contracting the disease, isolation,
loss of job/income etc. existing during the COVID-19 pandemic. The
characteristics of the respondents such as age, education, pre COVID tension
and pre COVID tension affecting the tension during the pandemic period are
found to influence the personality score statistically through Chi-square test.
Odds ratio test shows that respondents with PG qualification have about 4.62
times more chance of getting a higher psychological state score than those with
lesser qualification, indicating a better psychological condition for more
educated respondents during the pandemic period. Similarly, males are found to have 1.16 times more chance of
maintaining a better psychological state than females during the pandemic
period.