Addictive Behavior and Psychology - Essay Example

?Addictive Behavior and Psychology: Case Analysis Introduction In this report, an analysis of issues affecting a patient by Adams presented in Case Study C will be presented. The needs of the patient will be identified and also various psychological theories which apply to him will be addressed. Appropriate interventions for the patient will be identified based on the behavior and the condition of the patient through evidence-based literature. 1.1 Diabetes: Overview A group of clinical syndromes characterized by hyperglycemia secondary to relative or absolute insulin deficiency is known as diabetes mellitus (DM) (Votey, 2005). It is estimated that about 2.6million people suffer from this condition in the UK (Diabetes UK, 2010). There are basically 2 types of diabetes mellitus and they are type-1 and type-2. In type-1 DM, the onset is in young age like childhood, adolescence or even early adulthood. It occurs due to absolute deficiency of insulin as a result of destruction of the beta-cells in the pancreas. On the other hand, type-2 DM occurs mainly in adults, especially in older people and is mainly predisposed by several factors including sedentary lifestyle and obesity. Type-2 accounts for more than 85 percent cases of diabetes (Diabetes UK, 2010). Hereditary factors play an important role in this type of diabetes, either due to genetic predisposition or due to similar behavioral patterns in the families like sedentary lifestyle and eating habits. DM-2 occurs due to a combination of decreased secretion of beta cells in the pancreas and increased peripheral resistance to insulin at tissue-receptor level (Votey, 2005). DM-2 is the most common type of diabetes. It is managed by pharmacotherapy and appropriate diet and exercise. Diet and exercise have a major role to play in the treatment of diabetes-2. Adam was diagnosed with diabetes type-2 9 months ago. He has been advised to control his blood sugar levels with appropriate diet and exercise, rather than initiating antidiabetic medications. Antihypoglycemic therapy is initiated only when it is not possible to control diabetes through diet and exercise (Diabetes UK, 2010). It is very important to treat and control diabetes because of the notorious complications associated with it. Adam is obese and has been advised to reduce his weight. The main defect in diabetes type-2 is the inability of the tissues to respond to insulin. There is also decreased production of insulin by pancreas. Both these amount to increased glucose levels in the blood, known as hyperglycemia. An important causative factor is obesity. This is more so when obesity is more around the waist, known as central obesity (Votey, 2005). Obesity leads to decreased resistance of tissues to insulin. The fatty acid and triglyceride levels are high and these further interfere with insulin signaling. Another important aspect in obesity which influences the development of diabetes is dysregulation of the secretion of adipokine which is a hormone that causes peripheral resistance to insulin and contributes to the development of diabetes. Thus, obesity has a major role to play in the development of the most common form of diabetes, type-2 diabetes. 1.2 Complications of Diabetes Diabetes leads to increased catabolism and decreased anabolism. After reaching the renal threshold level of 180mg per dl, glucosuria occurs. This contributes to polyuria and polydipsia. Decreased levels of glucose in the cells contributes to delay in the healing of the wounds and also development of recurrent infections. it also causes lipolysis for generation of energy. Lipolysis causes an increase in the free fatty acid levels whih are taken up by the liver. Metabolism of free fatty acids in the liver yields ketone bodies, hydroxybutyric acid and acetoacetic acid. As the production of ketone bodies increases, metabolic acidosis ensues, resulting in dehydration. Infact, in many cases, diabetic ketoacidosis is the first presentation and it can turn fata due to development of cerebral edema. Increased lipolysis can contribute to weight loss and gluconeogenesis can cause muscle wasting. Diabetes is a silent killer and can lead to both acute and chronic problems that are potentially fatal or debilitating. Acute problems include, unconsciousness and coma either due to high or low blood glucose levels, confusion, anxiety and tremors. Chronic problems include development of retinal problems, grouped under retinopathy, kidney problems, known as nephropathy and problems related to nerves, known as neuropathy. Other than these long term problems, diabetes also leads to cardiac problems (Votey, 2008). Infact, any organ in the body can be damaged by diabetes. That is why it is very important to prevent diabetes and also keep it in control when contracted by this disease. 