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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 32  |  Issue : 2  |  Page : 177-178

Influence of psychiatric comorbidity on the treatment process of type 2 diabetic patient


1 Department of Rasashastra and Bhaishajya Kalpana, Abhilashi Ayurvedic College and Research Institute, Abhilashi University, Chail Chowk, Himachal Pradesh, India
2 Department of Basic Principles, Parul Institute of Ayurveda, Vadodara, Gujarat, India
3 Department of Rasashastra and Bhaishajya Kalpana, Gujarat Ayurveda University, Jamnagar, Gujarat, India

Date of Web Publication25-Apr-2016

Correspondence Address:
Dr. Rohit Sharma
Department of Rasashastra and Bhaishajya Kalpana, Abhilashi Ayurvedic College and Research Institute, Abhilashi University, Chail Chowk, Mandi - 175 028, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.181100

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How to cite this article:
Sharma R, Amin H, Prajapati P K. Influence of psychiatric comorbidity on the treatment process of type 2 diabetic patient. Indian J Soc Psychiatry 2016;32:177-8

How to cite this URL:
Sharma R, Amin H, Prajapati P K. Influence of psychiatric comorbidity on the treatment process of type 2 diabetic patient. Indian J Soc Psychiatry [serial online] 2016 [cited 2019 Dec 9];32:177-8. Available from: http://www.indjsp.org/text.asp?2016/32/2/177/181100

Sir,

Among the several comorbidities emphasized, in diabetic patients, stress and psychiatric disorders remain a forgotten and underestimated issue, which in fact have severe impact to the causation, manifestation, and progression of diabetes; therefore, these should be carefully diagnosed and treated early in the course of illness.[1],[2] Comorbidity of both depressive disorders and diabetes lead to decreased adherence to treatment, increased health care use and cost, poor metabolic control, higher complication rates, and decreased quality of life.[3],[4] Some stress is okay (sometimes referred to as “challenge” or “positive” stress) but when it occurs in amounts that individuals cannot cope with, both mental and physical changes may occur. Psychosocial/occupational stress (negative workload, managerial bullying, harassment, etc.), financial worries and unemployment have been linked to higher risk of hypertension, metabolic syndrome, clinical depression, and uncontrolled Type 2 diabetes.[5],[6],[7],[8] The hypothesized mechanisms linking psychosocial stress to Type 2 diabetes include direct psychoneuroendocrine effects and indirect effects through an unhealthy lifestyle.[9],[10]

Here, one would illustrate the aforesaid statements by a brief case study of aggravation of the glycemic levels in a well-controlled diabetic patient, who had an episode of anxiety and depression. The case was a 38-year-old male, diagnosed as Type 2 diabetic, whose glycemic level and sign and symptoms were well-controlled by ongoing oral allopathic medications from last 8 years. Albeit following same daily routine and regular medications, he suddenly had fluctuations in blood glucose between high and low levels and had the reappearance of sign and symptoms of diabetes. Having no relief with medicines, he consulted another physician who prescribed some higher doses of same oral anti-diabetic medications. More than a week passed but was still having clinically uncontrolled diabetes. Hence, he consulted a third physician who prescribed some other oral anti-diabetic agent with higher dosages. Even though he was continuing medicines for 2 weeks, he was still not having any improvement in glycemic levels and sign and symptoms either. Then, he approached our ayurvedic OPD. It was observed that he was having symptoms of anxiety and depression. On counseling, he expressed thus: “Couple of weeks back due my father's illness, I was unable to concentrate on some works which my company had assigned me, due to which my company fell into financial crisis. The boss warned me to sort out the problem within a week otherwise I have to face the legal consequences. However, I failed to do so and was fired off from the job. The incidence made me feel embarrassed before the colleagues. Till now, I am unable to get a new job and my family is facing financial troubles. My professional life is ruined and my all dream have shattered.” After this, he was counseled properly, reassured and along with antidiabetic medications (Chandraprabha vati and Vijayasaradi kwatha), antistress medicines (Ashwagandha churna and Mansyadi kwatha) were started with additional changes in diet and lifestyle, spiritual practices such as yoga asanas, pranayama, and meditation. Within a short period, the patient had started showing clinical improvement and in blood sugar levels.

