Keeping a Healthy Mind in a World of Stress
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- Evelyn Rich
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1 Keeping a Healthy Mind in a World of Stress James Randy Mervis, M.D. QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture. 1
2 Talk Outline Definition of Stress Types of Stress, emotional, financial etc. Models of Stress Impact - Psychological and Physiological Stress and work-performance/ burnout Stress and Suicide Stress and pregnancy- Case Patient with MS Stress in time of Wars & Disasters- PTSD Treatment of stress- pharmacologic and nonpharmacologic, yoga, exercise etc How are planning to you relax during the conference tonight? 1. Check and respond to your 2. Will do some work related chore 3. Spend time with family or friends 4. Go out drinking, gambling and dancing 5. Have a nice dinner- then early to bed Definition of Stress Physical, mental, or emotional response to events that causes bodily or mental tension. Simply put, stress is any outside force or event that has an effect on our body or mind. Most common cause of ill health, underlying up to 70% of all visits to family doctors. 2
3 QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture. Stress is Shared Physicians have stress, so we are aware of what this phenomenon is. If we are going to help patients with their stress we are going to have to deal with our own. Balance of compassionate concern with dispassionate objectivity Types of Stress External Stressors Life s everyday issues- crowds, making meals,etc. Work, job requirements, patients and co-workers Family, Financial, Political, Social Readjustment Rating Scale - Life events 1. Death of a spouse 2. Divorce 3. Marital separation from a spouse 4. Detention in jail or other institution 5. Death of a close family member 6. Major personal injury or illness 7. Marriage 8. Being fired from work 9. Marital reconciliation with mate 10. Retirement from work Holmes T., Psychosomatic Medicine 1978;9:747 3
4 Models of Stress Theory Walter Cannon s study of autonomic nervous system. When stimulated - fight or flight physiologic response initiated HTN, Tachycardia, etc animal acted. Discharge of energy Zebras don t have ulcers Human society.we cannot discharge physio response. Thus- Cardiovascular Disease etc. Neurotransmitter, Endocrine and Immune Responses to stress. Some Psychosomatic Disorders Acne Arrhythmias Asthma Gastrointestinal Disorders- GERD, Peptic Ulcer Disease, Ulcerative Colitis, Crohn s, Irritable-bowel syndrome, Chronic Constipation, etc. Headaches- migraines Herpes Chronic pain syndromes Coronary artery disease- HTN Rheumatoid arthritis Skin diseases- psoriasis Effects of Stress on the Heart 1. Increased heart rate 2. Increased blood pressure 3. Release of catecholamines from adrenals 4. Increased oxygen demand on the body 5. Lower threshold for abnormal heart rhythms 6. Spasm of coronaries--- ischemia Torpy, JAMA 2007;3;298 4
5 Impact - Psychological and Physiological Personal response to stress Emotional Thinking Behavioral Physical Workplace Stress Often complex system problem Affects every area of our lives At the heart of the problem Individuals feel overwhelmed by Demands/Responsibilities of the job or position Too little time, Not enough support Too many expectations Feel powerless to respond effectively Work Performance Burnout Burnout is a state of mental or physical exhaustion caused by prolonged stress. Three Stages of Burnout Stage 1 - Stress Arousal Stage 2 - Energy Conversation Stage 3 - Exhaustion 5
6 Have you ever considered suicide as an option to a major life problem? 1. Never 2. Yes 3. I don t want to answer Stress and Suicide Permanent solution to temporary problem Physicians have higher rates of suicide 70% higher than general population, F> M Greatest risk factors: Mental D/O or Substance Abuse D/O. Barriers to tx- Lack of time, confidentiality issues, stigma, cost, fear of unwanted intervention Stress and Pregnancy Evidence supports that the perinatal period is an extremely sensitive time for neuroplastic changes and may have impact on future psychopathology QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture. Fumagali F. Progress in Neurobiology 2007;81:
7 Case 35 y/o woman with hx of Multiple Sclerosis comes to see my in her 7th month b/c she is afraid she is going to have a flare up of MS. Had miscarriage Ist trimester- was depressed and anxious, crying jags and suicidal ideation. Treated herself with acupuncture and yoga. She wanted to discuss going on antidepressant. Brief History Hx of alcoholism, Goes to AA- Sober x 10 years. MS - 2 flare ups - both due to stress. First in 1999 due to graduate school. Currently on no MS meds. Had been on many, including Steroids and Copaxone Hx of depression - tx ed with Paxil in the past. Married x 2 years. 1st Marriage Man she met on the internet. Treatment She denied any stressors- family relationships or work. Later - cultural couple/family stressors revealed Couples work- reduced stress 7
8 Stress in our time - PTSD Trauma Re-experiencing Hyper-arousal Avoidance 8
9 Sleep Most common complaint Window to understanding a human being Dreams - way of allowing the mind to work out it s frustrations. Which Pattern Best Describes Your Usual Night s Sleep? 1. Fall asleep quickly and sleep thru the night 2. Fall asleep quickly but have multiple awakenings thru the night. 3. Initial trouble falling asleep but once asleep can sleep thru the night. 4. Initial trouble falling asleep with multiple awakenings thru the night. 5. Initial trouble falling asleep with multiple awakenings thru the night and with final unwanted early morning awakening. Stress Management Requires Intervention in: Cognitive Emotional Social Physical Environmental 9
10 Treatment of Stress- Non-Pharmacologic Regular Exercise, Yoga No smoking, Moderate alcohol intake Improve diet- Relaxation /Meditation -Classical Music Improve sleep habits Work breaks Realistic expectations for self and others Family and Friends- Support- talking Leisure activities- Prepare for your retirement Treatment of Stress- Pharmacologic Review all meds- Rx, OTC, illicit Decrease or discontinue caffeine Anti-depressants Beta Blockers Benzodiazepines Anti-psychotics Anti-cycling agents 10
11 How did I prepare this talk? Waited to the last minute- s - urging me to finish before deadline Drank coffee and did it early in the morning Didn t take breaks- worked for 3 hours straight. Worried- Am I going to screw up the talk and the audience going to hate me. Will you make any changes to lower your stress after this talk? 1. No, I don t have a problem with stress in my life. 2. No, I am too busy to make any changes. 3. Yes, I will try but I don think I can do it. 4. Yes, I will make definite attempts to lower my stress. 5. I am going to put $500 dollars on the Roulette table and if I win I will make some changes. 11
12 Thanks for Listening! 12
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