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Diabetes Mellitus as a Model of Psychosomatic and Somatopsychic Interrelationships

Published online by Cambridge University Press:  10 April 2014

Ludvig I. Wasserman  and
Elena A. Trifonova
Ludvig I. Wasserman*
Affiliation:
V.M. Bekhterev Psychoneurological Research Institute, St.Petersburg, Russia
Elena A. Trifonova
Affiliation:
V.M. Bekhterev Psychoneurological Research Institute, St.Petersburg, Russia
*
Correspondence concerning this article should be addressed to Prof. Ludvig I.Wasserman, Head of Laboratory of Clinical Psychology of V.M. Bekhterev Psychoneurological Research Institute, 193019, St. Petersburg, ul. Bekhtereva 3, Russia. Tel: +7-812- 265-04-44 / 567-71-27. Fax: +7-812- 265-04-44. e-mail: LW@KC5566.spb.edu, wasserman@bekhterev.org
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Abstract

The article reviews research on the problem of interrelationship between different physical and psychosocial factors in type 1 diabetes mellitus (DM1). The authors consider methodological principles of health-related quality of life (HRQoL) assessment in DM1 patients and stress the need for an integrated biopsychosocial approach to the management of the disease. DM1 is a chronic metabolic disease with an absolute requirement for insulin replacement therapy. The stress-inducing nature of DM1 is associated with its unexpected and dramatic manifestation in juvenile years, life-threatening nature of severe hypo-/hyperglycaemias and long-term complications, with the burden of diabetes self-management, threat of work disability, employment and career problems etc. These features of DM1 increase the likelihood of the development of anxiety and depressive disorders, which, in turn, may negatively influence the course of diabetes and in particular, diabetes self-care. This necessitates early diagnosis of emotional and behavioral disturbances in DM1 using self-report instruments as well as clinical assessment. Evidence suggests that active problem-focused coping behavior and adequate social support promote adherence to diabetes regimes and may act as a buffer against negative effects of the disease on HRQoL in DM1 patients. The core element in the HRQoL structure is personal disease picture (as opposed by objective clinical picture) – the cognitive-affective-behavioral complex reflecting the patient's personal perception of the disease. Examination of the personal disease picture and attitude towards the ailment in DM1 patients may help to improve understanding of the mechanisms of poor adjustment. Problems in disease adjustment can be detected also by diabetes-specific HRQoL assessment. The measures of HRQoL can be applied as screening instruments useful in increasing the effectiveness of patient-provider interactions and diabetes care.

El artículo revisa la investigación del problema de la interrelación entre diferentes factores físicos y psicosociales en la diabetes melitus tipo 1 (DM1). Los autores consideran los principios de la evaluación de la calidad de vida relacionada con la salud (CVRS) en pacientes de DM1 y ponen de manifiesto la necesidad de un abordaje biopsicosocial integrado del manejo de la enfermedad. La DM1 es una enfermedad metabólica crónica con una necesidad absoluta de terapia de reemplazo de insulina. La naturaleza estresante de la DM1 se asocia con su aparición inesperada y dramática durante los años de juventud, la naturaleza peligrosa de las hipo e hiperglucemias y las complicaciones a largo plazo, con la carga del auto-cuidado de la diabetes, la amenaza de discapacidad laboral, problemas de empleo y carrera, etc. Estas características de la DM1 aumentan la probabilidad de desarrollar trastornos de ansiedad y depresivos que, a su vez, pueden afectar negativamente el curso de la diabetes y, en particular, el auto-cuidado de la diabetes. Esto requiere un diagnóstico temprano de los trastornos emocionales y comportamentales en los enfermos de DM1, empleando instrumentos de auto-informe además de la evaluación clínica. La evidencia sugiere que el comportamiento de afrontamiento activo centrado en los problemas y el apoyo social adecuado promocionan la adherencia a los regímenes diabéticos y pueden amortiguar los efectos negativos de la enfermedad en la CVRS en los pacientes con DM1. El elemento esencial en la estructura de la CVRS es el cuadro clínico personal (en contraste con el cuadro clínico objetivo)—el complejo cognitivo-afectivo-conductual que refleja la percepción personal que tiene el paciente de su enfermedad. El examen del cuadro de enfermedad personal y la actitud hacia la enfermedad en los pacientes con DM1 puede mejorar la comprensión de los mecanismos de desadaptación. Los problemas en la adaptación a la enfermedad también pueden detectarse por medio de la evaluación de la CVRS específica para la diabetes. Las medidas de CVRS pueden aplicarse como instrumentos de criba útiles para incrementar la efectividad de las interacciones paciente-cuidador y del cuidado de la diabetes.

Keywords

diabetes mellituspsychosocial factorsdisease adjustmenthealth-related quality of lifepsychological assessmentdiabetes melitusfactores psicosocialesadaptación a la enfermedadcalidad de vida relacionada con la saludevaluación psicológica
Type
Articles
Information
The Spanish Journal of Psychology , Volume 9 , Issue 1 , May 2006 , pp. 75 - 85
Copyright
Copyright © Cambridge University Press 2006

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