This case, not uncommon, but it reflects the importance of concern on underlying psychological problem in diabetics. The case supports the association between psychosocial stress and Type 2 diabetes and signifies that even stress management can also reduce the increased glycemic levels in diabetes.[11],[12] Hence, regular counseling is of utmost importance to rule out the exact etiological factors involved in disease aggravation. Recent reports also propose that disease management programs for diabetics should include psychosomatic-psychotherapeutic management.[13] As a recommendation, the author suggests: (a) A strong referral linkage between diabetes and psychiatry clinic to be set functional and further integration of mental health care into diabetes clinic to be considered,[14] (b) motivation of patients to adopt self-coping strategies to buffer the various psychological stresses,[10] (c) educate the society to provide the emotional and practical support to such sufferers of psychosocial stress, and (d) motivate the organizations to understand their legal and moral responsibility to protect the physical and mental well-being of their workers.

In the current stressful lifestyle, to stay healthy is a duty, and helping the distressed is of the highest virtue. The prevailing health care system has been described as rushed, complex, and impersonal.[2] This report is intended to appeal every physician who takes this issue seriously to provide personalized attention and offer sufficient motivation to their patients and heal them in a friendly manner. Management strategies employed should reflect this shared understanding.

Financial support and sponsorship

IPGTRA, Gujarat Ayurved University, Jamnagar.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care 2001;24:1069-78.  Back to cited text no. 1
    
2.
Ciechanowski P. Diapression: An integrated model for understanding the experience of individuals with co-occurring diabetes and depression. Clin Diabetes 2011;29:43-9.  Back to cited text no. 2
    
3.
Andrea A, Mindy L, Linda G, Dennison CR. Depression as co-morbidity to diabetes: Implications for management. J Nurse Pract 2009;5:525-9.  Back to cited text no. 3
    
4.
Robert B, Andrew J, Stephen C, Arleen FB, Usha S, Lu SE, et al. Correlates of depression among people with diabetes: The translating research into action for diabetes (TRIAD) study. Prim Care Diabetes 2010;4:215-22.  Back to cited text no. 4
    
5.
Golmohammadi R, Abdulrahman B. Relationship between occupational stress and non-insulin-dependent diabetes in different occupation in Hamadan (West of Iran). J Med Sci 2006;6:241-4.  Back to cited text no. 5
    
6.
Peykari N, Djalalinia S, Qorbani M, Sobhani S, Farzadfar F, Larijani B. Socioeconomic inequalities and diabetes: A systematic review from Iran. J Diabetes Metab Disord 2015;14:8.  Back to cited text no. 6
    
7.
Heraclides AM, Chandola T, Witte DR, Brunner EJ. Work stress, obesity and the risk of type 2 diabetes: Gender-specific bidirectional effect in the Whitehall II study. Obesity (Silver Spring) 2012;20:428-33.  Back to cited text no. 7
    
8.
Collogan TW, Higgins EM. Workplace stress: Etiology and consequences. J Workplace Behav Health 2005;21:89-97.  Back to cited text no. 8
    
9.
McEwen BS. Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y Acad Sci 1998;840:33-44.  Back to cited text no. 9
    
10.
Lloyd C, Smith J, Weinger K. Stress and diabetes: A review of the links. Diabetes Spectr 2005;18:121-7.  Back to cited text no. 10
    
11.
Surwit RS, van Tilburg MA, Zucker N, McCaskill CC, Parekh P, Feinglos MN, et al. Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care 2002;25:30-4.  Back to cited text no. 11
    
12.
Soo H, Lam S. Stress management training in diabetes mellitus. J Health Psychol 2009;14:933-43.  Back to cited text no. 12
    
13.
Williams MM, Clouse RE, Lustman PJ. Treating depression to prevent diabetes and its complications: Understanding depression as a medical risk factor. Clin Diabetes 2006;24:79-86.  Back to cited text no. 13
    
14.
Dejene S, Negash A, Tesfay K, Jobset A, Abera M. Depression and diabetes in Jimma university specialized hospital, Southwest Ethiopia. J Psychiatry 2014;17:126.  Back to cited text no. 14
    




 

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