23.2 Not 23.1 Omm Management Of Patients With Psychiatric Disorders

Front 1

Learning Objectives

Back 1

-To learn the indications for OMT in the psychiatric patinet

-To learn the lack of indication or presence of contraindications to Osteopathic Manipulative Treatment

Front 2

What did A.T. Still believe about the nature of man?

Back 2

A.T. Still believed in the triune nature of man.
Body, Mind, & Spirit.

Front 3

How far back does treatment of somatic dysfunction to impact the mind go?

Back 3

To the beginnings of the profession.

Front 4

Which early osteopathic physicians were involved & what did they do?

Back 4

Still's sons - Charles & Harry, along with A.G. Hildreth, DO founded the Still-Hildreth Sanitarium in Macon, MO

Front 5

Who did the Stills hire?

Back 5

Lynn van Horn Gerdine, DO, MD.

Front 6

What were Lynn van Horn Gerdine aluma maters?

Back 6

Undergraduate: Johns Hopkins, Political Science
Masters Degree: Harvard University, Pscyhology
DO: Massachusetts College of Osteopathy
MD: Rush Medical School in Chicago

Front 7

Where did Van Horn Gerdine finish his practice?

Back 7

Van Horn Gerdine practiced the rest of his life at the Still-Herdith Sanitorium.

Front 8

What was the condition of patients brought to the Still-Heldreth Sanitorium?

Back 8

They had been diagnosed and treated elsewhere and were believed to beyond hope of recovery.

Front 9

In the time frame of 1915 to 1950, what were the "early findings"

Back 9

-In general, the mentally ill had restricted cranial motion.

Front 10

What kind of restricted cranial motion did schizophrenics have?

Back 10

Occipital Restrictions

Front 11

What kind of restricted cranial motion did manic/depressives have?

Back 11

Sphenobasilar dysfunctions

Front 12

What kind of restricted cranial motion did involution dementia have?

Back 12

Fronto-sphenodial dysfunction.

Front 13

In the 1950s, what did Floyd Dunn of PCO & KCCOS find?

Back 13

-Associated Autonomic Disorders with Psychiatric Problems
-studied 1,000 Psychiatric Patients
->50% had somatic dysfunction at C2 & T4-T6

Front 14

Early Sanitaria
#1

Back 14

Bowling Green Sanitarium, Bowling Green, Missouri

Front 15

Early Sanitaria #2

Back 15

Moore Sanitarium, Portland Oregon

Front 16

Early Sanitaria #3

Back 16

Southwestern Sanitarium, Blackwell, OK

Front 17

Early Sanitaria #4

Back 17

Crain Sanitarium, Richmond, IN

Front 18

Early Sanitaria #5

Back 18

The Fargo Sanitarium, Fargo ND

Front 19

Early Sanitaria #6

Back 19

Wayne-Leonard Osteopathic Sanitarium, Atlantic City

Front 20

Anxiety

Back 20

-Many patients report great comfort and tension relief from basic osteopathic manipulative techniques
-Simply being touched and cared for is very powerful treatment
-Much emotional tension is stored in the muscles
-Releasing that tension is at the core of treating anxiety with musculoskeletal symptoms.

Front 21

Thought on anxiety
When your life sucks...

Back 21

No amount of anxiolytic is going to make you feel better.

Front 22

Situational anxiety is not only acceptable, it is _______.

Back 22

NORMAL

Front 23

What are common somatic symptoms of anxiety?

Back 23

-Palpitations
-Tachycardia
-Sweating
-Trembling or shaking
-shortness of breath
-sense of being smothered
-feeling of chokng
-chest pain or discomfort
-nausea
-abdominal pain

Front 24

More common somatic symptoms of anxiety

Back 24

-dizziness
-light headedness
-derealization
-depersonalization
-fear of losing control or going crazy
-fear of dying
-paresthesias
-chills
-hot flashes

Front 25

Depression

Back 25

-Again many patients report great relief
-All patients with depression have some pain.
-any patient who is in pain more than about 48 hours will begin to manifest symptoms of depression.

Front 26

How do we know that chronic pain causes depression

Back 26

-Antidepressant medication provide 40% or less relief of the pain.
-Opiate analgesics and many of the NSAIDs can cause depression
-The concern with opiates is that the euphoria produced with the inital doses will feel so good that the patient will abuse the medication in an effort to reproduce the good feeling.

Front 27

When is it okay to use opiates in chronic pain & depression?

Back 27

As long as the patient is medicating the pain and not their mood, opiate use is acceptable for chronic, unremitting pain.

Front 28

Thoughts on depression...

Back 28

-When you are sitting on a thumbtack, it takes a lot of antidepressants to make you feel good about it.

-When you are sitting on two thumbtacks, removing one does not remove 50 % of the pain.

Front 29

More thoughts on depression

Back 29

-Again, when your life sucks you will remain depressed until you improve your life - tricyclics & SSRIs will not fix situational depression

-Situational depression must be distinguished from endogenous depression.

Front 30

Has osteopathic manipulative treatment shown to be of benefit for bipolar disorders?

