Physical Characteristics in Mental Illness 18-2

Physical Characteristics in Mental Illness Population – Literature Review

 Ron Feldman, Shaul Schreiber, Chaim G. Pick, Ella Been

 Abstract

Background: Mental disorders are common, worldwide health problems.  Starting July 1st 2015, mental health treatments in Israel have been incorporated into the “National Health Bill” (passed by the Knesset in 1994), bringing to an end the 21-year-old questionable division of responsibilities for treatment of body and mind (HMOs responsible for treatments of the body; Ministry of Health responsible for treatments of psychiatric and psychological conditions). Therefore, community caregivers need to take into account the needs and characteristics related to the patients' diagnoses and mental state when formulating treatment and rehabilitation programs to address these patients' health issues.

Aim: The aim of this review is to examine the existing knowledge in the literature regarding the physical characteristics and level of physical activity of people with depression, anxiety disorders, and schizophrenia, and to provide physical therapists with basic guidelines for managing the diagnosis and treatment of these patients.

Methods: A total of 106 articles were reviewed after a systematic and comprehensive search in the following databases: Google Scholar, PubMed, ScienceDirect, PsycINFO and Cochran. The first phase was carried out by searching the keyword Mental Health that was cross-linked respectively with the keywords: physical activity, pain, and body posture. In the second phase, the search was more specific using the following keywords: body posture, balance, pain, gait, fine motor, muscle strength, range of motion. Keywords in each of the above were cross-linked with the specific mental illnesses: schizophrenia, depression, anxiety disorders. The articles reviewed included interventional clinical trials, crpss-sectional surveys, cohort studies, literature reviews, and meta-analyses dealing with populations with mental illness.

Results: The review we conducted shows that patients with mental illness manifest unique physical profiles in accordance with their clinical diagnosis (schizophrenia, depression, and anxiety): the physical profile of patients with schizophrenia is characterized by a slow gait, decrease in stride length, poor pain perception, and slowdown in fine motor skills. Patients with anxiety disorders are characterized by balance disturbances, while depressed patients are characterized by a slow gait, slumped posture, a higher incidence of pain and a decreased pain threshold and pain tolerance.
Moreover, most of these patients do not engage in physical activity. There is a consensus that physical activity contributes to an overall better mental state and that the optimal physical intensity to achieve good mental health is moderate. Physical activity is a key component in improving self-esteem and an effective tool for coping with serious mental states.

Discussion: While formulating a diagnosis or treatment program for patients with mental illness, one should take into consideration some specific factors, such as pain perception, balance and gait patterns, in addition to the general physical activity program. More research is needed to improve our understanding of these patients in order to provide adequate recommendations and guidelines.

Keywords: physical activity, pain, balance, posture, motor skills, walking, mental illness