Lec3 adjusting to diabetes


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Lec3 adjusting to diabetes

  1. 1. The Physiology of DiabetesIslet cells of pancreas produce several hormones including glucagon & insulin – critically NB in metabolismGlucagon – stimulates release of glucose – acts to elevate blood sugar levelsInsulin – decreases level of glucose in blood by causing tissue cell membranes to open so that glucose can enter the cells more freelyDisorders of the islet cells result in difficulties in sugar metabolism
  2. 2. The Physiology of DiabetesDiabetes mellitus is caused by insulin deficiencyIf islet cells do not produce adequate insulin – sugar cannot be moved from blood to cells for useExcessive sugar accumulates in the blood which appears in abnormally high levels in the urineUnregulated or poorly regulated – can cause DEATH or COMA
  3. 3. 2 Types: Type I diabetes – juvenile-onset diabetes  Autoimmune disease – person’s immune system attacks insulin-making cells, destroying them  Usually occurs before age 30  Leaves person without the capability to produce insulin - dependent on insulin injections Type II – adult-onset diabetes  Usually after the age of 30  Often affects overweight and poor people
  4. 4. Other Health ProblemsLack of insulin prevents the blood sugar levels from being regulated by the body’s control mechanismsInability to regulate blood sugar levels can cause: Damage to the blood vessels Damage to the retina Kidney diseases Diabetic neuropathy
  5. 5. The Impact of DiabetesManagement of diabetes includes: Careful restrictions in diet Insulin injections Regular exerciseDietary restrictions include: Scheduling of meals and snacks Adherence to a set of allowed and disallowed foods
  6. 6. The Impact of DiabetesBlood sugar levels must be tested at least once a dayDone by drawing a blood sample and using the testing equipment correctlyResults guide diabetics to appropriate levels of insulin injections – source of fear and distressRegular medical visits are also part of the regimen – frightening for children, create scheduling difficulties for parents
  7. 7. Reactions that can Interfere with ManagementSome diabetics deny the seriousness of the condition and ignore lifestyle changes and medication regimensOthers become aggressive and turn their aggression either inwardly or outwardlyMany may become dependent, relying on others for their care – taking no active part in their own care
  8. 8. Health Psychology’s Involvement with DiabetesInvolved in researching and treating diabetes.Research: ways that diabetics understand & conceptualise their illness effect of stress on glucose metabolism dynamics of families with diabetic children factors that influence patient’s compliance with medical regimens
  9. 9. Health Psychology’s Involvement with DiabetesImproving compliance with medical regimensStress can play 2 roles in diabetes  as a possible cause of diabetes  as a factor in regulation of blood sugar in diabeticsDiabetics’ understanding of the illness affects their behaviourThere tends to be an assumption that patients recognize the symptoms of high & low blood glucose levelsSymptom perception is very NB in diabetes management and unfortunately is not as accurate as everyone assumes
  10. 10. Health Psychology’s Involvement with DiabetesCompliance with the treatment regimen is quite poorInnovative approaches such as self-monitoring of glucose levels have been less successful than expected patients fail to use the info they gather to alter their treatment.Patients tend to exhibit unrealistic optimism and cognitive distortions.The addition of hypnosis to a diabetic treatment regimen has been shown to be successful amongst adolescents – poorest compliers.Behaviour-oriented programmes such as problem- solving skills have been shown to improve diabetics’ adherence to diet, exercise, & blood glucose testing.
