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Psychological co-morbidity in Diabetes mellitus : assessment and therapy Prof. Dr. Claus Vögele

Psychological co-morbidity in Diabetes mellitus : assessment and therapy Prof. Dr. Claus Vögele. Disability-adjusted life-years (DALY): sum of years lived with disability and years of life lost. 20%. Co-morbidity of mental disorders with Diabetes mellitus: a brief summary.

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Psychological co-morbidity in Diabetes mellitus : assessment and therapy Prof. Dr. Claus Vögele

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  1. Psychological co-morbidity in Diabetes mellitus : assessment and therapyProf. Dr. Claus Vögele

  2. Disability-adjusted life-years (DALY):sum of years lived with disability and years of life lost 20%

  3. 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 ...

  4. 12-months estimated prevalence in mood disorders 1.4 1.3

  5. 12-months estimated prevalence in anxiety disorders 1.6 1.5

  6. 12-months estimated prevalence in anxiety disorders 1.3 1.3

  7. Co-morbidity of mental disorders with Diabetes mellitus: a brief summary

  8. Psychological factors and physical conditions: concepts Psychological factors Causal role in aetiology Mental Disorders as a consequence of the physical condition Psychological factors affect prognosis/ treatment Health risk behaviours Neurobiological/psychophysiological processes

  9. 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).

  10. Psychological factors and physical conditions: concepts Psychological factors Causal role in aetiology Mental Disorders as a consequence of the physical condition Psychological factors affect prognosis/ treatment CNS pathology Treatment side effects Responses to changed life-situation - Adjustment

  11. Diabetes as a risk factor for Depression:Nouwen et al., 2010

  12. 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.

  13. 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

  14. Psychological factors and physical conditions: concepts Psychological factors Causal role in aetiology Mental Disorders as a consequence of the physical condition Psychological factors affect prognosis/ treatment Subjective disease model Adherence Physician-patient communication

  15. Effects of severe mental illness on survival of people with diabetes Vinogradova et al., 2010

  16. What needs to be done? • 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

  17. What needs to be done? • 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

  18. What needs to be done? • Psychological Treatment • Health Promotion and Support in Illness Coping • Stress Coping • Patient Education • Relaxation Training • Biofeedback

  19. Who is / should be in charge? Appropriately qualified Psychologists e.g., Clinical Psychologists, Psychotherapists, Health Psychologists

  20. Literatur

  21. VillmolsMerci!

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