The first publication on sports psychiatry was written in 1967 by Arnold R Beisser, a doctor and tennis player.^[4] It was brought up in literature again twenty years later by JH Rick Massimino, MD, and mentioned again in 1992 by California-based psychiatrist Daniel Begel, who is known for officially launching the specialty. As the field developed, the World Psychiatric Association eventually created a section on Exercise and Sports Psychiatry, giving way for interest in other countries, including Britain and Germany.^[3]

International Society for Sports Psychiatry edit

In 1994, Begel founded the International Society for Sports Psychiatry (ISSP). The organization aims to spread the benefits of the field to the entire athletic community and promote mental health in sports. ISSP membership in 2020 is open to medical students, residents, psychiatrists, and other clinicians at times.^[5]

American Board of Sports & Performance Psychiatry edit

In 2023, seven sports psychiatrists founded the American Board of Sports & Performance Psychiatry: Brook Choulet, MD; Mark Allen, MD; Thomas Horn, DO; Amanda Klass, DO; Rolando Gonzalez, MD; Tia Konzer, DO; Ankur Desai, MD. Their mission is to credential sports and performance psychiatrists who demonstrate excellence in the comprehensive care of athletes and performers, fostering mental well-being and optimal performance. Through the certification of board-certified sports and performance psychiatrists, the ABSPP aim to enhance the mental health and well-being of athletes, performers, executives, and individuals striving for peak performance in their personal and professional lives.^[6]

Sports psychiatry positions often require specific experience in sports medicine, as well as a master's degree in clinical psychology, counseling, or sports psychiatry especially.^[7] However, in addition to that, they must be aware of individual and team culture as well as approach the prescription of medication with a perspective on doping in sports.^[4]

Professional differences edit

Differences between sports psychologists and psychiatrists, according to Antonia Baum, are that although both areas aim to enhance athletes' performance, psychiatry also focuses on psychopathology and tries to uncover deeper issues than performance problems. Additionally, psychiatrists are able to prescribe psychotropic medication.^[8]

Some of the most commonly found mental disorders in athletes that sports psychiatrists may come in contact with include mood disorders (such as major depressive disorder, bipolar disorder), anxiety disorders (including social anxiety disorder, obsessive-compulsive disorder, eating disorders, attention deficit hyperactivity disorder (ADHD), and substance abuse), and more sport-specific ones such as concussions, body dysmorphic disorder, traumatic brain injuries (TBI), and chronic traumatic encephalopathy (CTE).^[1][3]

Eating and body dysmorphic disorders have higher incidence in women in sports that emphasize appearance, like gymnastics or figure skating.^{[medical citation needed]} Substance abuse is commonly found in the athletic community. College athletes have been reported to use alcohol at higher levels than the general public despite its detriment to performance. Anabolic steroids are also a widely abused substance among athletes. These aid athletes in faster training and recovery time, but may also have psychiatric side effects like irritability and mood swings.^[1] Substance abuse is a concern among elite athletes.^[9]

The treatments of choice for many mental illnesses experienced by athletes include psychotropic medication as well as, depending on the specific situation and life of the athlete, psychotherapy, psychoeducation, counseling, and family therapy.^[3]

The majority of people who use Complementary and Integrative Health Care (CIC) to enhance their athletic performance report positive results. The most commonly used technique is yoga, which a high percentage of users have found helpful. Other styles such as manipulation, spiritual healing, special diets, acupuncture, meditation, and homeopathy were also reported to be beneficial for athletic performance.  With high percentages stating that hypnosis, herbal therapies, massage, yoga, and manipulation had helped with their performance. Additionally, spiritual healing, special diets, acupuncture, meditation, traditional healing, biofeedback, naturopathy, and energy healing therapies were also reported to be helpful. However, due to limited data, odds ratios on the effectiveness of these therapies could not be generated. Overall, the study shows that CIC therapies are widely used and perceived as beneficial for enhancing athletic performance.^[10]

