Mind, Body and Health

Mind, Body and Health

Depression, Anxiety and Heart



with Chronic Illness

How Depression and Anxiety Affect



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Role of the School Nurse

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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.

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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

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


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


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


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.