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Psychosocial issues for the diabetic patient
2010 Diabetes Area WorkshopFiona Little-CNC Mental Health
Overview
Prevalence of anxiety and depression Review of the symptoms Management of anxiety and depression-
screening, medication and therapeutic approaches
Referral pathways
Prevalence of depression and anxiety
Diagnosis of depression and anxiety is increasing in all areas of health especially in the area of chronic disease.
Incidence in the general population is reported to be between 10-30% (Lane et.al.)
Depression is reported by WHO to be the second most diagnosable illness by 2020.
Prevalence in relation to diabetes
Pts with diabetes are twice as likely to suffer from depression and anxiety as the general population
Higher rates in women (28%) than men (18%) (Anderson et.al.2001) but has been reported to be as high as 45% ( Grigsby et.al.2002)
Greater number of studies on the prevalence of depression than anxiety.
Impact of depression and anxiety for diabetes
Less likely to comply with the lifestyle recommendations for the management of diabetes- avoidance and decreased motivation
Increased risk of hyperglycemia Poorer compliancy with diet, medication and
exercise
Definition of depression
Major Depression is characterised by sadness that is out of proportion to the situation at hand, and is of sufficient persistence, duration and severity that it interferes with everyday functioning.
(Treatment Protocol Project,2007)
Low mood
Poor sleep
Change in appetite
Decreased motivation and interest-anhedonia
Feeling tired
Social, cognitive and behavioural symptoms of depression and anxiety
Decreased social interaction- withdrawal from activities previously enjoyed
Difficulty finding perspective- pessimistic outlook and negative thinking, problem solving impaired
Avoidance and procrastination-health issues become compounded
Definition of anxiety
6 month history of excessive anxiety or worry- “excessive” meaning more that would be expected for an event or situation
Significant difficulty controlling anxiety Over the past 6 months- 3 or more of the
following symptoms-restlessness, fatigue, decreased concentration, muscle tension and sleep disturbance.
Fear
Worrying thoughts
Indecision and difficulty problem solving
Confused thinking
Feeling restless and fidgety
Concern for the future
Practical strategies for management
Know the key symptoms-remember severity, duration and impact
Use of screening tools Basic psycho education Engagement and rapport are key principles in a
therapeutic relationship Know your referral pathways and how your role
can help
The role of screening tools
Used as a guide only to identify possible symptoms
Can be used as an educational tool for patients Useful as a benchmark to monitor changes in
progress HADS, Life Inventory, Worrying thought
questionnaire
The Hospital Anxiety Depression Scale
Screening tool that focuses on the cognitive aspects of depression and anxiety
Reduces the overlapping symptoms associated to both physical and mental health
Evidenced based Series of 14 questions-7 anxiety, 7 depression Scoring:0-3 for each question-cut off points for
both is 8-10 on each scale
The role of medication
The role of medication
There are 6 types of antidepressants SSRI-(Selective Serotonin Reuptake Inhibitors) MAOI-(Monoamine Oxidase Inhibitors) Tricyclic antidepressants Reversible MAOIS Tetracyclic antidepressants SNRI (Serotonin-noradrenaline reuptake inhibitors)
Therapeutic applications
CBT-depression-relationship between thoughts, feelings and behaviours
ACT-anxiety- based on mindfulness principles-teaching a person to accept their thoughts as part of a process-encouraging action based on values
Motivational interviewing-stages of change-precontemplation, contemplation,preparation,action and maintenance
Skills development-sleep, exercise, stress management
Referral Pathways
Need to tailor the care required to the most suitable service
GP/Physicians- available for psychological interventions under variety of mental health programs
Private Psychologist NGO’s- Centrecare, Life Solutions, Anglicare Public health- CMHT