Psychologic management of children with diabetes mellitus

General principles in child liaison consultation service: a literature review

Consultation-liaison psychiatry emerged in the late thirties as a bridge between body and mind splitting of medical care. Setting-up of consultation-liaison services in general hospitals began some years later and is still developing in many countries. Paediatric consultation-liaison services share some general characteristics with those for adults, but others are more specific. Different models of child consultation-liaison services have been described, such as their organization in relation to the specific characteristics of the ward (surgical, intensive care units, etc.) and to the resources provided. This paper describes the general basis of the organization of a child consultation-liaison service. The specific characteristics needed for working with children are emphasized.

Grief among parents of children with diabetes

The observation that parents respond with grief when their children are diagnosed with diabetes is supported in the medical literature. Dysfunctional family dynamics that disrupt the process of adapting to a diagnosis of diabetes can be attributed to unresolved grief. Group work is advocated as an effective means of promoting healthy familial interactions and adjusting to life with diabetes.

Liaison psychotherapy in a hospital paediatric diabetic clinic

A psychotherapist joined the medical team of the paediatric diabetic clinic three years ago. After some initial difficulties all agreed there had been appreciable benefits, not only to individual patients but also to the team in their handling of the psychological aspects of diabetes.

The role of recent life events and social support in the control of diabetes mellitus. A pilot study

This study evaluated objectively the relationship between recent life events, social support systems, and blood glucose control in diabetic patients using both short-term [fasting blood sugar (FBS)] and long-term [glycosylated hemoglobin (Hgb A-1C)] measures of control. We found that a higher number of life events was associated with a higher percentage of abnormal FBS and Hgb A-1C results, and that improved social support was associated with a smaller percentage of abnormal Hgb A-1C scores. These pilot findings are discussed in connection with a biopsychosocial approach to the understanding and management of diabetes mellitus.

The psychophysiologic aspects of stress in juvenile diabetes mellitus

Diabetes Mellitus is the most common endocrine disease found in children, and its reported incidence is increasing. Most investigators now agree that improved diabetic control is effective in decreasing both long and short term complications. The delineation of factors which affect control are, therefore, of importance. Classically, the physician has emphasized insulin dose, presence of infection, diet, and exercise. Emotional factors have long been thought to play a role in diabetes mellitus. The exact nature of this role, however, has been rather elusive and controversial. The authors review this literature, summarize the major viewpoints, and conclude that physiological factors can influence the physiology of the disease. The focus of this paper is the synthesis of recent advances in basic metabolic, endocrinologic, and stress research, relevant to juvenile diabetes, into a psychophysiologic model. The authors discuss future research directions necessary for clarification of the model, as well as its psychological and physiological therapeutic implications.

Comprehensive management of children on a paediatric ward: a family approach

A team approach in the comprehensive management of children on a general paediatric ward is described. The team comprises paediatricians, nurses, a child psychiatrist, and a social worker, with a psychologist, play-leader, and teachers making important contributions. In this way members of the team learn from each other, and the paediatrician in training gains valuable experience about the management of children with emotional problems. The team approach is based on the principles of family therapy, but it also uses other forms of therapy--such as behavioural, marital, and individual. Children with severe psychosomatic problems in particular can be helped by such treatment, but other emotional problems are also suitable for management using such an approach.