Dr.

Dheeraj Lamba
Head/Associate Professor,
Department of Physiotherapy,
Jimma University
Email: dheeraj.lamba@gmail.com
 Psychological well being
 Ability to enjoy life
 Mental performance
 Productivity
 Societal norms
 Consistency – mood, behaviour, functioning.
 Level of function
 Ability to cope
 Behavioural adjustment
 Circumstantial
 Mental illness is one of the main causes of disease
burden worldwide.
 1 in 6 in the last week, 1 in 4 in the last year .
 UK cost = £100bn per year.
 30% people with chronic physical illness .
 6,233 suicides recorded in the UK in 2013.
 In Ethiopia, depression contributes to about 6.5%
of the burden of diseases. In a predominantly rural
area, mental disorders were estimated to be
responsible for 11% of the total disease burden,
schizophrenia, and depression among the top ten
most burdensome conditions
 Prevalence =relevance.
 There is widespread stigma and discrimination
in Ethiopia which has contributed to under-
utilization of available mental health services in
the country. This should be addressed with
contextually designed and effective stigma
reduction interventions that engage
stakeholders (service users, service providers,
community representatives and service
developers and policy makers) so that the
United Nations universal health coverage goal
for mental health can be achieved in Ethiopia.
 Depression
 Anxiety
 Bipolar disorder
 Schizophrenia
 Bipolar-affective disorder
 Schizo-affective disorder
 Personality disorders
 Eating disorders
 Addiction
 PTSD
 OCD
 Episodes of depression and elation
 Mood instability – 1% of population.
 Type I, Type II, Rapid Cycling, Cyclothymia.(mood
changes – from feeling low to emotional highs)
 Constant sadness
 Loss of appetite
 Anhedonia
 Nihilism
 Low self-esteem
 Isolation
 Poor sleep and self care
 Avoiding eye contact
 Suicidality
 Very happy
 Flight of ideas
 Full of energy
 Over exercising
 Reckless spending
 Disinhibition
 Grandiosity
 Frustrated with others
who aren’t as happy
 Abnormal social behaviour
 Inability to understand what is real
 Hallucinations
 False beliefs
 0.3-0.7% prevalence
 Risk factors include genetics, being
male, cannabis use, older parents.
 Culture must be considered
 Paranoia
 Split Personality
 Incidence of SCZ in black African and Caribbean
population much higher than white population in UK
 Nine times more likely
 Differences in culture?
 Trend has continued with second and third generation
migrants.
 Many African religions include spiritual beliefs
 Shamanism – ability to connect with supernatural realm,
an aspect of many religions.
 Ireland – delusions of sainthood
 Industrialised countries – delusions of surveillance
 Cultural/societal norms – who can diagnose?
 5000BC
1st-20th Century
 Skull trephination the surgical  Asylums, mad houses,
procedure in which a hole is workhouses.
created in the skull by the
removal of circular piece of  Religion
bone  Abandonment
 Lobotomies a surgical
operation  Abuse and restraint
involving incision into  Confinement
the prefrontal lobe of the brain
 Exorcisms  Untrained staff
 Isolation

Ancient Greece
 Biomedical model
 Blood letting
 Purging
 Imposing balanced
diets
 Environmental change
 Occupational change
 Medication
 Antidepressants
 Antipsychotics
 Mood Stabilisers
 Anxiolytics
Community Teams
 Dedicated Care Co-
ordinator
 Multi-disciplinary
 Assistance with
occupation
 Social inclusion schemes
 Point of contact for all
care needs
 Medication issues
Talking Therapy
 CBT
 Mindfulness
 Psychotherapy
 Psychology
Acute Hospital
Care
 Controlled environment
 Medication trials
 MDT
 Identification of needs
 Assessment of risks
 Episodes of increased
illness severity
Social Care
 Community
support
 Financial support
 Housing
Electro-convulsive
Therapy
 Electrical current into the
brain - seizure
 Treatment resistant
depression
 Psychotic depression
 Catatonia - SCZ
 Informed consent
 Safe environment
Nausea – Indigestion – Constipation – Diarrhoea - Ache
Agitation – Insomnia – Anxiety – Sexual Dysfunction
Stiffness – Restlessness – Sleepiness – Tardive Dyskinesia
Weight Gain – Slowness – Increased Thirst – Urinary
Frequency – Muscle Weakness – Shaking – Drooling – Dry
Skin – Headaches – Sweating – Goitre – Feinting
Bradycardia – Bradykinesia – Increased Appetite
Confusion – Memory Loss – Tinnitus – Visual Disturbance
Ataxia – Skin Rashes – Itchiness – Hair Loss – Fluid
Retention – Reduced WBC – Chills – Fever – Anhedonia
 4.1 times the overall risk of premature death
 Dying up to 20 years too early
 Twice the risk of diabetes
 3 times the risk of hypertension
 10 fold increase in deaths from respiratory
disease
 Physical disease is under-diagnosed and under
treated in people with schizophrenia
 High chances of DM
 30% stroke patients suffer depression
 Long term physical morbidity = 3 times more
likely to have MH problems than population
 Major depression 4 times greater in people with
chronic LBP
 Gulliver et al. 2015 – half of elite athletes suffering
symptoms of mental ill health
 Fipro study 2015 – 38% professional footballers
suffer with depression
 Emotions, experience, perceptions.
 fMRI studies – same regions
activated with pain
 DeWall et al 2010 – paracetamol
reduces psychological pain.
 Demonstrating substantial overlap
between physical and
psychological pain.
 Humans are incredibly complex creatures
 Mental illness is common

 Even more common with physical morbidity

 Linked to poor physical health and early death

 You will have mentally unwell patients in every

specialty of physiotherapy
Therefore:
 Every physiotherapist should understand:
1. Symptoms of mental illness
2. Treatments for mental illness – side effects
3. Impact of mental illness on physiotherapy Rx
 There are many Physiotherapy interventions
that are potentially effective in improving
physical and mental health and health related
quality of life. The most common forms of
exercise are aerobic, strengthening, and
stretching.
 Aerobic exercises such as jogging, swimming,
walking, and cycling have been proven to
reduce anxiety and depression.
 Exercise reduces symptoms in people who suffer
from depression, anxiety, and stress through the
release of endorphins and also known as
"happiness chemical". Exercise can also help to
prevent cognitive decline.
 Physiotherapists can provide health promotion,
preventive healthcare, treatment, and
rehabilitation for individuals and groups. In
therapeutic settings, the physiotherapist can play
an essential role in preventing the diseases and
promoting the health by educating patients about
it.