Mind, Body and Health
Depression, Anxiety and Heart
with Chronic Illness
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Role of the School Nurse
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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 ones anger may have
more specific predictive value.
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
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
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
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.
In The Mind-Body Interface
“Depression and Anxiety in the Person with Diabetes”
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
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
That Person In The Health Suite, And What Does She (or He) Really Do?
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,
dont carry medicine around school in your pocket! People are very concerned about
the issue of illegal drugs and you dont 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. Lets face itsome 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
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.