Physiotherapy management strategies in people with schizophrenia

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Introduction

Aims and Learning Outcomes

Aims:

1. To provide final year physiotherapy students and newly qualified physiotherapy graduates with an online learning resources which will develop their knowledge and understanding of schizophrenia and its impact on the individual.

2. To enable final year students and newly qualified physiotherapy graduates to develop their knowledge and awareness of physiotherapy management strategies for people/adults with schizophrenia.

Learning outcomes:

By the end of this online learning resource you should be able to:

1. Identify and evaluate the biopsychosocial impact of schizophrenia on the individual.

2. Explain the effects of the common medications used in the management of schizophrenia and how these effects can impact physiotherapy management.

3. Critically appraise the evidence underpinning some of the key physiotherapy management approaches for schizophrenia and reflect on how the could be used in practice.

4. Select evidence informed communication strategies to be able to interact effectively with individuals with schizophrenia.

The Role of the Physiotherapist in Health Promotion

The Problem of Poor Health in Schizophrenia

It is well documented in the literature that people with schizophrenia have much poorer physical health than the general population and despite having more contact with health services they have a much poorer life expectancy, dying on average 15-20 years earlier. One of the key factors that contributes to the poor physical health in this population is very high rate of physical inactivity and the tendency to adopt a far more sedentary lifestyle than the general population (Lindamer et al. 2008, Janney et al. 2013, Stubbs et al. 2014).

In general, physical inactivity is associated with an array of health risks and is said to be one of the leading causes of long term and secondary conditions such as coronary heart disease, diabetes, obesity and different types of cancers (Booth et al.2012 and Lee et al. 2012). It is important to remember that the same health risks apply to people with schizophrenia but due to the nature of their condition and other influencing factors the risk is much greater (Gorczynski and Faulkner 2010).

Along with physical inactivity and sedentary behaviour there are a whole range of other factors that could influence the physical health of people with schizophrenia. These include; antipsychotic medications (as discussed earlier), poor diet, high alcohol intake, high rates of smoking and high rates of substance misuse (Phelan et al. 2001, McCreadie 2003 and Vancampfort et al. 2012). ).Together these factors put people with schizophrenia at much higher risk of developing long term conditions and as such they are 1.5-2 times more likely to be overweight, have a two-fold increased risk of developing diabetes and hypertension and an increased risk of cancer of which they are 50% less likely to survive than the general population (NICE 2014, Vancampfort et al.2012).

The evidence shows that there is great disparity between the physical health of those with schizophrenia and the general population and this ‘problem’ is now becoming widely recognised. We feel it is important to explore the role of the physiotherapist in terms of addressing these modifiable factors that are contributing to poor health whilst also paying special attention to the fact that these people have a mental health condition and recognising that it could be influencing their ability to engage in a healthy lifestyle.

A patient centred approach - treatment planning/goal setting

A patient centred approach is vital in the management of people with schizophrenia, particularly with regards to treatment planning and goal setting. Autonomy is something that many of us take for granted. In schizophrenia, the combination of positive and negative symptoms as well as side-effects from the medication can result in major changes in a person’s personality and the way they live their life that this independence can often be lost.

The Royal college of Nurses (2015) describes person centred care as care which allows the person to become an equal partner in their care. It encompasses shared decision making and in direct relation to schizophrenia it is about working together to develop treatments and set goals that are meaningful and at a level the person is ready for, willing to and able to achieve (Fogarty and Happell 2005).

References

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