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”