2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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.
12.
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21.
22. 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
23. 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
24. 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
25. 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
26. The Transmission of HIV
Most at risk behaviours include:
Male-male sexual contact
Injection drug use
Heterosexual contact
Transmission during the birth process
27. 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
28. 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.
29. 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
