Mental, Social, and Emotional Health

Trauma Pathophysiology

an overwhelming or life threatening event experienced or witnessed (most commonly family or interpersonal violence)

Fear is helpful to

initiate short term survival response but can be damaging if still present in the absence of danger

Clinical SS Trauma

mood changes/agitation, difficulty concentrating, guilt/shame, freeze patterns, eye darting

PT Considerations and treatment for Trauma

avoid triggering behaviors or reactions (sounds, smells, places, media, feelings), observe your patient/client reactions, want to screen initial visit

PTSD pathophysiology

occurs following a traumatic event, consistent stress responses that were not present before the event

Clinical SS of PTSD

Intrusion, avoidance, arousal

Intrusion

reliving the event

Avoidance

of thoughts, feelings, etc related to the event

Arousal

on guard or hyperreactive physiologic reactions like sweating, elevated HR

Treatment for PTSD

pharmacologic, cognitive behavioral therapy (CBT), desensitization therapy, stress management techniques, eye movement, desensitization reprocessing (EMDR), exercise

PT considerations for PTSD

trauma informed care

Trauma informed care

safety, trustworthiness, peer support, collaboration, empowerment, cultural issues

Anxiety disorders pathophysiology

generalized state of emotional fear or apprehension

Clinical SS of anxiety disorders

heightened state of physiological arousal

Treatment of anxiety disorders

combo of pharmacologic and psychotherapy is most effective (antidepressants and antianxiety meds)

Antidepressants

increase serotonin

Antianxiety medications

control symptoms and panic attacks

PT considerations for anxiety

be on alert for suicide risk, alcohol, or drug abuse, generalized anxiety disorder 7 can be used for screening

Depressive disorders (major depressive disorder) pathophysiology

individualized experiences of loss of interest and pleasure that can cause significant distress or impairment in all aspects of functioning, most commonly seen MOOD DISORDER

Clinical SS of depressive disorders

fatigue, sleep disturbances, loss of interest, headaches, back pain, weakness

Treatment of depressive disorders

Antidepressants, CBT or other therapies

PT considerations for depressive disorders

notice S &S, caution with side affects of medication, routine screening (PHQ)

Obsessive compulsive disorder (OCD) pathophysiology

constantly reoccurring thoughts/obsessions and compulsive behaviors that interfere with daily activities (attempts to remedy reduce anxiety)

Clinical SS of OCD

fear of germ exposure, counting, etc…

Treatment of OCD

antidepressants or antianxiety medications, CBT, transcranial magnetic stimulation (TMS)

PT considerations of OCD

specific guidelines for HEPs, Consistency, attentiveness to environmental cleanliness

Somatic symptom and related disorders pathophysiology

group of conditions where individuals have physical symptoms that can cause significant distress that are disproportionate to the actual severity (malingering is not occurring though)

Clinical SS of somatic symptom

maladaptive responses to somatic symptoms

Treatment of somatic symptom

may treat underlying condition causing symptoms

PT considerations of somatic symptom

patience and understanding that the patient is not making it up, refer appropriately

Feeding and eating disorders pathophysiology

spectrum of eating disorders that can cause persistent disturbances of eating or eating related behaviors

Low energy availability in athletes (LEA)

energy intake does not meet training demands

Related energy deficiency in sports (RED S)

LEA + menstrual dysfunction and osteopenia

Clinical SS of feeding and eating disorders

red flags of eating disorders

Treatment of feeding and eating disorders

varies by diagnosis, but usually therapy of some sort and maybe pharmacologic

PT considerations of feeding and eating disorders

physical side effects on disordered eating, monitor labs and imaging, may need to refer to counselling, body positivity and therapeutic alliance

Substance use disorders (SUD) pathophysiology

continued use of a substance for 12+ months, alcohol most common

How is substance use disorders different form addiction

chronic relapsing despite negative consequences

Clinical SS of substance use disorders

impaired control, social impairment, risky use, pharmacologic concerns, withdrawal

Treatment of substance use disorders

biopsychosocial approach is most effective

PT considerations of substance use disorders

know withdrawal sings, during inquiries, or current drug use prior to session, PT’s role in smoking cessation

Bipolar and cyclothymic disorders pathophysiology

cyclical mood swings of between depressed episodes and manic/hypomanic, onset usually in the mid 20s

Clinical SS of bipolar and cyclothymic disorders

Manic behaviors and depressive signs

Manic behaviors

racing thoughts, risky behavior, euphoric feelings

Treatment of bipolar and cyclothymic disorders

multimodal (pharmacologic, behavioral therapy)

PT considerations for bipolar and cyclothymic disorders

side effects of meds

Schizophrenia and psychotic disorders pathophysiology

various subtypes but include loss of contact with reality, onset usually teens or early 20s

Clinical SS of schizophrenia and psychotic disorders

typically delusions and hallucinations

Treatment of schizophrenia and psychotic disorders

multimodal (antipsychotics primarily)

PT considerations of schizophrenia and psychotic disorders

medication side effects, promote benefits of exercise

Suicidal behavior pathophysiology

past history of suicidal behavior, chronic alcohol or drug use, exposure, genetic predisposition

PT considerations for Suicidal behavior

observe changes in patient behavior or concerning statements, be ready to respond by keeping the patient safe, do not promise to not share info, see help from self harm professionals

What are PT’s role in prevention and early detection of psychological disorders

attend to the complete human experience, support, screen, provide referrals, seek immediate medical attention if necessary, promote exercise and PA, observe cues of signs of distress, mindful of communication

Intake forms and screening tools

facilitate patient provider communication for psychosocial behaviors and screening for yellow flags

OSPRO YF

yellow flag tool

What disorder is most common to see in the PT clinic

major depressive disorder

What percent of health professionals have a substance use disorder

20 to 25%

Yellow flags

psychosocial factors that relate to patients/clients thoughts, feelings, behaviors, and social environment that can influence pain, disability and recovery