Mind-Body Medicine and Endocrinology – Part I
Interdisciplinary endocrinology is an exciting field, and mind-body medicine is a unique connecting point between psychology and hormones. In this multinational interview, our Education Editor Sanjay Kalra takes the help of experts from five continents to explore the breadth and depth of mind-body medicine in endocrinology.
Vaishali Deshmukh, Sanjay Phadke, India
Hypothalamus acts as a master organ and also functions as an organ of mind. The mind talks to body via two pathways viz: through hormones and through autonomic neural pathway. Therefore, any disturbance of mind is bound to affect the endocrine axis of the body and vice versa. Hence treatment of endocrine disorders should always focus on treating mind also and hormone imbalance must be sought actively in every patient with mental health issues. Mind-body interventions and positive psychology techniques play a significant role in improving mental health and prevention of all non-communicable diseases.
Norman Sartorius, President, Association for the Improvement of Mental Health Programs, Geneva, Switzerland
People with diabetes will suffer from a comorbid depressive illness twice as often as people who do not have diabetes. Those who have diabetes and depression at the same time will have significantly more complications of diabetes, more difficulties in controlling their diabetes and higher mortality rates than persons who suffer from either disease appearing alone.
Although these facts are well known and documented by research in various parts of the world and although depressive illnesses can be effectively treated the comorbid conditions are usually not discovered nor provided treatment in general practitioners’ diabetologists’ or psychiatrists’ clinics.
Action is possible and necessary. It should target the training of medical students and specialists in diabetes and depression; the introduction, as a routine of screening for depression and diabetes in health care; at least elementary in-service training of health workers enabling them to provide treatment or refer those who have comorbid diabetes and depression for comprehensive care. While introducing these measures it is important to consider ways of improving the health literacy of the population so as to involve it in the discovery and care of people with comorbid mental and physical diseases.
Roopa Mehta, Mexico
Diabetes Distress (DD) is a psychological state in persons with diabetes or their caregivers that arises due to the burden of living and self- managing this disease. It does not fulfil the criteria for a major depressive disorder. The consequences of DD include poor adherence to treatment, inadequate glycaemic control and an increased risk for diabetes complications. The multidisciplinary team must be aware of this condition, and actively screen to ensure prompt diagnosis. Management involves initiating discussion with the patient in order to identify the cause, share methods to minimize distress, teach healthy coping skills and improve the quality of diabetes support.
Gagan Priya, India
Diabetes care is challenging for the person living with diabetes as well as for the diabetes care provider. While there is a significant focus on the identification of diabetes distress and its management, the ideal would a state of euthymia or glycemic happiness.
Glycaemic happiness is a state of physiological and emotional well-being in person with diabetes, reinforced by healthy communication with the healthcare provider and support from family/friends, that fosters in them an ability to manage the biomedical and psychosocial challenges of living with diabetes. The four pillars of creating glycemic happiness include the patient, his/her family, the provider and a healthy communication between all. The way forward includes patient support, empowerment and motivation, as well as shared decision-making and shared responsibility.
Kirtida Acharya, Kenya
Menopause can be a daunting era in a woman’s life journey, but if the myriad challenges that shroud it can be viewed with a different perspective, almost a magical paradigm shift can occur to create an interesting adventure! Besides the physical distress of hot flushes, insomnia, weight gain and dyspareunia. there are emotional upheavals, mood conflicts, and relationship fears.
This is the time to align and nurture mind-body and soul balance. Exercise, nutrition and yoga can help optimize health. Insomnia can be soothed by meditation, calming music, reading, blue filters, cool rooms, nutmeg milk and various sleep techniques.
Emotional wellbeing is the key to overall health. Good endocrine and holistic management help transform angry hormones to happy hormones; endorphins are a gamechanger. There is always support available, reach out. Embrace, accept, celebrate. It will pass.