Athletes need enough sleep to recover from their rigorous training, especially young athletes who engage in intense activity. To ensure proper recovery, they should aim for 10 hours of sleep. It's important to follow a consistent sleep schedule and work on gradually increasing sleep duration while reducing the time it takes to fall asleep. By doing so, athletes can improve their overall recovery and alertness. Questionnaires like the Pittsburgh Competitive Exercise Questionnaire and the Pittsburgh Sleep Quality Index can help assess athletes' sleep before events. However, it's important to note that self-reporting techniques are subjective, and athletes might identify different issues. Additionally, some nutrients, such as carbohydrates, protein, alcohol, and caffeine, can affect sleep quality. Carbohydrates are particularly important for athletes to maintain energy levels during intense activities and help in their recovery between training sessions or competitions.^[11]

Psychotropic medication edit

Usually, sports psychiatrists choose non-sedating medications^[12] because they are less likely to cause side effects such as an increase in weight and body fat, sedentary behavior, a decrease in insulin sensitivity, cardiac issues.^[3] The effect on athletes' performance must also be taken into consideration, as well the anti-doping guidelines of different sports leagues. The World Anti-Doping Agency (WADA) provides a list of generally banned substances, and it is left to each leagues' discretion to add a more strict code.^[1]

The interpretation of natural athletic performance is essential in determining acceptable and non-acceptable performance-enhancing means and justifying the ban on Performance Enhancing Drugs (PEDs). To illustrate this point, consider exposure to hypoxic conditions through technology, such as altitude tents and chambers, which utilizes the phenotypic plasticity of the human organism and is deemed to be acceptable as it falls within the natural range. In contrast, the use of EPO is unacceptable as it goes beyond the biological response and adaptation processes that are ideal for natural performance. By understanding the distinction between these two methods, natural performance can promote and continue to improve athletic achievements within acceptable and safe boundaries. ^[13]

According to a recent review, circumin has several biological activities, due to its antioxidant and antiinflammatory properties. It can have positive effects on the heart, immune system, nervous system, and liver. Furthermore, circumin has shown posstive effects on athletes and exercise practitioners. A clinical trial involving both men and women showed that taking 500mg of circumin after eccentric exercise significantly reduced exercise-induced muscle damage and creatine kinase concentrations, leading to better recovery after exercise. ^[14]

Widely used medications include antidepressants (e.g. bupropion), mood stabilizers, anticonvulsants (e.g. lithium), anxiolytics (e.g. benzodiazepines), Psychostimulants/ADHD medications (e.g. dextroamphetamine), and sometimes sedative hypnotics and antipsychotics.^[1]

In professional sports more than others, seeking assistance to improve one's mental health is often stigmatized.^[9] Athletes will most commonly seek help from psychologists first or not go for help at all, and serious mental health-related issues might go unrecognized. Hence, another role of sports psychiatrists is to help de-stigmatize and promote mental health among athletes.^[1][8]

• Sports medicine

• Conant-Norville DO (December 2016). "Child and adolescent sports psychiatry in the US". Int Rev Psychiatry. 28 (6): 556–563. doi:10.1080/09540261.2016.1197189. PMID 27352924. S2CID 3380749.
• Currie, Alan; Owen, Bruce (2016). Sports psychiatry. Oxford: Oxford University Press. ISBN 978-0-19-105382-5. OCLC 958096512.
• Glick, Ira D.; Todd, Stull; Kamis, Danielle (2018-01-19). The ISSP Manual of Sports Psychiatry. Routledge. ISBN 978-1-351-81335-8.
• Currie, Alan; Johnston, Allan (2016). "Clinical sports psychiatry: an international perspective". International Review of Psychiatry. 28 (6). The International Review of Psychiatry Sports Psychiatry 2016: A Developing Field: 587–594. doi:10.1080/09540261.2016.1197188. PMID 27347772. S2CID 3337262.