PRSENETATION BY DR. JOSEPHINE A.OMONDI CHILD/ADOLESCENT PSYCHIATRIST KNH
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Transcript of PRSENETATION BY DR. JOSEPHINE A.OMONDI CHILD/ADOLESCENT PSYCHIATRIST KNH
PRSENETATION BY
DR. JOSEPHINE A.OMONDICHILD/ADOLESCENT
PSYCHIATRIST
KNH
SYMPOSIUM
DIABETES AND DEPRESSION
KNH CONFERENCE18TH OCTOBER 2012
DefinitionEpidemiologyWhy depression in DMTypes of depressionClinical pictureReduction of morbidityManagementchallenges
DefinitionsHealth - a state of physical, mental and social well being and not merely the absence of disease or infirmity
Mental Health: - a state of well being in which the individual realises his or her own abilities, can cope with normal stresses of life, can work productively and fruitfully and is able to make a contribution to his her community
Prevalence of Mental illness WHO health report 2001 – estimated that
450m suffered from mental disorders Psychiatric disorders ranked 5th out of the 10
causes of disability in the global population 3-18% children have significant psychiatric
disorders 50% of psychiatric disorders have their onset
by age of 14 years 75% have onset by 24 years
Therefore intervention on preventive measures is best solution
By 2020 depression will be 2nd in burden of disease
Physical illness and depression Having a severe or chronic physical illness is associated with an increased risk for depression
With Diabetic Mellitus, the mechanism is non clear, however, possibility of stresses associated with physical illness may act by bringing out an individuals lifetime vulnerability to depression
Most cancer patients have no depression
Parkisons disease
Diabetes Mellitus + Depression◦The most frequent psychiatric disorders in patients with Diabetes Mellitus (DM) are anxiety and depressive disorders
◦Among Diabetics in the general population, anxiety disorders occur in 45% Depressive disorders up to 35%
◦Rosenthal et all in a 3 year prospective study of hospitalization and mortality in older patients with DM found that a combined presence of retinopathy and high depressive score on a depressive scale had the strongest relationship with mortality
Research in outpatient clinicsMost research done in outpatient clinics in KNH on psychiatric morbidity have demonstrated that psychiatric morbidy in out patient clinics ranges from 40-60% with depression taking the lead
◦For both type 1 and 2 DM patients, they are twice as likely to experience depression as those without DM
◦New finding – patients with Schizophrenia are at increased risk of developing DM – type II probably shared inherited risk factors for the two disorders (weak evidence)
◦2nd generation antipsychotics i.e. Olanzapine,Quetiapine, are associated with type II DM due to abnormal glucose metabolism
Neurotransmitter Deficiency of NE and 5HT Dysregulation of synaptic transmission Reward/ punishment neural system ( behavior potentiated via NA system and inhibited following unpleasant experience by 5HT system.
Genetic risks Sociological Response to intolerable life situations Adverse life events
Sociological Chronic illnesses Behavioral Conditioning by repeated losses in the past Cognitive dysfunction(Beck et al 1979) Psychoanalytic Loss of love object(lost object in cooperated
into self and bitterly attacked by superego) Premorbid personality sub-depressive personality e.g.
insecure ,obsessional and sensitive to criticism
Bipolar – alt with mania
Unipolar- major depression ,dysthymia
Psychotic verses neurotic
Endogenous verses exogenous
Masked verses reactive
Typical verses atypical
Dysphoric mood- sad, blue ,irritable hopeless Loss of interest or pleasure in previously enjoyed
activities Changes in psychomotor activity Changes in appetite and wt Sleep disturbance Sense of worthlessness Cognitive slowing(pseudo-dementia) Thoughts of death or suicide Self neglect ,excessive concern with physical health Atypical symptoms
Reduction of morbidity◦Psychiatric disorders are appropriately treated
◦Monitor Psychiatric patients for excess weight gain and Diabetic Mellitus
◦The presence of anxiety/Depression is important in determining the quality of a patients life irrespective of DM
Adherence problems that complicate care especially children and adolescents with type 1
ImpatienceLack of understanding the developmental requirements
Family disorder/dysfunction and no support
limited education
Management of depression◦Multimodal approach◦Holistic evaluation of the patient◦Non-medication interventions-CBT ,family sessions, social cultural
◦Medication – Keep in mind the Diabetogenic effects of some antipsychotics and antidepressants
◦Lack of support system◦Difficult personality◦Limited choice of medication◦Lack of information among some of the health care providers
◦Image of the patients especially the youth
THE END
THANK YOU