diabetes and mental health

Diabetes and Mental Health

Chapter 18

David J. Robinson, Meera Luthra,

Michael Vallis

Canadian Diabetes Association 2013 Clinical Practice Guidelines


1. Psychiatric disorders, particularly depression, anxiety and eating disorders, are prevalent in diabetes

2. Mental illness increases risk of diabetes and diabetic complications

3. Patients taking psychiatric medications need metabolic screening

4. Screening for depression and anxiety is important in patients with diabetes

2013Key Points


1. Psychiatric disorders, particularly depression, anxiety and eating disorders, are prevalent in diabetes


2. Mental illness increases risk of diabetes and diabetic complications

• Non-adherence to medication and self-care• Functional impairment• Risk of complications • Healthcare costs• Risk of early mortality

Mental Illness

Diabetes

Depression increases risk of

DM by 60%!


Psychoactive Medications May Predispose to Diabetes

• Especially second-generation antipsychotics (olanzapine, clozapine, risperidone, quetiapine, aripiprazole, ziprasidone)

• Biochemical and lifestyle factors may also contribute

• Co-morbid mental illness can worsen diabetes control


3. Patients taking high-risk psychiatric medications need metabolic screening

Parameter Base-line

1 mo 2 mos 3 mos Every 3-6 mos

Annually

Weight (BMI) X X X X X

Waist circumference X X X

Blood pressure X X X

Fasting glucose and/or A1C

X X X

Fasting lipids X X X

Personal history of alcohol, tobacco, recreational drugs

X X X

Family history X X


Depressive symptoms in 30% of patients with diabetes

• Major depressive disorder in 10%

• Co-morbid depression worsens clinical outcomes in DM– Lower physical fitness?– Poor medication adherence?


Diabetes Distress

• Despondency and emotional turmoil related to

diabetes, the need for monitoring and treatment,

preoccupation with complications, and loss of

relationships

• Related to poorer outcomes


Websites with psychological / psychiatric scales:www.phqscreeners.com

www.outcometracker.org/scales_library.php.

4. Screening for depression and anxiety is important in patients with diabetes

Purpose Tools

Diabetes-specific •Problem Areas in Diabetes (PAID) Scale•Diabetes Distress Scale (DDS)

Quality of Life •WHO-5

Depression/Anxiety •Hospital Anxiety and Depression Scale (HADS)

•Patient Health Questionnaire (PHQ-9)•Beck Depression Inventory (BDI)

http://www.phqscreeners.com/

http://www.outcometracker.org/scales_library.php


Treatment

• Cognitive-behavioural therapy

• Other psychotherapy

• Antidepressant medication


Other Psychiatric Associations

• Bipolar disorder

• Anxiety

• Eating disorders

• Schizophrenia and other psychotic disorders


Recommendation 1

1. Individuals with diabetes should be regularly

screened for subclinical psychological distress and

psychiatric disorders (eg. Depressive and anxiety

disorders) by interview [Grade D, Consensus] or with a

standardized questionnaire [Grade B, Level 2]


Recommendation 2

2. Psychosocial interventions should be integrated

into diabetes care plans [Grade B, Level 2], including

– Motivational interventions [Grade B, Level 2]

– Stress management strategies [Grade B, Level 2]

– Coping skills training [Grade A, Level 1A for type 2 diabetes;

Grade B, Level 2, for type 1 diabetes]

– Family therapy [Grade A, Level 1B]

– Case management [Grade B, Level 2]

2013


Recommendation 3

3. Antidepressant medication should be used to

treat acute depression [Grade A, Level 1A] and for

maintenance/prophylactic treatment of depression

[Grade A, Level 1A]. Cognitive-behaviour therapy (CBT)

alone [Grade B, Level 2] or in combination with

antidepressant medication [Grade A, Level 2] may be used

to treat people with depression in diabetes.


Recommendation 4

4. Antipsychotic medications (especially

atypical/second generation) can cause adverse

metabolic changes [Grade A, Level 1]. Regular

metabolic monitoring is recommended for patients

with and without diabetes who are treated with such

medications [Grade D, Consensus]

2013


CDA Clinical Practice Guidelines

http://guidelines.diabetes.ca – for professionals

1-800-BANTING (226-8464)

http://diabetes.ca – for patients

http://guidelines.diabetes.ca/

http://diabetes.ca/

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