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