BANARSIDAS CHANDIWALA INSTITUTE
OF PHYSIOTHERAPY
TOPIC: PSYCHIATRIC
ISSUES IN DISABLED
BY: Dr. Sonam Chadda
CONTENT
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ANXIETY NEUROSIS
OCD
TEMPER TANTRUMS
ASSESSMENT
CHARACTERISTICS OF CHILDREN
WITH BEH. DISORDERS
▰ MANAGEMENT
▰ BEHAVIORIALTHERAPY
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Anxiety Neurosis
Anxiety reaction is a state of chronic apprehension
with recurrent symptoms of acute episodes of
anxiety.
Many people get anxious before an exam or an
interview but when the client becomes
hyperactive, his pulse is fast, his blood pressure
shoots up, his sleep gets affected, and he cannot
concentrate on the job at hand, then he or she
could be suffering from anxiety neurosis. BCIP
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Obsessive Compulsive
Neurosis

Obsessive-compulsive Neurosis: Obsessions are persistent
recurrences of unwelcome ideas. The ideas usually revolve
around sex, dirt, or religion. Some people are obsessed about
starting for work at auspicious timings. Others are obsessed
about cleanliness and would not mind taking bath even a
dozen times a day. They often are miserable and guilty about
these obsessions and try to remove them from their mind
without much success Compulsions are irresistible urges to
carry out meaningless and irrational activities, if the patient
does not carry out his impulse, he experiences discomfort and
tension. We see people constantly checking if they have
brought their keys, purse or tickets with them, or inspecting if
their room is locked—these are compulsive disorders.
BCIP 2
Temper Tantrums
 Temper
Tantrums
This is one of the behavioral problems
exhibited by some children who will
scream to get their way done when
frustrated. This may be accompanied by
breath holding spells. Boys are more likely
to show temper, aggressive behavior and
hyperactivity, while girls are more likely to
be anxious, fearful, shy and clinging.
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

Hysteria—conversion reaction
When the tension of the unconscious or subconscious
mind manifests itself in to somatic symptoms the
resulting illness is known as conversion reaction.
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Reactive depression: This type of depression occurs
usually in persons of anxious, melancholic or
obsessive personality. The illness is preceded by a
physical, physiological or psychosocial stress situation
like a death in the family, loss of job or prestige,
financial stress, marital and sexual disharmony, etc.
The patient suffers from insomnia, and feels better in
the evening than in the morning. He is more
comfortable when in company than alone.
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
Delusion: It is a false or mistaken belief, which has for
the patient the force of conviction and is firmly held
despite all evidence to the contrary, e.g. delusion of
grandeur—a mere commoner believing that he is a king.

