Effect of stress on mind and body and Rehabilitation plan

1. Psychosomatic Pain And Paralysis
Dr. Rainy B. Sule
MPT (Neuroscience)
Lecturer
C.M Patel College of Physiotherapy

2. Pain is the 5th Vital Sign

3. What is Pain ?
• International
association for study of
pain described pain as
‘ An unpleasant sensory
and emotional
experience associated
with actual or potential
tissue damage, or
described in terms of
such damage’

4. Pain categories
1. Somatogenic pain : Pain with cause (usually
known) localized in the body tissue
✓ Nociceptive
✓ Neuropathic
2. Psychogenic pain : No known physical cause
but processing of sensitive information in
CNS is disturbed.

5. Psychosomatic Paralysis
• Conversion disorder :
Defined as a psychiatric
illness in which
symptoms and signs
affecting voluntary
motor or sensory
function cannot be
explained by a
neurological or general
medical condition

6. Sign and Symptoms of conversion
disorder
• Blindness
• Paralysis
• Dystonia
• Psychogenic Nonepileptic Seizures (PNES)
• Swallowing Difficulties
• Motor Tics
• Difficulty Walking
• Anesthesia
• Hallucinations And
• Dementia

7. Theory
• Psychophysiology – focuses on how emotion,
thoughts etc. modify the physiological response to a
stimulus
– Selye noted that the stress response is dependent on the
nature, the intensity and the individual’s previous
experience with that stimulus
• Psychoanalytical Approaches – noted that stress
produces a general effect; attempted to explain why
a particular organ was affected in under certain
circumstances

8. Contd …
• Cognitive Theories – evaluated the links
between stress, personality and coping
–Martin (1985) identified the alexithymic
personality:
• Inability to identify stressful situations and
express emotions, leading to inability to modify
and cope.

9. Introduction
• Stimulus → Interpretation → Emotional
response → Biological response
• Our physiological reaction to an event is
dependent on our perception and
interpretation of it
– i.e. its predictability, controllability, implications

10. The Mind
• Three levels:
– Awareness - the ability to perceive and respond to stimuli
– Conscious mind - our emotional reactions to those stimuli
and our intelligent behaviour
– Self-conscious mind - knowing that one knows
• Philosophical problem: the mind has no direct access
to the body, mediated through the brain

11. The Limbic System
• Part of the brain that translates ideas and affects into
feelings and emotions
• Structurally it is composed of an upper and lower
circuit, which bridge the neocortex (thinking brain) to
parts of the endocrine system
• Upper circuit appears to be involved in feeling states,
while the lower circuit is involved in emotional states
specific to survival (flight or fight response)

12. Contd …
• Functions of the limbic system include:
– Olfaction
– Arousal, motivation, etc.
– Coding in laying down new memories
– Emotional responses, learning and higher control over
exchanges between the body and the external world
through emotions
– Regulation of homeostasis through the autonomic and
endocrine systems

13. Body-Mind Pathway
• Stimuli are recognized and processed in the
neocortex (thinking brain)
• The limbic system interprets and perceives these
stimuli as stressful or not (emotional response)
• Results in a physiological response through the
endocrine system

14. HPA Axis
• Hypothalamic-pituitary-adrenal (HPA) axis part of
neuroendocrine system, controls reactions to
stress and regulates various body processes
• Amygdala, hippocampus and hypothalamus
(lower circuit of limbic system) facilitate
activation of HPA axis, which leads to the release
of cortisol
• Prolonged high levels of cortisol have been
associated with suppressed immune function,
depression and may facilitate central adiposity, a
risk factor for coronary heart disease and
diabetes

15. SAM Axis
• Sympathetic-adrenal-medulla (SAM) axis part of the
sympathetic nervous system, responsible for
initiating fight or flight response
• Stress stimulates nerves that directly innervate the
adrenal medulla, releasing norephinephrine and
epinephrine
• Results in increased heart rate, increased blood flow
to muscles and diverted blood flow from digestive
system, inhibited salivary flow, dilated pupils etc.

16. Link to Disease
• Chronic stress → chronic HPA & SAM
activation
– May disrupt normal homeostatic processes resulting in
abnormal physiological functioning
– May have long-term effects on the immune and
cardiovascular systems, increasing risk of disease and
leading to more rapid progression once established

17. Cause of Psychogenic Pain and
Paralysis
• Theory 1 : Underlying psychological factor causes the
symptoms
✓ Anxiety disorder
✓ Depression
• Theory 2 : Psychogenic pain that happened in
previous injury and not fully healed
• Theory 3 : psychogenic pain causes the existing pain
to feel worse than the situation actually warrants

18. Symptom discription
• No relief in spite of taking medication
• Difficulty in describing location, quality and depth of
pain.
• Non localized pain that encompass larger part of
body
• Worsening of symptoms independent of any
underlying medical condition
(all above symptoms exist in absence of any chronic disorder
with physical cause)

19. Multimodal treatment of
psychosomatic disorders

20. General Goals and outcomes of patient
with Psychosocial issue
• Impact of pathology is reduced by providing
awareness and plan of care to patient and
caregivers
• Reduce impact of impairment by improving
cognitive function, communication and
participation
• Ability to perform physical activities is improved
by bringing out independence in ADLs,
encouraging problem solving and decision making
skills

21. Contd …
• Health status and quality of life is improved by
enhancing sense of well being, reducing or
training ability to manage stressors.
• Ability to resume self care and home
management is improved by enhancing
participation in work and community
activities.

22. Intervention strategies
• Cognitive Behavioral therapy (CBT)
• Body Awareness Therapy (BAT)
• Aerobics
• Music Therapy

23. Rehabilitation interventions
• Approach each patient uniquely and
treatment goal should incorporate the
patient’s individual personality characteristics,
response and needs.
• Establish a therapeutic atmosphere of
communication, understanding and
cooperation with patients, which can serve as
the foundation necessary to produce positive
rehabilitation outcome

24. Contd …
• Optimize patient involvement in therapy by
giving clear explanation of patient’s situation,
anticipated goals, expected outcomes and
interventions.
• Therapist must maintain a receptive ear to
patient concerns and encourage
communication.

25. Contd …
• Therapist need to be aware of their own feelings,
motivation and responses and monitor their own
response to patient.
• Emotional attachment may lead the therapist to
misperceive patient needs and respond inappropriately
• Therapist should continue to build a respectful
relationship with the patient and refrain from
responding emotionally to the patient’s unconscious
association

26. THANK YOU ….