Co-morbidity of mental disorders with Diabetes mellitus: a brief summary
• Prevalence rates vary in relation to assessment techniques used. Typically higher prevalence rates (in particular depression and anxiety disorders) occur with the use of self-report scales as opposed to clinical interviews.
• Nevertheless ...
Co-morbidity of mental disorders with Diabetes mellitus: a brief summary
Mental Disorder OR or observed prevalence
Mood Disorders Major Depression 1.4Dysthymia 1.3
Anxiety Disorders GAD 1.6Agoraphobia/Panic 1.5Social Phobia 1.3PTSD 1.3
Schizophrenia 15% versus 2-3% (comm.)
Psychological factors
Mental Disorders as a consequence
of the physical condition
Psychological factors affect
prognosis/treatment
Causal role inaetiology
Health risk behavioursNeurobiological/psychophysiological processes
Psychological factors and physical conditions: concepts
Depression as a risk factor for Diabetes:neurobiological/psychoneuroendocrinological mechanisms
• Depression is an independent risk factor for type 2 Diabetes (Eaton et al., 1996; Kawakami et al., 1999)
Evidence for endocrinological mechanisms:
Depression is associated with • increased serum glucocorticoids, catecholamines, and growth hormone (which counter the effects of insulin)
and• insulin resistance
and• secrection of inflammatory cytokines, which could facilitate development of diabetes (Musselmann et a.,
2003).
Psychological factors
Mental Disorders as a consequence
of the physical condition
Psychological factors affect
prognosis/treatment
Causal role inaetiology
Psychological factors and physical conditions: concepts
CNS pathologyTreatment side effects
Responses to changed life-situation - Adjustment
Anxiety Disorders common amongst Diabetics
• Hypoglycaemia anxiety
– This can be associated with impaired perception of hypoglyaemic symptoms, which increases the probability of unexpected hypoglycaemic episodes and, therefore, the development of severe anxiety.
• Specific type of blood-injection-injury phobia
– Can lead to irregular insulin injections with all adverse consequences.
• Panic Disorder (with or without Agoraphobia)
– Panic attacks are often accompanied by very similar symptoms than hypoglycaemic episodes. Hypoglycaemic episodes can, therefore, contribute to the development of Panic Disorder.
Eating Disorders common amongst Diabetics
• The management of Diabetes requires patients to constantly be aware and check their food. The cognitive pattern (restrained eating) is typical for patients with Eating Disorders.
• Anorexia nervosa and Bulimia nervosa are not more prevalent amongst Diabetics compared to community samples.
However:
• EDNOS (sub-clinical Eating Disorders syndromes) are more than twice as prevalent amongst young female Type-I diabetics.
• Insulin-purging: deliberately reduced insulin intake in order to promote weight-reduction and fat-loss
Psychological factors
Mental Disorders as a consequence
of the physical condition
Psychological factors affect
prognosis/treatment
Causal role inaetiology
Psychological factors and physical conditions: concepts
Subjective disease modelAdherencePhysician-patient communication
What needs to be done? 1.Psychological assessment
• Interview (DSM), Questionnaires
• Behavioural analysis:
Analysis of individual conditions maintaining pathological processes
Subjective Disease Models
Illness Behaviour and Treatment Adherence
Assessment of Individual Resources
What needs to be done?
2.Psychological Treatment
Treatment of Co-morbid Mental Disorders
Depression: CBT and/or Pharamcotherapy
Anxiety Disorders: CBT
Blood glucose awareness training
Discrimination training (learning to discriminate between symptoms of hypoglycaemia and panic reactions)
Exposure based techniques
Eating Disorders: CBT techniques
in particular mirror image exposure
What needs to be done?
2.Psychological Treatment
• Health Promotion and Support in Illness Coping
Stress Coping
Patient Education
Relaxation Training
Biofeedback
Who is / should be in charge?
Appropriately qualified Psychologists
e.g., Clinical Psychologists, Psychotherapists, Health Psychologists
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