Northern County Psychiatric Associates

Attention Deficit Disorder
Adult AD/HD
Children & Adolescents
Family Issues
Organization Skills

Children & Adolescents
Seasonal Depression

Bipolar Disorder
Family Issues

Obsessive-Compulsive Disorder
Body Dysmorphic Disorder
Separation Anxiety Disorder

Specific Medications
Free Medication Programs

For Kids and Teens
Family therapy


Mental Health Book Reviews


Managed Care Humor

Search Our Site by Key Words

Enter the word or phrase to search for:
Only match whole words

Our Privacy Policy







































Mind, Body and Health

Depression, Anxiety and Heart Disease

Coping with Chronic Illness

How Depression and Anxiety Affect Diabetes

NCPA Publications on Mind-Body Issues

The Role of the School Nurse

 Search Our Site by Key Words

Enter the word or phrase to search for:
Only match whole words
Not sure of how a word is spelled?
Enter the first few letters of the word:

Your Mind and Your Heart
How Depression and Anxiety Can Have a Major Impact on Heart Disease

Carol E. Watkins, MD

By now, most people are aware that psychological factors can have powerful detrimental or protective effects on the development and progression of cardiovascular disease (heart attacks, strokes and high blood pressure). In the 1950s, researchers described individuals with a "Type A" personality who were more likely to have cardiovascular disease than those with the more laid-back "Type B" personality. The classic definition of "Type A" includes impatience, an aggressive attitude, a sense of time urgency and competitiveness. Since then, research has further refined and expanded our understanding of the relationship between emotions and heart disease. Hostility as well as conflicts about expressing one’s anger may have more specific predictive value.

wpe1.jpg (3587 bytes)wpe2.jpg (3160 bytes)wpe4.jpg (3150 bytes)

Anxiety or other stress may be associated with an increased rate of sudden cardiac events. Individuals who are more isolated or who are over-worked are more likely to develop heart problems. Stress can lead first to intermittent and then to constant high blood pressure. Mental stress has been shown to cause decreased blood flow to the heart. If an individual with cardiac disease is depressed, he or she is much more likely to have a subsequent heart attack.

If an individual with cardiac problems or high blood pressure has depression, anxiety or a "Type A" personality, psychiatric treatment may be a lifesaver. Some researchers suggest that it is critical for all cardiac patients to be carefully evaluated for depression. If depression is present, it should be treated carefully and completely. Hypnosis, relaxation, and other anxiety-reduction techniques can reduce blood pressure and reduce cardiac risk. "Type A" individuals may benefit from psychotherapy to help them modify their personality style. Family or couples therapy may reduce interpersonal sources of stress. Some individuals with cardiac disease may need medication to relieve their anxiety or depression. Now we have newer antidepressant and anti-anxiety medications that are easier and safer to use in individuals with cardiac disease.

Many individuals experience a heart attack as a "wake-up call." They re-evaluate their lives and relationships. The crisis becomes an invitation to finally deal with long-standing depression, anger and anxiety.

Carol Watkins, MD

Coping With Chronic Illness and Living a Full Life
Glenn Brynes, PhD, MD

Most of us go through our lives with only limited medical problems. We take for granted our good health and our freedom from chronic pain. We live in an invisible bubble that seems to protect us from the pain and suffering that others may have. We think, "It won't happen to me."

That protective bubble bursts when we experience a serious or chronic illness. Joints that used to ache only after unusual exertions, now hurt daily and worsen after even moderate exercise. We are shocked, and we begin to worry about our ability to do the things we have always done and enjoyed. We feel sad at the possibility of losing our favorite activities. Dealing with this requires a change in self-image. A tennis pro with a back problems may feel a big loss even if she can still play a more sedate game.

Feeling sad, angry or worried is understandable. How can we deal with this loss? The coping process may involve reorganizing the self-concept and taking stock of what we still can do. Are there other activities that can fill the void?

