Gary M. Rodin

Depression And The Medically Ill : An Integrated Approach

Discusses the relationship between depression and medical illness and the diagnosis and management of depression in the medically ill.

Eating Disorders in Female Adolescents with Insulin Dependent Diabetes Mellitus

Recent case reports have suggested an association between anorexia nervosa and/or bulimia with insulin-dependent diabetes mellitus (IDDM). Fifty-eight females aged fifteen to twenty-two with IDDM for more than one year were assessed for the presence of eating disorders. Patients were screened for eating and weight pathology using the Eating Disorder Inventory (EDI) and Eating Attitudes Test-26 (EAT-26). Glycosylated hemoglobin (HbAl) was measured to assess metabolic control. Subjects who scored above the cut-off points associated with eating and weight pathology were interviewed. Clinically significant eating and weight pathology was found in 20.7 percent of the population. Of these subjects, anorexia nervosa was found in 6.9 percent and the syndrome of bulimia, based on DSM-III criteria, was found in 6.9 percent. In patients with bulimia, there was a strong inverse correlation between bulimic symptoms and metabolic control. These findings suggest that anorexia nervosa may be more common in female adolescents with IDDM than in nondiabetic populations and that bulimic symptoms may be a risk factor for poor metabolic control.

Anorexia nervosa and bulimia in female adolescents with insulin dependent diabetes mellitus: a systematic study.

An unselected sample of 46 female adolescents with insulin-dependent diabetes mellitus (IDDM) for more than one year were assessed systematically for the presence of anorexia nervosa and bulimia. These disorders and their partial syndromes were found in 19.5% of this population. Anorexia nervosa and bulimia diagnosed on the basis of DSM-III criteria were each found in 6.5% of the population representing approximately a 6-fold and 2-fold increase respectively in the expected prevalence for similar nondiabetic individuals. Bulimic symptoms were associated with poor metabolic control as reflected in blood levels of glycosylated hemoglobin (HbAl). These findings have important implications both for the pathogenesis of anorexia nervosa and bulimia and for the management of some cases of IDDM with unstable metabolic control.

Stopping Life-Sustaining Medical Treatment: Psychiatric Considerations in the Termination of Renal Dialysis

Data are presented regarding the decision by medical staff and by patients to discontinue renal dialysis. Some relevant issues regarding the patients are discussed, including their mental competence, underlying motivation and psychiatric state. Also some of the medical factors involved in the decision to stop treatment are considered. Emphasis is placed on the importance of the patients sense of active participation and involvement in his treatment. Mention is made of the importance of interventions to decrease the psychological morbidity in survivors of patients who stop dialysis.

Stress, coping, and depression in non-ulcer dyspepsia patients.

Thirty adults with upper gastrointestinal symptoms in the absence of structural organic disease diagnosed with non-ulcer dyspepsia (NUD) were compared to 30 healthy adults who had visited the hepatobiliary clinic for medical evaluation of non-organic complaints without NUD. Medical investigation in both groups were negative. Before independent gastrointestinal physicians conducted diagnostic evaluations, all subjects were evaluated for anxiety and depressive symptoms, stressful life events, coping style, and social support. The measures included Symptom Checklist 90-Revised (SCL-90-R), Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Ways of Coping Checklist, and Interpersonal Support Evaluation List, and a self-report questionnaire, which measured the quantity of perceived stressful life events. The NUD patients reported significantly more symptoms of depression, more perceived stressful life events, less problem-focused coping, and less social support than the control subjects. Depressive symptoms were negatively correlated with interpersonal support, whereas, problem-focused coping was positively correlated with interpersonal support in the NUD patients. The two groups did not differ significantly in terms of anxiety and emotion-focused coping. The implications of these findings for the diagnosis and treatment of NUD are discussed.