Back 30

It has not shown to be of any benefit.

Front 31

What is the general description of a somatoform disorder?

Back 31

-Vague, expansive, recurring, multi-system somatic symptoms
-A somatic symptom is considered significant if it results in social, occupational, or other areas of functioning.
-These patients typically overuse the emergency room, osteopathic and chiropractic treatment or other forms of intervention.

Front 32

What is needed to establish a diagnosis of somatoform disorder?

Back 32

-At least FOUR (4) different sites (Head, Neck, Chest, Abdomen, Low back, rectum)
- or functions (menstration, urination, sexual intercourse, defecation)

Front 33

What is osteopathic manipulative treatment been used for in somatoform disorders?

Back 33

-OMT has been used to relieve symptoms and to demonstrate to the patient that no serious disease states are being missed.
-This reassurance is critical to the patient's recovery
-Exercise is also a good "stress burner" for these patients.

Front 34

How does conversion hysteria present?

Back 34

It frequently presents as a possible neurologic disorder and a thorough work-up is necessary to rule out this possibility.
-It has been said that with some of the rarer neurologic disease that by the time the patient is diagnosed, either the patient is crazy, or the doctor has become crazy.

Front 35

Symptoms of conversion hysteria

Back 35

-impaired coordination or balance
-localized weakness
-difficulty swallowing
-aphonia
-urinary retention
-dimming vision
-blindness
-hearing impairment
-pseudoseizures
-amnesia
-coma

Front 36

The patient with conversion hysteria is...

Back 36

-typically women are diagnosed with this condition, it is much less common, or may be diagnosed under a different name in men.
-these patients may have a seductive, "come hither" outward personality.
-OMT is contraindicated - this type of patient frequently misinterprets the benign physical contact of the manipulative treatment as something much more.

Front 37

Schizophrenia...

Back 37

Will generally not permit physical contact, or will tenses so much during the process that OMT is difficult to perform and probably offers no benefit.

Front 38

Psychotic Disorders..

Back 38

-Even when stabilized on medication, touch is often confusing and misinterpreted
-OMT is of limited or no value.

Front 39

Substance Abuse

Back 39

-once the addictive behaviors are stabilized, osteopathic manipulative treatment is often useful in managing somatic symptoms.

Front 40

Cocaine addiction

Back 40

-even good substance abuse programs produce mixed results
-osteopathic manipulative treatment of this type of patient may be beneficial, but is truly challenged by this chemically induced total breakdown of body, mind, and spirit.

Front 41

Alzheimer Disease

Back 41

-Osteopathic care centers on providing active planning and supportive counseling for both the family & care givers.
-These people manifest the musculoskeltal and emotional stresses of coping with this disease.

Front 42

Axis II - Personality Disorders

Back 42

-commonly seen in Osteopathic Manipulative Medicine specialty practices
-characterized by alternating extremes of idealization and devaluation of the physician/patient relationship.
-There is markedly disturbed or distorted self body image.
-They fight with the staff and are never satisfied.
-OMT is ALWAYS misinterpreted, never productive, and complicate an ever increasingly complex doctor/patient relationship.

Front 43

What is you role for your patients under psychiatric care as a primary care physician?

Back 43

Your role as a primary care physician is to leave the psychiatry to the psychiatrist and focus instead on diet, exercise, healthy relationships, and appropriate osteopathic manipulative care.

Front 44

What is the one exception where osteopathy in the cranial field is helpful in treating psychiatric disorders?

Back 44

If the mental illness is of recent onset and followed abruptly on the heels of significant head trauma, there are case reports of dramatic recovery following cranial treatment of these patients.

Front 45

What is the OCF protocol for mental illness subsequent to head trauma?

Back 45

-These patients are general offered a trial of 6 - 10 manipulative treatments.
-If they or their family is seeing noticable improvement, then treatment should continue.

Example: patient struck her right frontal region during an MVA-developed post-traumatic depression unresponsive to antidepressant.
-depression was relieved by cranial OMT.

Front 46

Somato-Emotional Release

Back 46

Definition - The sudden release of repressed memories
-The sudden and dramatic release of emotional tension
-during osteopathich manipulative treatment.

Front 47

Example of somato-emotional release #1

Back 47

-Middle Aged woman who remembered being held down and strangled by her older brother during an incestal rape
-This occurred during cervical soft tissue technique.

Front 48

Example of somato-emotional release #2

Back 48

-While performing thoracic soft tissue technique in the lateral recumbent position, the patient suddenly recalled being locked in the closet by her mother and her grandmother.
-During these episodes, she would curl up on her side in a fetal position.

Front 49

What is the mechanism for somato-emotional release?

Back 49

-It is at present unknown.

Front 50

What is an hypothesized mechanism for somato-emotional release?

Back 50

-It is possible that either the body position, hand contact to a part of the body, or just the relaxation evoked by the OMT causes the emotional release.
-Touching the patient will break down barriers between physician and the patient. Patients will you tell you things during OMT that they will not tell their own psychiatrist or psychologist.