Depression itself may be a cause of diabetes, says study

While it is common knowledge that having a chronic disease increases chances of depression in patients, here is evidence that indicates depression could also be a factor in causing chronic diseases such as diabetes.

A paper published in Diabetes Technology and Therapeutics, 2010, from Chennai showed higher levels of depression among those newly detected with diabetes and those with impaired glucose tolerance, as against those who had normal blood sugar levels.

Authored by S. Poongothai of Madras Diabetes Research Foundation, as part of a series of articles she worked on for her Ph.D, the paper is significant in that the tests were done in the community and the depression noted before blood sugar tests were done.

Co-author V. Mohan, who heads Dr. Mohan's Diabetes Specialities Centre, says, “What this article flags off is the idea that depression itself may be a likely cause of diabetes.”

The subjects for the study were recruited from the Chennai Urban Rural Epidemiological Study. Of the total of over 23,000 persons tested, there were 1218 people with newly- detected Diabetes (NDD), 7,657 with impaired fasting glucose (IFG); and 14, 912 with normal fasting glucose (NFG).

While the overall prevalence of depression was 14.3 per cent, an increasing prevalence was seen with increasing grades of glucose tolerance: NFG (13.1 per cent), IFG (15.7 per cent) and NDD (19.7 per cent), being higher among women at all grades.

Depression can increase the risk of diabetes due to increased levels of counter-regulatory hormones, which can lead to obesity, insulin resistance and glucose intolerance, Dr. Poonothai says in the paper. “The lesson in this is that not only should we treat diabetics for depression, but that by treating depression, the person may actually be able to side-step diabetes,” Dr. Mohan explains.

His recommendation is also that everyone with depression must be screened for diabetes as well.

Absent-mindedness

Absent-mindedness can refer to three very different things:

1.  a low level of attention ("blanking" or “zoning out”);

2.  intense attention to a single object of focus (hyperfocus) that makes a person oblivious to events around him; or

3.  unwarranted distraction of attention from the object of focus by irrelevant thoughts or environmental events.

Consequences

Lapses of attention are clearly a part of everyone’s life. Some are merely inconvenient, such as missing a familiar turn-off on the highway, and some are extremely serious, such as failures of attention that cause accidents, injury, or loss of life. Beyond the obvious costs of accidents arising from lapses in attention there is lost time, efficiency, personal productivity, and quality of life in the lapse and recapture of awareness and attention to everyday tasks. Individuals for whom intervals between lapses are very short are typically viewed as impaired. Given the prevalence of attentional failures in everyday life and the ubiquitous and sometimes disastrous consequences of such failures, it is rather surprising that relatively little work has been done to directly measure individual differences in everyday errors arising from propensities for failures of attention.

ADHD predominantly inattentive (ADHD-PI or ADHD-I)

This is one of the three subtypes of Attention-deficit hyperactivity disorder (ADHD). While ADHD-PI is sometimes still called "attention deficit disorder" (ADD) by the general public, these older terms were formally changed in 1994 in the new Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

DSM-IV criteria

The DSM-IV allows for diagnosis of the predominantly inattentive subtype of ADHD (under code 314.00) if the individual presents six or more of the following symptoms of inattention for at least six months to a point that is disruptive and inappropriate for developmental level:

§  Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

§  Often has trouble keeping attention on tasks or play activities.

§  Often does not seem to listen when spoken to directly.

§  Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).

§  Often has trouble organizing activities.

§  Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period (such as schoolwork or homework).

§  Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).

§  Is often easily distracted.

§  Is often forgetful in daily activities.

A requirement for an ADHD-PI diagnosis is that of the symptoms that cause impairment must be present in two or more settings (e.g., at school or work and at home). There must also be clear evidence of clinically significant impairment in social, academic, or occupational functioning. Lastly, the symptoms must not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder).