This process becomes easier if we believe that the most important part of ourselves is still intact. Strong self-esteem and spiritual beliefs are helpful. As with any loss, a period of mourning is normal. This permits recognition of, and gradual acceptance of the loss. This can free our energies for re-investment in new activities. This is not a time for lengthy periods of self-pity. The sadness of mourning can be a way-station, but dwelling there too long can undercut our self-image. We need to re-channel our energies toward things we can still do and enjoy. This often means learning new skills, or pursuing activities we mastered in the past but put aside. A model ship builder with failing vision, might start writing about the ships he loves.

Adapting to a chronic illness is not the same as lowering our expectations for ourselves. Coping is a dynamic process that continues to challenge our tolerance, strength and creativity. Although the illness or physical limitation will probably continue to be frustrating, and sometimes burdensome, it does not need to devastate us or break our spirits.

NCPA Scientific Interests In The Mind-Body Interface

"Depression and Anxiety in the Person with Diabetes" Watkins, CE
Practical Diabetology December 1998.
This article reviews research on the relationship between depression, anxiety and diabetic control. Both depression and anxiety are associated with poorer diabetic management. When either condition is treated, the diabetic control improves. Certain antidepressants can raise blood glucose and others can lower it. This should be taken into consideration when treating an individual with depression and diabetes.

"Recognition of Anxiety and Depression By Residents in a General Medicine Clinic" by Walker, Novack, Brynes and Kaiser , Journal of Medical Education, March 1982.

This research found that about a quarter of patients presenting to a general medical clinic were depressed. The physicians (medical residents) had difficulty identifying depressed patients. Since the patients themselves were more aware of the depression, it highlighted the importance of asking patients about depression during general medical visits.

Who Is That Person In The Health Suite, And What Does She (or He) Really Do?

Carol Watkins, MD

The school nurse is a pretty busy person. She usually does a number of different things as part of her job.

She is often the first medical person to see you if you get sick or hurt at school. Most people have met her when they got hit too hard by a baseball or had a cut or scrape. For this kind of thing, she may fix it up and send you back to class. If it is a fever or the flu, she takes care of you until your parents get there. Occasionally, someone has a bad accident or gets seriously ill at school. Then you really see her in action. She arranges for an ambulance or other emergency help and may start emergency medical care. Hopefully it will never happen, but it is nice to know that she can handle that sort of thing.

Some students need to take medicine at school. Unless you have special permission, don’t carry medicine around school in your pocket! People are very concerned about the issue of illegal drugs and you don’t want anyone getting the wrong idea! The nurse or an assistant should keep the medicine and give it to you at the right time. Some people really like that daily visit and the nurse gets to be a special friend. Other students are embarrassed. They worry that people will find out about the medicines and will laugh at them. Let’s face it—some people can be rude or even cruel. If this worries you, talk to your doctor and to the school nurse. Between them, they may be able to figure a way to get around the problem.

Students with diabetes, asthma or other medical problems may get more intensive help from the nurse.

Occasionally, a student likes the health suite too much. Then the nurse may have to be firm and send him back to class.

A student may have a medical problem and be afraid to tell his or her parents. The nurse can often help you find a way to talk to your parents or your doctor.



Northern County Psychiatric Associates:

Our practice has experience in the treatment of A wide variety of psychiatric disorders. We also deal with pain, psychosomatic disorders and the emotional effects of physical illnesses. We are located in Northern Baltimore County and serve the Baltimore County, Carroll County and Harford County areas in Maryland. Since we are near the Pennsylvania border, we also serve the York County area.   Our services include psychotherapy, psychiatric evaluations, medication management, and family therapy. We treat children, adults, and the elderly.

Awards for other sections of the NCPA site

Carol Watkins, MD
Northern County Psychiatric Associates
Lutherville and Monkton
Baltimore County, Maryland
Phone: 410-329-2028
Web Site: or 

Copyright 2006  Northern County Psychiatric Associates
Last modified: October 13, 2006



Featured Links

Daytrana: New Skin Patch Treatment for ADHD

Treating Girls and Women with AD/HD

Slides From Our Past Presentations

Is It Still Safe to Treat Kids with Antidepressants?

Why Do I Take So Many Medications?


How Therapy Heals