Chronic physical illnessandmental health

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Group member

• Alina Shiraz

• Anoshah Ashiq Ali

• Danial Hassan

• Muazzama Moiz

• Jamila Pinin Khan

• Sania Zulfiqar Ali

• Sajjad Ali

• Zahra Lalani2

Objectives

Following to our presentation, students will be able to;•Discuss case scenarios highlighting chronic physical illness and mental health and vice versa.

•List the factors of chronic physical illness effecting mental health and vice versa.•Integrate the relation between chronic physical illness and mental health with literature.•Analyze the prevalence of the topic in Pakistan.•Discuss the role of public health nurse in alleviate the incidence of either case.•Discuss the resilience strategies to overcome chronically ill patient

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Case study

CASE STUDY

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Risk Factors

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Chronic Hepatitis C and Depression

• There are three dimensions which would help in understanding variety of factors of depression in patients with HCV:

1. Depression associated with HCV and related complications

2. Associated psychosocial variables that may confer increased risk of depression

3. IFN-induced depression. (Chereji et al., 2016)

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Depression associated with HCV and related complications

• Relationship chronic hepatitis C and depression is unknown.

• However there are three factors that may contribute in building association:

1. Infected individuals are usually young.2. Associated psychosocial variables that may confer

increased risk of depression.3. The virus may causes an alterations in the regulation

of dopamine and serotonin neurotransmitters.(Chereji et al., 2016)

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Depression associated with HCV and related complications

Reference Sample size and characteristics

Purpose Result

Gallegos-Orozco 157 patients with HCV attending a Hepatology clinic and with no previous history of antiviral treatment

Prospective assessment of HRQOL, and depression

Approximately 60% had significant symptoms of depression.Patients had significantly lowerHRQOL scores associated withdepression and poor illnessunderstanding.

(Chereji et al., 2016)9

Psychosocial variables

• Followings are the psychosocial variable that may co-occur with CHC:

1. Concurrent substance abuse

2. Socio-economically underprivileged populations

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IFN-induced depression

• IFN has been the primary component of antiviral treatment.

• Pegylated formulations of IFN allowed once per week injections and dramatically increased SVR, particularly when given in combination with ribavirin.

• Depressive symptoms usually starts to appear within the first 3 months of treatment.

(Chereji et al., 2016)

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Cont..

• Multiple proposed mechanisms exist by which IFN therapy may result in depressive symptoms;

1. Increase serotonin reuptake and decrease serotonin concentrations in the brain

2. Increased pro-inflammatory cytokines

3. Tryptophan (a precursor of serotonin) depletion

(Chereji et al., 2016)12

IFN-induced depression

Reference Sample size and characteristics

Purpose Result

Otsubo et al. 85 patients with HCV receiving IFN therapy at auniversity hospital

Prospective assessment (6 month treatment period) of depressionduring IFN therapy

37.3% of individuals who were asymptomatic for depression at the start of treatment were diagnosed with MDD at least once during IFN treatment.

(Chereji et al., 2016)13

Treatment Approaches

• It is highly significant to screen individuals who are at risk for depression before preceding to the treatment. Pre-existing depressive symptoms can get worsen with interferon therapy.

• Several antidepressant medications are being used in treating IFN-induced depression

• Cognitive-behavior therapy.(Malhotra et al., 2011)

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CVD and Depression

• Depression is more prevalent in patient with CVD.

• It is also responsible for increased risk of cardiac morbidity and mortality, independent of other risk factor.

• This bi-directional association between depression and cardiac disease likely involves both physiologic and behavioral effects.

(Huffman et al., 2013)15

Risk factors of depression in CVD

Fear of impending mortality

Other debilitating disease like Diabetes

Depression

Mal-adaptive behaviors such as;smoking, sedentary lifestyle,

and social isolation

Demographic variables such as; gender, social economic status

Cardiac disease

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Mechanisms by which depression may impact cardiac outcomes

(Huffman et al., 2013)17

Diabetes and Depression

• Comorbid diabetes and depression are a major clinical challenge as the outcomes of both conditions are worsened by the others.

• It is estimated that 285 million people are suffering from diabetes and will rise to 438 million by year 2030.

• Individuals with diabetes are twice as likely to undergo anxiety and depression as compare to general population.

(Khuwaja et al., 2010)18

Cont..

• A variety of explanatory theoretical models have been proposed to explain the comorbidity of diabetes and depression;

1. Clinical Burden of Disease

2. Lifestyle Factors and Adherence

3. Antidepressant Medications

4. Sleep

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• In Pakistan people with DM II have 24% increased risk of depression and Pakistan has ranked 7th on the list of countries having major burden of DM.

SAMPLE SIZE AND CHARACTERSTICS

AIM OF STUDY

RESULTS REFERENCE

n= 140Both male and female suffering from DM II

Patient with DM II and history of psychiatric illness were excluded.

To determine frequency of depression among patient with DM II

Depression was present among 103 (73.6 %) of sample84 (60%) people have severe depression 10 (7.2%) moderate and 9 (6.4% ) mild depression

Depression was more common in females than in males.

Khan et al , 2014)

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Mental illness and Physical health

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(Hert, et al.,2011)23

Schizophrenia and Physical illness

• Schizophrenia is also known as ‘life-shortening disease.’

• The substantial cause of high mortality in schizophrenic patients is physical illness.