Examples of observed symptoms
Life Period	Example
Children	Failing to pay close attention to details or making careless mistakes when doing school-work or other activities
	Trouble keeping attention focused during play or tasks
	Appearing not to listen when spoken to (often being accused of "daydreaming")
	Failing to follow instructions or finish tasks
	Avoiding tasks that require a high amount of mental effort and organization, such as school projects
	Frequently losing items required to facilitate tasks or activities, such as school supplies
	Excessive distractibility
	Forgetfulness
	Procrastination, inability to begin an activity
	Difficulties completing household chores
Adults	Often making careless mistakes when having to work on uninteresting or difficult projects
	Often having difficulty keeping attention during work, or holding down a job for a significant amount of time
	Often having difficulty concentrating on conversations
	Having trouble finishing projects that have already been started
	Often having difficulty organizing for the completion of tasks
	Avoiding or delaying in starting projects that require a lot of thought
	Often misplacing or having difficulty finding things at home or at work
	Disorganized personal items (sometimes old and useless to the individual) causing excessive "clutter" (in the home, car, etc.)
	Often distracted by activity or noise
	Often having problems remembering appointments or obligations, or inconveniently changing plans on a regular basis

How common is ADHD?

It is difficult to say exactly how many children worldwide have ADHD because different countries have used different ways of diagnosing it, while some do not diagnose it at all. In the UK, diagnosis is based on quite a narrow set of symptoms, and about 0.5 - 1% of children are thought to have attention or hyperactivity problems. In comparison, until recently, professionals in the USA used a much broader definition of the term ADHD.

As a result, up to 10% of children in the USA were described as having ADHD. Current estimates suggest that ADHD is present throughout the world in about 1-5% of the population. About five times more boys than girls are diagnosed with ADHD. This may be partly because of the particular ways they express their difficulties. Boys and girls both have attention problems, but boys are more likely to be overactive and difficult to manage. Children from all cultures and social groups are diagnosed with ADHD. However, children from certain backgrounds may be particularly likely to be diagnosed with ADHD, because of different expectations about how they should behave. If you are a parent, it is therefore important to ensure that your child’s cultural background is understood and taken into account as part of the assessment.

Treatement

Recent studies indicate that medications approved in USA, in the treatment of ADHD tend to work well in individuals with the predominantly inattentive type. These medications include two classes of drugs, stimulants and non-stimulants. Drugs for ADHD are divided into first-line medications and second-line medications. First-line medications include several of the stimulants, and tend to have a higher response rate and effect size than second-line medications. Some of the most common stimulants are  Methylphenidate (Ritalin), Adderall and Vyvanse.

Although medication can help improve concentration, it does not cure ADHD-I and the symptoms will come back once the medication stops. Moreover, medication works better for some patients while it barely works for others.

Also, along with medication, behavioral therapy is recommended to improve organizational skills, study techniques or social functioning.

There has been anecdotal evidence that dietary changes such as reducing food additives, colorings and sugars may be a useful treatment, however, there is no evidence from trials to support this information.

Strategies

Parents are recommended to learn about this disorder in order to first be able to help themselves and then their children.

Behavioral strategies are of great help and they include creating routines, getting organized, avoiding distractions (television, video and computer games especially on weekdays during homework), limiting choices, using goals and rewards, ignoring behaviors.

Since children with ADHD can be extremely disorganized, parents should work with children to find specific places for everything and teach kids to use calendars and schedules. Parents are also advised to get children into sports to help them build discipline, confidence, and improve their social skills. Physical activity boosts the brain’s dopamine, norepinephrine, andserotonin levels and all these substances affect focus and attention. However, some sports may be too challenging and would add frustration. Parents should talk to their children about what kinds of sports or exercise most stimulate and satisfy them before signing them up for classes or enrolling them in a given team sport.

It is very important to establish close communication with the school in order to develop an educational plan to address the child’s needs. Accommodations in school such as extended time for tests or more frequent feedback from teachers are also beneficial for these individuals.