STRESS AND LUPUS
Howard Hauptman, MD
STRESS
2011 APA SURVEY
• MOST AMERICANS REPORT FEELING MOD-
HIGH STRESS LEVELS
• 44%: STRESS LEVELS INCREASED IN PAST 5
YEARS
• 39%: OVEREAT OR EAT UNHEALTHY 2/2
STRESS
• ≥ 50%: EXERCISE IS IMPORTANT, BUT ≤ 33%
WAS SATISFIED WITH LEVEL OF EXERCISE
STRESS
• A REACTION TO A STIMULUS THAT DISTURBS PHYSICAL OR MENTAL EQUILIBRIUM
• PREVENTS US FROM LIVING IN A STATE OF CONTENTMENT AND FULFILLMENT
• BOTH ACUTE OR CHRONIC STRESS CAN CAUSE ILLNESS
STRESS
• OUT OF BALANCE BETWEEN: DEMANDS PLACED ON US V.S. RESOURCES TO DEAL WITH THEM
• GOAL: DEMANDS, R ESOURCES
DEMANDS
• ACUTE: INFECTIONS TRAUMA DANGER ENVIRONMENTAL: NOISE, HUNGER…
• CHRONIC: WORK RELATIONSHIPS/FAMILY CHRONIC ILLNESS
DEMANDS
• MAJOR LIFE EVENTS DIVORCE DEATH OF A LOVED ONE LOSS OF JOB MAJOR ILLNESS
STRESS
• GOOD VS BAD STRESS: STIMULATES SAME CHEMICALS/HORMONES FIGHT OR FLIGHT RESPONSE
• ACUTE VS CHRONIC: SUDDEN NEGATIVE CHANGES : DANGER, INFECTIONS, ENVIRONMENTAL TRAUMA: ACCIDENT, WAR, NATURAL DISASTER ROUTINE: DAILY, WORK, FAMILY PRESSURES CHRONIC ILLNESS
STRESS RESPONSE
• BRAIN: INCREASED HORMONE PRODUCTION; CORTISOL, CATECHOLAMINES, NEUROTRANSMITTERS
• HEART, LUNGS, CIRCULATION
• IMMUNE SYSTEM
• MOUTH, THROAT, SKIN, MUSCLES
• RELAXATION RESPONSE
MECHANISM OF ACTION
CORTISOL
SIGNS OF STRESS
• DIFFICULTY SLEEPING
• EASILY ANGERED
• FEELING DEPRESSED
• LOW ENERGY
• INCREASED ALCOHOL/SUBSTANCE ABUSE
• CHANGE IN EATING HABITS
STRESS AND DISEASE
• UP TO 80% OF PATIENTS REPORT UNCOMMON EMOTIONAL STRESS BEFORE DISEASE ONSET
• LINKED TO DISEASE FLARES
• UNDERLYING DISEASE CAN CAUSE INCR. STRESS
STUDIES
• BF/CBT VS CONTROLS IN SLE: LESS PAIN, IMPROVED PSYCHOLOGICAL AND PHYSICAL FUNCTION
• VACCINE STUDY: BETTER RESPONSE TO VACCINATION IN NON-STRESSED PATIENTS
• RETROSPECTIVE STUDIES: SLE,RA FIRST/RECURRENT FLARES ASSOCIATED WITH STRESSFUL PERIODS
• ?LIFETIME VS LIFESTYLE STRESSORS?
FACTORS THAT INFLUENCE THE RESPONSE TO STRESS
• EARLY NURTURING
• PERSONALITY TRAITS
• GENETIC FACTORS
• IMMUNE DISEASES
• LENGTH, INTENSITY OF STRESSORS
STRESS REDUCTION
COPING WITH STRESS
• GET PROPER HEALTH CARE
• SEEK HELP: HEALTH CARE PROVIDER, FAMILY, FRIENDS, COMMUNITY
• SET PRIORITIES
• EXERCISE DAILY
• SCHEDULE HEALTHY/RELAXING ACTIVITIES
• STRESS COPING PROGRAMS
STRESS COPING PROGRAMS
• EXERCISES: AEROBIC, YOGA, TAI CHI
• MINDFULNESS BASED PROGRAMS: MEDITATION
• COGNITIVE-BEHAVIORAL THERAPY (CBT)
COGNITIVE BEHAVIORAL THERAPY
• IDENTIFYING SOURCES OF STRESS
• QUESTIONING THE SOURCES OF STRESS
• RESTRUCTURING PRIORITIES
• FINDING METHODS TO MANAGE/REDUCE STRESS
STRESS
• CHOICES WE MAKE: DISTINGUISH WHAT WE HAVE CONTROL OVER VS NO CONTROL!
• “OUT OF CONTROL EVENT”
• MANAGING EXPECTATIONS: REALISTIC GOALS
• “SMALL STEPS”