Diabetes mellitus and concomitant depressions

The fact that there is a high prevalence of depressions among patients with diabetes mellitus (DM) is well known. However, the relationships between the nosological entities of depressions and the clinical characteristics of DM are little studied. The study was undertaken to search for such relationships. A hundred and fifty outpatients with DM (out of them 38 males, Type 2 DM was diagnosed in 102 patients) the median age was 54.0 years (25 and 75 percentiles: 43.0-61.5), the median duration of diabetes was 7.2years (2.0-15.0); the median level of HbAlc was 8.6% (7.49.7%). Depression was revealed in 50 (33%) patients. Their comparison with patients without depression indicated that there was no association with the main clinical characteristics of MD (the type and duration of the disease, the prevalence of acute and chronic complications, insulin therapy). At the same time, a comparison of three groups of patients with the major clinical forms (nosogenic, cyclothymic, and dysthymic) of diagnosed depression by using x² revealed the following associations: between DM-1 and cyclothymic depression and between DM-2 and nosogenic and dysthymic depression (р = 0.01). Cyclothymic and dysthymic depression showed no associations with clinical characteristics of DM. The prevalence of nosogenic depression was significantly higher in patients with a history of second-three grade diabetic retinopathy (p = 0.02), arterial hypertension (p = 0.001), proteinuria (p = 0.02), myocardial infarction (p = 0.04), and foot ulcerative defects (p = 0.04). The results show that nosogenic depression are mental responses to the severe course of DM, namely to the severity of micro- and macrovascular complications. The associations between the types of DM and the clinical types of depression -cyclothymia and dysthymia - await further study. Overall general predisposition may be discussed as a possible explanation.

1. Болезни органов эндокринной системы / Под ред. ИИ. Дедова // Руководство по внутренним болезням. Под ред. Е И. Чазова. - М„ 2000. - С. 158-162.

2. Дробижев М. Ю. Нозогении (психогенные реакции) при соматических заболеваниях: Дис. ... канд. мед. наук. - М., 2000.

3. Лурия Р. А. Внутренняя картина болезни и иатрогенные заболевания. - М., 1977.

4. Смулевич А. Б. Депрессии в общемедицинской практике. - М., 2000.

5. Anderson R. J., Freedland К. Е., Clouse R. Е., Lustman Р. J. // Diabetes Саге. - 2001. - Vol. 24. - Р. 1069-1078.

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

7. Cameron O. G., Kronfol Z., Greden J. K., Carroll B. J. // Arch. Gen. Psychiatry. - 1984. - Vol. 41. - P. 1090-1095.

8. Cassidy F, Ahearn E., Carroll B. J. // Am. J. Psychiatry. - 1999. - Vol. 156. - P. 1417-1420.

9. Chiba M., Suzuki S., Hinokio Y. et al. // Metabolism. - 2000. - Vol. 49, N 9. - P. 1145-1149.

10. Coiro И, Volpi R., Carpetti L. et al. // Ibid. - 1995. - Vol. 44. - P. 538-542.

11. De Groot M., Jacobson A. M., Samson J. A., Welch G. // J. Psychosom. Res. - Vol. 46. - P. 425-435.

12. Eiber R., Berlin I., Grimaldi A., Bisserbe J. С. 11 Encephale. - 1997. - Vol. 23, N 5. - P. 351-357.

13. Geringer E. D. // Neuropsychological and Behavioral Aspects of Diabetes /Ed. C. S. Holmes. - New York, 1990. - P. 239-272.

14. Gessa G. L. // Eur. Psychiatry. - 1996. - Vol. 11, - P. 123s.

15. Ghizzoni L, Vanelli M., Viridis R. et al. // Metabolism. -

16. - Vol. 42. - P. 1141-1145.

17. Horrobin D. F, Bennet C. N. // Prostagland. Leukot. Essent Fatty Acids. - 1999. - Vol. 60, N 4. - P. 217-234.

18. Hudson J. I., Hudson M. S., Rothschild A. J. et al. // Arch. Gen. Psychistry. - 1984. - Vol. 41. - P. 1086-1089.

19. Jacobson A. M. Brain functioning cognition and psychiatric disordes in patients with Type 1 diabetes. American Diabetes Association, http://www.fmdarticles.com.

20. Leedom I. J., Meeham W. P., Procci W. R., Zeidler A. // Psychosom. Med. - 1989. - Vol. 51. - P. 256.

21. Lloyd С. E., Matthews K. A., Wing R. R., Orchard T. J. // Diabetes Care. - 1992. - Vol. 15. - P. 166-172.

22. McMahon F. J., Hopkins P. J., Jiafend X. et al. // Am. J. Hum. Genet. - 1997. - Vol. 61. - P. 1397.

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

24. Nathan P. E., Langenbucher J. W. // Annu. Rev. Psychol. - 1999. - Vol. 50. - P. 79.

25. Nathan R. S., Sachar E. J., Asnis G. M. et al. // Psychiatry Res. - 1981. - Vol. 4. - P. 291-300.

26. Padgett D. K. // J. Nerv. Ment. Dis. - 1993. - Vol. 181. - P. 123-129.

27. Palinkas L. A., Barrett-Connor E., Wingard D. L. // Diabet. Med. - 1991. - Vol. 8. - P. 532-539.

28. Peyrot M., Rubin R. R. // Diabetes. - 1989. - Vol. 38. - Suppl. 1. - P. 9A.

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

30. Popkin M. K., Callies A. L., Lentz R D. et al. // Arch. Gen. Psychiatry. - 1988. - Vol. 45. - P. 65-68.

31. Roy M. S., Collier B., Roy A. // Psychiatry Res. - 1990. - Vol. 31. - P. 31-37.

32. Roy M. S., Roy A., Gallucci W. T. et al. // Metabolism. - 1993. - Vol. 42. - P. 696-700.

33. Roy M. S., Roy A., Broun S. // J. Diabet. Complications. -

34. - Vol. 12. - P. 24-27.

35. Strachan M. W., Deary I. J., Ewing F. M., Frier В. M. // Diabetes Care. - 2000. - Vol. 23. - P. 305-312.

36. Straub R. E., Lehner T., Luo Y. et al. // Nature Genet. - 1993. - Vol. 8. - P. 291.

37. ‘The Sixth Report of the Joint National Committee on Prevention. Detection, Evaluation, and Treatment of High Blood Pressure. - 1997.

38. Yinamaki H., Niskanen L., Uusitupa M. // Acta Psychiatr. Scand. - 1995. - Vol. 92. - P. 392-397.