psychological co morbidity in diabetes mellitus assessment and therapy prof dr claus v gele l.
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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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disability adjusted life years daly sum of years lived with disability and years of life lost
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
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 ...
slide8

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

depression as a risk factor for diabetes neurobiological psychoneuroendocrinological mechanisms
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).
slide10

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

anxiety disorders common amongst diabetics
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
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
slide14

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

what needs to be done
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
what needs to be done17
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
what needs to be done18
What needs to be done?
  • Psychological Treatment
    • Health Promotion and Support in Illness Coping
      • Stress Coping
      • Patient Education
      • Relaxation Training
      • Biofeedback
who is should be in charge
Who is / should be in charge?

Appropriately qualified Psychologists

e.g., Clinical Psychologists, Psychotherapists, Health Psychologists