October 31, 2019

Common chronic diseases in my practice:

Two common chronic diseases that are relevant to my practice in mental health are diabetes mellitus type 2 and hypertension. There are many mental illnesses that I work with on a daily basis that are heavily impacted by both diseases for various reasons which I will further explore.

Diabetes mellitus type 2 is defined by the Cleveland Clinic (2019) as “a disease that prevents your body from properly using the energy from the food you eat. Diabetes occurs in one of the following situations: the pancreas (an organ behind your stomach) produces little insulin or no insulin at all. Insulin is a naturally occurring hormone, produced by the beta cells of the pancreas, which helps the body use sugar for energy or the pancreas makes insulin, but the insulin made does not work as it should. This condition is called insulin resistance.

Hypertension, otherwise known as high blood pressure, is defined by the Cleveland Clinic (2019) “the measurement of pressure or force of blood pushing against blood vessel walls. In hypertension the pressure against the blood vessel walls is consistently too high. It is often called the “silent killer” because you may not be aware that anything is wrong, but the damage is occurring within your body.

Rates of DMII and HTN and Determinants:

According to a study conducted by Statistics Canada (2017) the prevalence of type 2 diabetes across Canada is 7.3% of the population. In Ontario, that number is elevated at 8% of the population having a diagnosis of Diabetes Mellitus II. This works out to over one million Ontarians having the diagnosis. If we apply the same logic to the population of the rural community that I work in, that works out to approximately 6800 clients with diabetes mellitus II. In terms of the relation between type 2 diabetes and mental illness, there are a number of contributing factors. Suvisaari et. al (2016) explain that people with schizophrenia have a much higher risk of type 2 diabetes than the general population due to complications such as obesity, poor diet, and sedentary lifestyle, which are secondary to negative symptoms of the illness. Also, people with schizophrenia also often have low socioeconomic status and income, which affects their possibilities to make healthy lifestyle choices. It is also known that antipsychotic medications increase the risk of type 2 diabetes both directly by affecting insulin sensitivity and indirectly by causing weight gain (Suvisaari et. al. 2016).

The Heart and Stroke Foundation of Ontario conducted a study with the University of Ottawa Heart Institute and Statistics Canada which found that in 2006, nearly 1.5 million or 21% of Ontarians are living with hypertension. Of these, more than 500,000 Ontarians were suffering from uncontrolled high blood pressure (Heart and Stroke Foundation, 2006). Although this statistic is somewhat aged, it remains relevant to our population. In terms of mental illness, McCarron et al. (2017) explain that hypertension not only is common among patients with psychiatric illness, it likely contributes to worse clinical outcomes. Studies across different cultures have found higher mortality rates in individuals with mental illness. Those diagnosed with schizophrenia and other severe mental illnesses can have a shortened life expectancy upwards of 25 years, with the primary cause of death being cardiovascular disease.

How do we handle it?

In my practice, clinicians are regularly screening for any change in baseline measures, assessing for indicators of metabolic syndrome, and monitoring lab work and vital signs routinely. There are specific physical assessments that are ordered in conjunction with certain pharmacological interventions such as clozapine or lithium. Both of these medications have a risk of significant side effects including agranulocytosis, extrapyramidal effects, and severe hypotension (National Alliance on Mental Illness, 2019). Additionally, in my area each clinician has a dual function as a healthcare navigator, ensuring that clients are referred to all other appropriate community resources to meet their healthcare needs. This may include a diabetes nurse, dietician, support groups or exercise programs.

References

Heart and Stroke Foundation of Ontario. (2006). PRESSURE RISING:High Blood Pressure Rates Still Very High, Particularly for some ethnic groups. Ottawa, Ontario, Canada: Heart and Stroke Foundation of Ontario.

McCarron, K. L. (2017, June 16). How to diagnose and manage hypertension in a psychiatric patient. Retrieved October 31, 2019, from MDedge Psychiatry: https://www.mdedge.com/psychiatry/article/138880/schizophrenia-other-psychotic-disorders/how-diagnose-and-manage

National Alliance on Mental Illness. (2019). Clozapine. Retrieved October 31, 2019, from NAMI: https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Clozapine-(Clozaril-FazaClo)

Statistics Canada. (2018, November 14). Diabetes, 2017. Retrieved October 31, 2019, from Statistics Canada: https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54982-eng.htm

Suvisaari, K. E. (2016, January 23). Current Diabetes Reports. Retrieved October 31, 2019, from Springer Link: https://link.springer.com/article/10.1007/s11892-015-0704-4