Friday, 20 July 2007

Psychosocial Issues

Issues relating to Cushing's:
  • Loss of energy, a decreased level of activity and fitness
  • Loss of libido, infertility, low sex drive, impotence
  • Lack of self-esteem/confidence (body image issues) due to altered body image/physical changes/imbalance of hormones
  • Feelings of loss of control
  • Depression**/mood swings
    • restlessness, agitation
    • memory affected
    • sleep patterns affected
  • "Something is wrong with me"
  • History of being treated for other stress/mood related disorders. Doctors tend to imply to patients that they suffer from psychological disorders rather than physical disorders.
Because of the above factors:
  • strain on relationships
    • unmarried? divorced? - could this be an underlying reason?
    • family/relatives - unable to cope with the change in personality/mood swings etc.
    • snide or unkind comments from family/relatives/co-workers/friends regarding inability to lose weight/other physical changes or mood changes
  • strain on employment
    • unable to carry out normal duties due to depressive personality
    • unable to cope with stresses
Treatment/Management issues:
  • "Uncertainty is worse than reality" - therefore important for patient to learn all about the condition to reduce uncertainty and perhaps aid in alleviating depression
  • Cortisol replacement:
    • worries regarding the ups and downs of cortisol replacement
    • financial issues: able to pay for drugs? insurance?
    • forgetting to take medication daily?
    • stress!
  • Surgery:
    • distress regarding the procedures/risks
  • Managing depression*:
    • moderate alcohol/caffeine intake
    • have hormone levels checked
    • anti-depressants?
    • talk with others (cognitive behaviour therapy/mindful meditation/support group)
    • adequate sleep (reduced alcohol and caffeine intake helps)
    • proper diet and exercise routine - even after surgery, may take a while for body to go back to 'normal'
    • stressful life? change it! Or change reaction to stresses
Sources:
http://www.pituitary.org.uk/content/view/69/80/
http://www.pituitary.org.uk/content/view/278/157/

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