Volume 4 Issue 1 January, 2014
Consultation Liaison Psychiatry Focus: ‘Physical medicine and rehabilitation’
Physical Medicine and Rehabilitation (PMR), also known as Physiatry or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a Physiatrist. Physiatry and Psychiatry are specialties that are relatively new and both treat those conditions affecting humans which have been historically affected by charlatanry, with the result that suspicions still linger in minds of general public.
Historically from the time of Hippocrates, hydrotherapy and other physical modalities were used in the treatment of certain mental conditions. Conversion disorders such as astasia abasia need a physiatric approach with occupational therapy, exercises, prescription of appropriate aids and orthosis along with effective psychiatric management.
Physiatry deals with patients with chronic pain and diseases associated with physical impairment and disability such as amputation, spinal cord injury, traumatic brain injury, cerebral palsy, etc. All the diseases unfortunately come with the burden of severe mental distress to the patient and in some cases to their caregivers also. A basic knowledge of psychiatry to recognize conditions like post traumatic stress disorder, adjustment disorder, depression, organic / functional mental disorders, suicidal ideation is very essential in preventing unwarranted complications and ensuring compliance with rehabilitative measures. New discoveries in neurobiology have created an opportunity for use of older drugs for novel causes. A example being use of Fluoxetine for motor recovery following ischaemic stroke (FLAME Trial, Lancet Neurol. 2011 Feb; 10(2):123-30).
Restorative or compensatory strategies that help in functional recovery and community reintegration of a person affected by cognitive, emotional and psychological impairments as a result of brain injury are collectively summed as neuropsychiatric rehabilitation. Recovery from an acquired brain injury is often complicated by psychiatric disorders. Psychosis, depression, post traumatic stress disorder, mania, and aggression being some of them. The challenge lies in diagnosing a psychological disorder in a patient with profound physical disability, with inability to effectively communicate. Early diagnosis and effective management with appropriate medication and behavioral therapy helps in accelerating the cognitive and physical recovery. Many literature reviews suggest lack of literature regarding conditions like post traumatic psychosis and depression due to lack of operational criteria and non compliance to use of DSM criteria. Post Traumatic Aggression is a common feature in patients after Traumatic Brain Injury (TBI) and yet is very poorly documented and researched topic. Further research is warranted in establishing operational definitions for
post traumatic aggression. Hence the requirement of a multidisciplinary rehabilitation by a team consisting of psychiatrists and physiatrists is the need of the day.
Department of Physical Medicine & Rehabilitation, CMC Vellore