Hallucination: A hallucination is a perception through one
of the senses, which does not correspond to any stimulus
in the outside world. People have visual hallucinations of
forms appearing in front of them, auditory hallucinations
of voices speaking to them, and occasionally they
complain of a feeling as if someone is touching them or
strangulating them (tactile hallucination).
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Illusion: An illusion is a perception, which although produced by an external
stimulus, is misinterpreted by the patient in purely subjective terms. The classic
example is that of a person seeing a rope and mistaking it for a snake
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 Dementia:
These are pathological conditions
where behavior gets altered due to atrophy,
age related changes or ischemia in the brain.
Public figures may keep poking their ears or
gesticulating to no one in particular on the
platform of a political meeting.
 Shameless and inappropriate behavior, such
as crude sexual advances to casual
acquaintances or masturbation or micturition
in public, may be the first sign of something
very seriously wrong in a hitherto normal
elderly and respected person.
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 Head
Injury and Stroke: Some brain injured
patients display disinhibited, aggressive, selfabusive or otherwise inappropriate behavior.
 They may also become depressed or
withdrawn. In hemiplegia they may not be
aware of the affected side, anosognosia, and
may exhibit inappropriate emotions and 108
Textbook of Rehabilitation as emotional
liability.
 The primary objective is the modification of
inappropriate behaviors and the teaching of
more effective means of communication and
social interaction.
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Psychological Evaluation: It is essential to look at the
mental framework of the patient to predict his prognosis.
The better the persons coping skills are prior to the mishap
the better the outcome.
 This is where the history taking skills of the examiner
comes into play. He would have to delve into the past of
the patient, the educational background, his nature,
whether gregarious or withdrawn, details of the members
of his family, his friends and their comprehension of the
situation.
 This would have to be matched with the patient current
behavior samples by keen and continuous observation.
The reason for such elaborateness is because of the fact
that future behavior is based on past behavior
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 Tests
for behavior assessment: Portland
adaptability inventory is an instrument that
measures degree of impairment in the
areas of temperament, emotion, activities,
social behavior and physical capabilities
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 Halstead-Reitan
Neuropsychological
Battery: It is a fixed battery approach in
that a specific set of tests is given to all
patients.
 Here sets of seven standardized tests are
administered which include Wechsler
Intelligence scale, trial making test,
sensory perceptual examination, and
Reitan-Indiana Aphasia screening
examination
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 Behavior
disorders are the result of complex
interactions between the child and his
environment.
 “If a child’s behavior has a negative effect on
its own adjustment or if it interferes with the
lives of other people, then it is said that the
child is behavior disordered.” It is generally
estimated that six to ten percent of school
age children have noticeable behavior
problems.
 The incidence is greater in boys than girls.
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Delay in social cognitive development:
They do not learn from their own past experiences
or the experiences of other children.
 They are not sensitive to the fact that their
behavior affects others in a negative way. • They
are isolated from their peers.
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They lack a sense of right and wrong. Low
academic achievement: Most of these children are
poor in academics, do not like school, and are poor
in time bound tasks like finishing home work or
assignments. They have a poor self image which
interferes with learning and they resist change
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
Autism means a developmental disability
significantly affecting verbal and nonverbal
communication and social interaction, generally
evident before age three that adversely affects a
child’s educational performance.
Autistic children generally engage in repetitive
activities and stereotyped movements. There is
lack of eye contact, resistance to change of daily
routine and abnormal responses to sensory
experiences.
It is generally accepted that autism is not a single
entity but a series of behaviors.
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 Drug
Therapy: Drugs have to be prescribed
by a psychiatrist. Combinations of the
following may be used: • Antipsychotic drugs •
Antianxiety drugs

Antidepressant drugs. Group Therapy: When
the patient is in a group he gets to interact
with others like him. This visual feedback
gives him information of what others are
going through. He sees that there are others
worse off than him, and decides that life is
worth living after all.
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 Family
Therapy: Sometimes the family
members in all good intention end up by
doing more harm.
 They discourage rehabilitation -appropriate
behavior by doing all functions for the
patient, or by giving them unwanted
sympathy.
 Giving a concrete job to the patient and
family member can prevent day dreaming
and negative attitudes
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
Whenever called up on to correct a deviant
behavior, psychologists use behavior therapy
which lays emphasis on current individual behavior
rather than the historical origins of its problems.

First, the behavior to increase or decrease is
identified. It is also noted how often this behavior
occurs and reinforcers are identified. Reinforcers
are nothing but stimuli that increase or decrease
the frequency of a behavior. Positive reinforcers
(carrot) increase the frequency while negative
reinforcers (stick) decrease its frequency
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For example a child not co-operating to therapy can be
offered a sweet, or the therapy can be converted into a game.
An adult can be given the option of listening to music while
doing therapy.
It is not enough to reduce unwanted behavior it is equally
important to provide alternate behavior. For complicated tasks
which do not find approval or cooperation with the patient, the
tasks are broken down into smaller steps and the patient is
instructed on what he can do.
Encouragement increases performance Leisure and
prevocational activities have to be given. We must remember
that the patient has a lot of time on his hands. An idle mind is
the devils workshop. Hence he must have something to
occupy his mind throughout his tenure.
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 Behavioral
modification techniques are classified
as:
 Techniques
for reducing anxiety including
relaxation training Graded exposure treatment
involves exposing the subject to the feared
stimulus one step at a time.
 Aversion
therapy aims to reduce maladaptive
behavior by associating it with an unpleasant
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 Techniques
to Increase Desired Behavior •
Rewards
 Behavioral contracts—written agreements
between people who desire a change in
behavior
 Shaping—gradual development of complex
pieces of behavior by reinforcement of the
constituent parts. This technique is used to
develop basic skills (such as eating and
dressing) in cases of mental retardation.
 Psychological
treatment—hypnosis
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