 PRSENETATION
 DR.
BY
JOSEPHINE A.OMONDI
 CHILD/ADOLESCENT
PSYCHIATRIST
 KNH
SYMPOSIUM
DIABETES AND DEPRESSION
KNH CONFERENCE
18TH OCTOBER 2012
 Definition
 Epidemiology
 Why
depression in DM
 Types of depression
 Clinical picture
 Reduction of morbidity
 Management
 challenges
 Health
 Definitions
- 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
 Most
in outpatient clinics
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
Impatience
Lack
of
understanding
developmental requirements
Family disorder/dysfunction
no support
 limited education
the
and
 Management
of depression
◦Multimodal approach
◦Holistic evaluation of the patient
◦Non-medication interventionsCBT ,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