  11. 11. What is Alzheimer’s Disease?A degenerative disease of the brainMajor source of impairment amongst older peopleCan only be diagnosed definitely through autopsyBrains of Alzheimer’s patients reveal “plaques” & tangles of nerve fibers in the cerebral cortex and hippocampus – physical basis for Alzheimer’s
  12. 12. 2 Forms:One that occurs before age 60 – early onset Due to a genetic defectOne that occurs after the age of 65 – late onset Related to apolipoprotein E (a protein involved in cholesterol metabolism)(E4 form) – increases the risk for developing tangles of neurons by about 3 times E2 form seems to offer some protection
  13. 13. Characteristics of Alzheimer’sSerious cognitive, language and memory difficultiesAgitation and irritability, aggression,Sleep disordersSuspiciousness and paranoiaIncontinenceSexual disordersDepressionDelusionsHallucinations
  14. 14. Characteristics of Alzheimer’sMemory loss starts with “normal” forgetfulness and progresses to the point where Alzheimer’s patients fail to recognize family members and forget how to perform even routine self-careAlso forget words and exhibit word-finding difficulties – dysnomiaForget where they had put their belongings – relates to suspiciousness and paranoia
  15. 15. Helping the PatientNo cure existsPhysical symptoms & accompanying disorders can be treated.Treatment approaches include Drugs Delaying the progression of cognitive deficits Neuroleptic drugs for reducing agitation and aggression Use of music and pets to relax the patient, Behavioural approaches – identifying antecedents, altering the environment Progressively Lowered Stress Threshold Model
  16. 16. Helping the FamilySymptoms for the disease are distressing for family membersPersonality changes and memory difficulties seem most distressingSuspiciousness and paranoia may lead to accusations that hurt family members and aggressive outbursts can disrupt family functioningFamilies tend to find dangerous or embarrassing behaviours particularly distressingCaring for an Alzheimer’s patient greatly disrupts family routine
  17. 17. Helping the FamilyAlzheimer’s caregivers typically experience feelings of loss for the relationship that they once shared with the patientThis sense of loss may be similar to bereavement; only the person is still aliveCaregivers experiencing the stress of their role exhibit a number of their own symptoms:  Fatigue  Frustration  Helplessness  Grief, shame, embarrassment  Anger  Depression
  18. 18. Helping the FamilyResearch - Alzheimer’s caregivers tend to be more distressed, exhibits a poorer immune response, develops more infectious diseasesSupport received from the friends and family members of caregivers can improve the immune functioning of Alzheimer’s caregiversCognitive-behavioural therapies - manage their negative emotionsSupport groups that encourage an open, honest sharing of feelings, including negative feelings, can provide support that families may not be able to giveSupport groups can also be sources of information about caring for the patients & about community resources that provide respite care
  19. 19. Symptoms of HIV and AIDSHIV progresses over a decade or more through 4 stagesPeople vary greatly in the length of time in each stageStage 1 Symptoms are not easily distinguishable from those of other diseases Within approximately a week of infection, people frequently experience fever, sore throat, skin rash, headache, and other mild symptoms First period usually lasts 1 to 8 weeksStage 2 Latent period that may last as long as 10 years Infected people are asymptomatic or experience only minimal symptoms
  20. 20. Symptoms of HIV and AIDSStage 3 Patients normally have a cluster of symptoms including:  swollen lymph nodes  fever  fatigue  night sweats  loss of appetite  loss of weight  persistent diarrhea  white spots in the mouth  painful skin rashStage 4 Patients’ CD4+ T-lymphocyte cell count drops to 200 or less per cubic millimeter of blood
  21. 21. Symptoms of HIV and AIDSAs immune system loses defensive capacities, patients become susceptible to various opportunistic infectious diseasesThese infections involve the lungs, gastrointestinal tract, nervous system, liver, bones, and brainSymptoms include: greater weight loss general fatigue fever shortness of breath dry cough purplish bumps on the skin AIDS-related dementiaAt this point HIV becomes full-blown AIDS
  22. 22. The Transmission of HIVThe main routes of infection are from: person to person during sex mother to child during pregnancy or birth direct contact with blood or blood productsConcentrations of HIV are especially high in the blood and the semen of infected peopleContact with infected semen or blood is a riskContact with saliva, urine or tears – much less of a riskNo evidence that casual contact spreads the disease
  23. 23. The Transmission of HIVMost at risk behaviours include: Male-male sexual contact Injection drug use Heterosexual contact Transmission during the birth process
  24. 24. Psychologists’ Role in the HIV EpidemicEarly years of the epidemic, psychologists involved in both primary and secondary interventionPrimary intervention – changing behaviour to decrease HIV transmissionSecondary intervention:  helping people who are HIV+ to live with the infection  counseling people about being tested for HIV  helping patients live with and deal with social & interpersonal aspects of HIV  helping patients adhere to their complex treatment programmeIncreased survival of HIV+ patients – psychologists’ knowledge about adherence to medical regimens very relevant
  25. 25. Psychologists’ Role in the HIV EpidemicEncouraging protective measuresEncouragement of people to stop high-risk behaviours or to prevent high-risk behaviours by imparting knowledge.Health care workers also have to protect themselves against possible infection.Helping people with HIV infectionPeople who believe they are infected and HIV+ people can benefit from certain psychological interventions.People with high-risk behaviours may have difficulty deciding whether to be tested for HIV – psychologists can provide information & support.Decision to be tested has both benefits and costs.
  26. 26. Psychologists’ Role in the HIV EpidemicBenefits  Knowing HIV status as soon as possible  Positive test can lead to early treatment – prolong person’s life  Possible reduction & elimination of behaviours that place others at riskCosts  May increase anxiety, depression, anger, and psychological distress  Psychological interventions can reduce distress of people who learn they are HIV+  Cognitive-behavioral stress management interventions – successful with boosting positive coping and increasing social support  Psychologists also play a role in adherence to complex medical regimens designed to control HIV infection  Patients typically take antiretroviral drugs, drugs to combat their side effects, drugs to fight opportunistic infections