1. Psychosocial issues for the diabetic patient 2010 Diabetes Area Workshop Fiona Little-CNC Mental Health

2. Overview Prevalence of anxiety and depression Review of the symptoms Management of anxiety and depression- screening, medication and therapeutic approaches Referral pathways

3. 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.

4. 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.

5. 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

6. 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 )

7. Low mood

8. Poor sleep

9. Change in appetite

10. Decreased motivation and interest- anhedonia

11. Feeling tired

12. 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

13. 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.

14. Fear

15. Worrying thoughts

16. Indecision and difficulty problem solving

17. Confused thinking

18. Feeling restless and fidgety

19. Concern for the future

20. 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

21. 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

22. 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

23. The role of medication

24. 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)

25. 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

26. 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