The patient’s attitude to treatment in diabetes mellitus. The influence of comorbid depressive and anxiophobic disorders

Medical compianee of patients with diabetes mellitus (DM) responsible in many cases for the disease outcome forms under impact of a number ofpsychological and social factors, concomitant mental illnesses. Among the laffer most frequently were anxious and depressive states, but their relationship with patient ’s attitude to treatment remains disputable. To specify the relationship between symptoms of depression and anxiety, revealed in patients with diabetes mellitus, and their attitude to diabetic specific treatment. 31 patients with DM type 1 and 2 were examined (mean age - 53,9 ± 2,2years, mean disease duration - 6,3 ± 3,1 years, mean А_1с level - 8,4 ± 2,2%). The results of the study indicate a high rate of depressive states (29%) and anxious-phobiac states (45%) in patients with DM and association of these disorders with different variants of attitude to treatment. Depression represents "fatalistic" and "medical" ’locus of control’ (LOC). In addition, feedback on independent LOC is discovered. Such type of altitude will negatively affect efforts of the patient of achieve carbohydrate metabolism compensation, e. g., in the educational process. Therefore, intensive education measures should be preceded by treatment of depression. Anxiety is represented by self- sufficient type of ’locus of control’, which does not impede the patient’s active participation in the process of control and management of the disease.

1. Анциферов М. Б., Дробижев М. Ю., Суркова Е. В. и др. // Пробл. эндокринол. - 2002. - № 4. - С. 23-27.

2. Бевз И. А. Внутренняя позиция пациента по отношению к болезни и выбор стратегии медицинского поведения (на модели ишемической болезни сердца): Дис. ... канд. пси- хол. наук. - М., 1998.

3. Добровольский А. В. Клинические особенности ишемической болезни сердца и внутренняя картина болезни (психологические и психопатологические проявления): Дис. ... канд. мед. наук. - М., 1999.

4. Дробижев М. Ю. // Соврем, психиатр. - 1998. - № 2. - С. 28-31.

5. Смулевич А. Б., Дробижев М. Ю. // Рус. мед. журн. - 1996. - Т. 4, № 1. - С. 4-10.

6. Смулевич А. Б., Тхостов А. Ш., Сыркин А. Л. и др. // Журн. невропатол. и психиатр. - 1997. - № 2. - С. 4-9.

7. Berlin Bisserbe J. С., Eiber R. et al. // Diabetes Care. - 1997. - Vol. 20, N 2. - P. 176-178.

8. Coker A. O., Ohaeri J. U., Lawai R. A., Orija О. В. // E. Afr. Med. J. - 2000. - Vol. 77, N I. - P. 42-45.

9. Green L., Feher M., Catalan J. // Diabet. Metab. Res. Rev. - 2000. - Vol. 16, N 4. - P. 287-293.

10. Lane J. D., McCaskill С. C., Williams P. G. et al. // Diabetes Care. - 2000. - Vol. 23, N 9. - P. 1321-1325.

11. Liakopoulou M., Alifieraki T., Katideniou A. et al. // Psychother. Psychosom. - 2001. - Vol. 70, N 2. - P. 78-85.

12. Lloyd С. E., Dyer P. H., Barnett A. H. // Diabet. Med. - 2000. - Vol. 17, N 3. - P. 198-202.

13. Macrodimitris S. D., Endler N. S. // Hlth Psychol. - 2001. - Vol. 20, N 3. - P. 208-216.

14. Mollema E. D., Snoek F. J., Ader H. J. et al. // J. Psychosom. Res. - 2001. - Vol. 51, N 5. - P. 665-672.

15. Peyrot M., Rubin R. R. // Diabetes Care. - 1997. - Vol. 20, N 4. - P. 585-590.

16. Piette J. D., Weinberger M., McPhee S. J. // Med. Care. - 2000. - Vol. 38, N 2. - P. 218-230.

17. Pouwer E, Snoek F. J. // Diabet. Med. - 2001. - Vol. 18, N 7. - P. 595-598.

18. Rubin R. R., Peyrot M. J. // Clin. Psychol. - 2001. - Vol. 57, N 4. - P. 457-478.

19. Thernlund G., Dahlquist G., Hagglof B. et al. // Acta Paediatr. - 1996. - Vol. 85, N 8. - P. 947-953.

20. Wearden A. J., Tarrier N., Davies R. // J. Psychosom. Res. - 2000. - Vol. 49, N 2. - P. 125-130.

21. Worrall-Davies A., Holland P., Berg L, Goodyer I. // Eur. Child. Adolesc. Psychiatry. - 1999. - Vol. 8, N 1. - P. 11 - 16.

22. Zigmond A. S., Snaith R. P. // Acta Psychiatr. Scand. - 1983. - Vol. 67. - P. 361-370.