ANOREXIA NERVOSA AND BULIMIA IN FEMALE ADOLESCENTS WITH INSULIN DEPENDENT DIABETES MELLITUS: A SYSTEMATIC STUDY

Summary An unselected sample of 46 female adolescents with insulin-dependent diabetes mellitus (IDDM) for more than one year were assessed systematically for the presence of anorexia nervosa and bulimia. These disorders and their partial syndromes were found in 19.5% of this population. Anorexia nervosa and bulimia diagnosed on the basis of DSM-III criteria were each found in 6.5% of the population representing approximately a 6-fold and 2-fold increase respectively in the expected prevalence for similar nondiabetic individuals. Bulimic symptoms were associated with poor metabolic control as reflected in blood levels of glycosylated hemoglobin (HbAl). These findings have important implications both for the pathogenesis of anorexia nervosa and bulimia and for the management of some cases of IDDM with unstable metabolic control.

Stress, Social Support, and Symptoms of Depression in Spouses of the Medically Ill

This study investigated the level and frequency of depressive symptoms in spouses of dialysis patients, as a function of a) severity of patient disease, b) level of stress experienced by the spouse, and c) perception of support from the ill partner. The subjects were forty patients who had begun dialysis in the last year and their spouses. Measures of depression, impact on family, perceived social support, and disease severity were applied. Significant depressive symptoms were reported by 20 percent of spouses. Symptom severity was not correlated with age, sex, or occupation of the spouses, nor with level of depression or functional impairment of the dialysis patients. The amount of social support received from the ill partner accounted for 37 percent of the variance in spouse depression, while social and financial stressors reported by the spouse explained 13 percent of the variance in spouse symptoms. These findings suggest that depressive symptoms in spouses of dialysis patients are associated with the social and economic consequences of the illness for the family but even more so with the amount of perceived support from the patient. The determinants of this perceived support need further exploration.

Eating problems and the observed quality of mother-daughter interactions among girls with type 1 diabetes

This study examined how eating problems are linked to autonomy and intimacy in the observed interactions of 88 diabetic girls (M = 14.9 years) and their mothers. On the basis of self-reported symptoms, teens were classified as having no eating problems (n = 40), mild eating problems (n = 30), and frequent eating problems (n = 18). Mothers and daughters participated in 2 videotaped problem-solving tasks (1 diabetes related and I a general parent-teen issue) that were rated with a macroanalytic coding system (Autonomy and Intimacy Rating System). Compared with interactions among mothers and daughters with no eating problems, interactions among mothers and daughters with eating problems simultaneously constrained the expression of autonomy and intimacy. Findings support clinical theory that links eating problems to emotional misattunement in the mother-daughter relationship, which is postulated to interfere with the teens capacity for individuation.

Psychosocial aspects of diabetes mellitus.

The significance of emotional factors in diabetes mellitus is reviewed in the light of recent changes in treatment. Newer evidence has not supported the concept of a specific diabetic personality. However, lowered self-esteem and feelings of depression have been found to be common in diabetics and particularly in those with poor control of their illness. Illnesses such as diabetes may be associated with feelings of defectiveness and helplessness about regulating bodily functions and achieving a sense of self-sufficiency. Poor control of diabetes in children appears to be associated with pathological interactions in their families. Also, the course of the illness in most patients is correlated with measures of life stress. Newer treatment modalities offer the possibility for improved metabolic control and perhaps for increased psychological well-being.

Geriatric referrals to a psychiatric consultation-liaison service

Geriatric patients constitute a significant proportion of referrals to a psychiatric consultation-liaison service, accounting for 29% of referrals in the present study. Organic mental disorders, the most common psychiatric diagnosis, were identified in 51% of geriatric referrals. The next most common psychiatric conditions were affective disorders and adjustment disorders, each of which were diagnosed in 17% of geriatric referrals. Transfers to in-patient psychiatry were unusual and the most common recommendations were for psychotropic medications, further medical investigations, and for psychosocial and behavioural interventions to be carried out by the ward staff. Although more specialized psychogeriatric units and community treatment resources are necessary, it is likely that the general hospital setting will continue to be important in the diagnostic assessment and short-term management of medical-psychiatric problems in the elderly.