• In spite of physical illness, somatic wellbeing of such patients has been neglected; mainly due to the stigmatization.

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Principal Causes of Ill health in Schizophrenia

• Behavioral factors:

1. Sedentary lifestyle

2. Diet

3. Smoking

• Medications; Side effects of antipsychotic drugs.

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Anti-psychotic drugs and Obesity

• Several Canadian and US studies reported rates of obesity (BMI ≥30) in patients with schizophrenia of 42–60%.

• Mechanism is related to serotonin receptors in the brain and delayed satiety signaling.

• According to NICE (2002), drugs cause increased appetite, and thus causes weight gain.

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Anti-psychotic drugs and CVD

• Patient with schizophrenia are at increased risk for cardiovascular morbidity and mortality.

• There is significantly high risk of developing orthostatic hypotension with Atypical antipsychotics especially clozapine.

(Mackin, 2008)

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CVD and Antipsychotic drugs

• Antipsychotic drugs also makes a significant change in ECG. It causes the elongation of QTc. Prolong QTc is an indicator of arrhythmia.

• Torsade de pointe, may lead to syncope, dizziness or ventricular fibrillation and sudden death.

• The fundamental mechanism of these effects is unclear.

(Mackin, 2008)28

Viral diseases

• Patients with SMI are at increased risk for a variety of chronic viral infections, due to which persons immunity gets low and chances of chronic physical illness increases.

• Of which the most serious are the diseases associated with human immunodeficiency virus (HIV) and hepatitis C virus.

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ROLE OF NURSE FOR INTEGRATING MENTAL

AND PHYSICAL HEALTH IN DIFFERENT SETTINGS

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Building Resilience

Making connections

Move toward

your goals

Avoid seeing crises as

insurmountable problems

Accept that change is a

part of living

Take decisive actions

Look for opportunities

for self-discovery

Nurture a positive view of yourself

Keep things in perspecti

ve

Maintain a hopeful outlook

Take care of

yourself

Meditation and

spiritual practices

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Summarization

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Referenceo Depression in adults. (2017). Uptodate.com. Retrieved 30 August 2017, from

https://www.uptodate.com/contents/depression-in-adults beyond-the-basics

o Depression - Mental Illness - Mental Health Basics - Mental Health - CDC. (2017). Cdc.gov. Retrieved 30 August 2017,

from https://www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm

o Ciechanowski, P., Katon, W., & Russo, J. (2000). Depression and Diabetes. Archives Of Internal Medicine, 160(21), 3278.

doi:10.1001/archinte.160.21.3278

o Nicholson, A., Kuper, H., & Hemingway, H. (2006). Depression as an aetiologic and prognostic factor in coronary heart

disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart

Journal, 27(23), 2763-2774. doi:10.1093/eurheartj/ehl338

o Larsen, B. A., & Christenfeld, N. J. (2009). Cardiovascular Disease and Psychiatric Comorbidity: The Potential Role of

Perseverative Cognition. Cardiovascular Psychiatry and Neurology, 2009, 1-8. doi:10.1155/2009/791017

o Huffman, J. C., Celano, C. M., Beach, S. R., Motiwala, S. R., & Januzzi, J. L. (2013). Depression and Cardiac Disease:

Epidemiology, Mechanisms, and Diagnosis. Cardiovascular Psychiatry and Neurology, 2013, 1-14.

doi:10.1155/2013/695925

o O’Neil, A. (2013). The Relationship Between Coronary Heart Disease (CHD) and Major Depressive Disorder (MDD): Key

Mechanisms and the Role of Quality of Life. Europe’s Journal of Psychology, 9(1), 163-184.

doi:10.5964/ejop.v9i1.466http://onlinelibrary.wiley.com/doi/10.1002/j.2051-5545.2011.tb00014.x/full

o Groot, M. D., Kushnick, M., Doyle, T., Merrill, J., Mcglynn, M., Shubrook, J., & Schwartz, F. (2010). Depression Among Adults

With Diabetes: Prevalence, Impact, and Treatment Options. Diabetes Spectrum, 23(1), 15-18.

doi:10.2337/diaspect.23.1.15

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o Dusheiko, G. (1997). Side effects of α interferon in chronic hepatitis C. Hepatology, 26(S3). doi:10.1002/hep.510260720

o Mackin, P. (2007). Cardiac side effects of psychiatric drugs. Human Psychopharmacology: Clinical and Experimental, 23(S1). doi:10.1002/hup.915

o http://imsear.li.mahidol.ac.th/bitstream/123456789/159384/1/dpj2011v14n1p143.pdfo Mackin, P. (2007). Cardiac side effects of psychiatric drugs. Human Psychopharmacology: Clinical and

Experimental, 23(S1). doi:10.1002/hup.915o Chereji, E., Kern, S., Fuller, B., Morasco, B. J., Phelps, A., & Hauser, P. (2016). Co-occurring Depression,

Chronic Pain and Substance Use Disorders in People with Hepatitis C. Open Medicine Journal, 3(Suppl 1: M5), 79-103. doi:10.2174/1874220301603010079

o Mental Health And Chronic Physical Illnesses- The Need For Continued And Integrated Care. (2010). Retrieved from http://www.encontrarse.pt/wp-content/uploads/2016/12/docs_wmfh2010.pdf

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