slideshow

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.

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

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