1.3 Target group Adam is a young man, of 35 years of age. According to the latest statistics of UK (Diabetes UK, 2010), among young individuals, males are more likely to suffer from diabetes than females. Type-2 diabetes is more common among older people than young people and thus, Adam is considerably diagnosed at an young age. There is no mention of his race in the case study. Those who are of Asian or African-Caribbean origin are at increased risk of developing the disease. Adam is from Croydon. According to the report from the Diabetes Services in Croydon (2010), 4.4. percent of the population of Croydon suffer from diabetes (Diabetes Services In Croydon, 2010). Complications due to diabetes may be avoided by receiving appropriate medical care from a physician-coordinated team which includes physicians, nurse practitioners, physician’s assistants, nurses, dietitians, pharmacists, and mental health professionals with expertise and a special interest in diabetes (American Diabetes Association, 2004). The most important aspect in the management of diabetes is modification of lifestyle factors. This is because, unhealthy lifestyle like excessive eating, indulgence in excessive alcohol consumption, sedentary lifestyle and type-A personality behaviour cause initiation and propagation of type 2 diabetes mellitus. Diabetes self-management education is an integral component of care. 1.4 Key issues There are several key issues related to Adam which must be addressed before devising interventions. 1.4.1 Patient compliance Non-compliance to treatment is very common in diabetes. According to Banyard (1996), more than 75 percent of patients with diabetes do not follow a strict diet regimen as advised to them. It is unclear whether the compliance is related to improper communication strategies by the general practitioner or lack of motivation by the patient for self-management. There is evidence that patients with diabetes mellitus, despite being advised to take less than 30 percent calories from fat, do not follow the advice and land up consuming fat that is more than 40 percent of total calorie intake. According to Neuhouser (399), "an important question for nutrition professionals is the extent to which we can bridge the large gap between patient knowledge of the effectiveness of nutrition therapy and the ability to sustain long-term adherence to a prescribed dietary pattern.” 1.4.2 Driving and diabetes Adam drives a car and he is a mechanic which involves some driving. In diabetes, the insulin surges are erratic and can result in hypoglycemic episodes too. Also, once Adam in started on antihypoglycemic agents, he is at increased risk of developing hypoglycemia. Hypoglycemia is dangerous for driving and performing risky jobs. When a patient with diabetes develops complications, his license can be restricted or taken away (Diabetes UK, 2010). It is important to educate Adam about these implications of diabetes in the long term. 1.4.3 Hereditary aspects It is unclear whether Adam's parents had diabetes. However, considering that family and genetic influences are prevalent in diabetes, Adam's son is at risk of developing diabetes. If the same lifestyle factors prevail among other family members, even they are at risk of developing the disease. 2. Applied Psychological Theory One theory which is useful to explain the behaviour of the patient which prevents him from adapting to newer lifestyle is Change model. According to this model, there are 5 stages in change and they are precontemplation change, contemplation change, preparation change, action change and maintenance change (Naidoo & Wills, 2008). This model is actually a cycle and a patient can go back and forth between the various stages of change. Adam is in the preparation stage. This is evident from the fact that he has not totally adapted healthy lifestyle behaviour. he is not eating a healthy diet and is not exercising regularly. But he has begun to walk to his office. Another psychological theory which can be applied to Adam is the Health belief Model (Naidoo & Wills, 2008). According to this model, it is the core beliefs of the individual that predict the health behaviours of the individual. Some of the beliefs which influence the behaviour of an individual are susceptibility to disease, belief in the fact that the disease can lead to complications, costs involved in the adapted behaviours and cues of action. Adam may be believing that he is unlikely to develop any complications. He may not be believing that diabetes is a serious disease because he is not suffering from any physical disability. He is also not started on any medication and hence he must be thinking that his disease is not significant or is a mild stage. He also probably has the perception that healthier food is more expensive. he may feel that exercising may consume lot of valuable time. All these beliefs occur because Adam is actually unaware of the consequences of diabetes. He probably has not seen anyone suffering from the complications of diabetes and thus is unaware of them. 3. Interventions 3.1 Aims The main aims of interventions in Adam are to achieve control of diabetes without taking any hypoglycemic medications and to prevent or delay diabetes related complications. The objectives are to help Adam adapt to healthier lifestyle habits. Complications due to diabetes may be avoided by receiving appropriate medical care from a physician-coordinated team which includes physicians, nurse practitioners, physician’s assistants, nurses, dietitians, pharmacists, and mental health professionals with expertise and a special interest in diabetes (American Diabetes Association, 2004). Diabetes self-management education is an integral component of care. 3.2.1.Glycemic control This is fundamental to the management of diabetes. Research has shown that improved glycemic control is associated with sustained decreased rates of retinopathy, nephropathy, neuropathy (DCCT/EDIC Research Group, 2000, cited in American Diabetes Association) and cardiavascular complications (American Diabetes Association, 2004). The goal should be to achieve glycosylated hemoglobin of Read More