3. introduction to psychological issues of physically disabled persons

8/12/2019 3. Introduction to Psychological Issues of Physically Disabled Persons

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REHAN ALI MALIKGOLD MEDALIST BS(HONS.)O&P

GENERALSECRETARY POSP

CPO. ALAC AFIRM RWP.

Introduction To Psychological issues of

Physically Disabled persons


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Definitions According To World Health Organization

Impairment

Permanent or Transitory psychological, physiological or

anatomical loss or abnormality

E.g. a missing or defective part, tissue organ or mechanism of the

body such as amputated limb, paralysis after polio, Myocardial

Infarction, cerebrovascular thrombosis, Restricted Pulmonary

capacity, Diabetes, Myopia, Disfigurement, Mental Retardation,

Hypertension, perceptual disturbance and sensory deprivation


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Functional Limitation

Impairment may cause functional limitations which are partial or

total inability to perform those activities necessary for motor,

sensory or mental functions within the range and manner of

which the human being is normally capable.

Walking, lifting loads, seeing, speaking, hearing, reading, writing,counting, taking an interest in and making contact with

surroundings

Functional limitation may last for a short time, long time, be

permanent or reversible

Should be quantified whenever possible

Could be progressive or Regressive


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Disability

Impairment or functional limitation is causative factor

Defined as an existing difficulty in performing one or more

activities which in accordance with the subjects age, sex and

normative social role are generally accepted as essential

Depending on the duration of functional l imitation:

Disability could be:

Short Term Long Term

Permanent


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Case

5o years old male who has had hypertension for several years suffers astroke resulting in right sided hemiparalysis & dysphasia

Impairment:

Hypertension along with disturbance of brain function Functional Limitation:

Decreased ability to talk

Decreased ability to walk & use right hand

Disability:

Inability to work

Partial inability to look after himself

Reduced ability to interact with surroundings


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Some Psychological Stresses Originating From Physical

Disability

I ndividual Consequences:

Decreased Independence

Compromised Mobility

Hampered Leisure Activities

Problems related to Social integration

Decreased economic Viability


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Family Consequences

Needs for Constant Care

Constant Liability on Family Members

Disturbed Social and Interpersonal Relationships

Economic Burden

Marital Disharmony and interpersonal conflicts


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Societal Consequences

Demands for Care

Fulfillment of special needs

Loss of Productivity leading to inability to fulfill social demands

Disturbed social integration

Stigmatization

Constant sympathy of society leading to low self esteem


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Major Psychological Problems Originating As A Result

Of Being Handicapped

Stress, Distress and Depressive Disorder

Post Traumatic Stress Disorder

Anxiety Disorder

Mixed Anxiety and Depressive Disorder

Adjustment Disorder

Acute Psychotic Episode (New onset or Relapse)

Acute Manic Episode (New onset or Relapse)

Agitated Depression

Personality Changes

Substance Misuse ( Alcohol, Cannabis, Opioids,Benzodiazepines)


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Depressive Disorder

Important to differentiate depressive symptoms which

can also be categorized as sadness which requires no

specific treatment

Depressive disorder or agitated depression on other

hand would require specific medical treatment


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When to diagnose

Depressive disorder should be diagnosed only:

When persons symptoms are severe enough to fulfill the

criteria

When persons symptoms are severe enough to disablethe individual functionally

Full blown symptoms of depressive disorder wouldrequire both pharmacological and psychological help


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Signs and symptoms of Depressive Illness

Depressed mood Feelings of sadness

Anguish & feelings of agony

Mournful, irritable & anxious

Reduced energy, easy fatigability, decreased activity, markedtiredness on slightest of effort

Reduced concentration & attention on a task

Reduced confidence & low self esteem

Feelings of guilt & worthlessness

Bleak & pessimistic view of the future Act of self harm & attempted suicide

Disturbed sleep, diminished libido, reduced appetite


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Physical symptoms in Depression

Many patients with Depression present to doctor with

physical symptoms such as:

Headache Chest Pain

Loss of Appetite

Burning sensations Pins and needles sensations

Gas, Gola etc


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Pharmacological Treatment

Choice of antidepressants would depend upon:

Anticipated side Effects

Safety

Tolerability

Presence of Comorbid physical illnesses


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Anxiety Disorders

Anxiety Disorders include:

GAD

Panic Disorders

social and Specific Phobias

PTSD


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Signs and Symptoms

Prominent somatic symptoms:

Increased Heart Rate

High Blood Pressure

Palpitations

Muscle tremor

Perspiration

Abdominal discomfort

Hyperventilation Restlessness

Fidgety feeling


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Post Traumatic Stress Disorder

Condition which can occur soon after disability

When people face an overwhelming event in life

Event thats perceived as dangerous & beyond normalcoping capabilities

When ability to respond to such event gets hampered

PTSD is not a single symptom but cluster of symptoms


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Symptoms of PTSD

Re-experiencing the event e.g. Nightmares

Routine avoidance of reminders of event

General lack of responsiveness

Diminished interest and engagement

Increased sleep disturbance and poor concentration


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Management of PTSD

Psychological F irst Aid

Psychoeducate patient and family

Help the patient understand his condition

Repeated reassurances that their reactions are b/c of stressdue to traumatic event

support from family, friends, relatives

Let the individual know that he is not alone and is notresponsible for the event

Deep Breathing and Muscle Relaxation Exercises

May require pharmacological Rx for management of anxiety


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interpersonal relationships with handicapped

people

H istor ical perspective:

Historically disabled have been confronted with physical and

mental impediments of their Disabilities

Confronted also by accompanying social stigma and Negative

social attitudes

A persistent negative attitude and social rejection of people with

disabilities is quite evident throughout history and cross culturally

Ancient Roman and Greek cultures viewed disabled as burden on

the society and as less than Human


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Interpersonal Difficulties in disabled

Early Research examined interactional Difficulties b/w people

with and without disabilities

A feeling of Discomfort and unease identified as interaction strain

Later on researchers noticed novelty of interactional situation and

self consciousness over appropriate behavior during these

interactions may also contribute to the problem


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People without disabilities vs. disabled

According to Fichten, Robillard, Judd and Amsel(1989):

People without disabilities perceive the Disabled to be different

across several social dimensions for e.g.

To be more socially Anxious

Uneasy about keeping social liaisons

To be socially more vulnerable to be picked up by others or being

criticized


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Impact of the negative attitudes on disabled

A significant impact on both social & vocational lives

of Disabled

Befriended

Social isolation Social stigmata

Social distance causing Low self esteem

Self image problems

Conscious of oneself all the time

Feeling of being lonely or left out


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How to improve attitudes regarding

interpersonal relationships of Disabled

Increased social contacts with the Disabled

Greater awareness campaigns for the Disabled

Improving societal attitudes about various Disabilities

True understanding about underlying cause

Be more empathic towards the disabled

Addressing the negative perceptions about the Disabled

Fostering the development of more friendly and optimistic

attitude towards the disabled Role of counselors and Educators regarding awareness generation

about various Disabilities

H t i i l l ti hi i


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How to improve social relationships in

physically challenged children

1). Building of self concept & self esteem 2). Confidence Building

3). Fostering involvement in games & creative acts

4). Channelizing energies & reducing frustrations byinvolving in certain activities

5). Acceptance of ones disability rather than feeling

ashamed of it

6). Social involvement and Deinstitutionalization

7). Community based rehabilitation

8). Vocational Training ( Knitting, Sewing, Tailoring, cooking)

9). Encouraging to participate into self Help Groups


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Th n s

3. introduction to psychological issues of physically disabled persons

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