 PRSENETATION BY  DR. JOSEPHINE A.OMONDI  CHILD/ADOLESCENT PSYCHIATRIST  KNH

SYMPOSIUM DIABETES AND DEPRESSION KNH CONFERENCE 18 TH OCTOBER 2012

 Definition  Epidemiology  Why depression in DM  Types of depression  Clinical picture  Reduction of morbidity  Management  challenges

 Definitions  Health - 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 5 th 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 2 nd 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 clinics  Most 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) ◦ 2 nd 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 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