An Analysis of Stress - A View From A Holistic NP
Abstract
Alternative health is no longer on the fringe of healthcare. More than 30 % of patients seeking treatment are using alternative practitioners for their care.(1) The literature is rich with articles discussing complimentary/alternative care. One of the most common uses for complimentary/alternative treatment modalities is depression.(2).
Depression is significant sequelae of stress. Stress is the inherent variable in a person’s life. It can result from a burden or challenge depending on the individual’s response to the cause. Depression caused by stress can have devastating consequences. It can lead to heart disease. A methodology is suggested in this article is the use of complimentary/alternative methods by a psychiatric nurse practitioner. The belief is suggested that the psychiatric nurse practitioner, with the specific training in complimentary/holistic methods, can provide an improved level of psychiatric care over conventional (Western based) psychiatric care. Having this combined training, I envision other psychiatric nurse practitioners that can utilize both schools of thought for improved client outcomes.
Literature Search
While preparing this article the traditional and the alternative care literature was reviewed. One notices more and more is being published about the benefit of nurses performing non-invasive, complimentary methods. Dossey has written about the benefit of complimentary practices used by nurses in a general hospital setting (3) . Richardson suggests traditional and alternative methods benefits patients in a geriatric psychiatry unit in Massachusetts (4). Other articles discuss the use of herbs (5) and whether therapeutic touch has benefits.(6) Indeed there is an interesting article written by Clark which gives an overview of complimentary options.(7) An article, by Earnst, Rand and Stevinson specifically discussed the relationship between alternative methodologies and depression.(8). Although discussing the benefit for the described methods, these articles were geared toward an understanding of complimentary methods and their possible use. This article attempts to make the argument that the psychiatric nurse practitioner is best able, due to his/her specific training in nursing practice, to be the guide for implementation of these complimentary protocols along with the traditional methodologies to best serve the psychiatric patient to achieve balance and maintain balance in his/her life. Therefore, the psychiatric nurse practitioner, with the specific training in complimentary care can provide psychiatric care beyond what has been offered heretofore.
Natural Health not on the fringe anymore.
According to the Natural Center for Complementary and Alternative Medicine, only 10 to 30 per cent of healthcare is provided by conventional, bio-medically oriented practitioners. The balance of healthcare is provided by alternative practitioners.(9) Alternative therapies are no longer on the fringe as they were only a decade ago. Since these methods are being sought out by millions and millions of patients a year it is important for the prudent practitioner to consider all methods to meet these identified patient needs.
Alternative practitioners may lack the ability to incorporate the treatment strategies of modern psychiatric care. The psychiatric nurse practitioner has the potential to rise to the occasion. Nursing care places its’ focus on the person , not the illness. (The latter suggests the medical model. Physicians have been trained to focus on their patients’ symptoms; not a whole person.) Psychiatric NP’s have specific training to treat patients with medication and therapy (in collaboration with a physician). Blending the two roles; that of the Psychiatric NP with training of a Naturopath provides a forum for insight into holistic treatment modalities not often considered as treatment options by allopathic (western medical) practitioners.
A significant issue that the psychiatric nurse practitioner and the Naturopath deal with is - stress. It can lead to the psychological malady of depression and physiological diseases including heart dysfunction(10). Therefore, I will discuss stress in terms of psychological and physical dysfunction and the resultant sequelae.
What is Stress?
Stress has an initial effect on the mind. It is a psychological (and subsequently physiological) inherent variable in a person’s life. It can result from a burden or challenge depending on the individual’s response to the cause. Responses to stress differ due to the variables associated with personalities and temperaments. Additionally, the method of effective or ineffective coping can also determine the response to stress. (11)
Anxiety is an alerting signal of stress. It produces such physiological features as dry mouth, accelerated heart rate, high levels of stress hormones and increased muscular tension. Physical, social and psychological stressors can trigger anxiety reactions. Fear is a similar alerting signal, however, it differs from anxiety in the following aspects: fear is in response to a threat that is known, external, definite or non-conflicting in origin. Anxiety is in response to a threat that is unknown, internal, vague or conflicting in origin.(12)
Coping is a method that one uses to deal with stress and anxiety. Coping involves the defenses of the ego.(13) If the person’s ego is functioning properly, it is an adaptive process that helps a person maintain the balance of both the external events and internal drives. If the defenses of the ego are not functioning properly and the imbalance continues the person could develop chronic anxiety.(14)
Defenses are the ego’s protective mechanism. They protect the individual from threats or anxiety and help to reduce or eliminate the anxiety (or stress). Defense mechanisms operate on an unconscious level.(15) Anxiety has adaptive features. It can be considered the same basic emotion as fear in that it can warn of an external or internal threat. Anxiety can have life saving qualities. At lower levels, anxiety warns of threats of bodily damage, pain or possible punishment. This allows the person to take action to prevent the threat or lessen its consequences. Actions resulting from anxiety can be constructive, such as studying for an examination reduces test anxiety. However, it can also be destructive- such as when anxiety is heightened and the impulse is fight or flight.
Analysis of Anxiety
There are four major schools of thought regarding the causes of anxiety: psychoanalytic, behavioral, existential and biological. In addition, physical and psychological models are cited in the literature. (16,17,18)
The three major neurotransmitters associated with anxiety are nor epinephrine, GABA (gamma-amino-butyric-acid) and seratonin. Norepinephrine is produced in the locus ceruleus of the brain. GABA is an inhibitory neurotransmitter and is the most abundant neurotransmitter in the brain. Seratonin is produced in the raphe nuclei.(19)
Hans Selye wrote about a physical model where stress occurs in every living organism. He also believed that ‘stressors’ are stimuli that cause stress. Selye is known for the General Adaptation Syndrome (GAS) of somatic symptoms produced by nonspecific stress. The GAS consists of three stages, the alarm reaction, resistance and exhaustion phases. (20,21,22)
The human nervous system is divided into the central nervous system (CNS) and the peripheral nervous system. The central nervous system consists of the brain stem and spinal cord. The peripheral nervous system consists of the cranial and spinal nerves and peripheral ganglia. The peripheral nervous system sends sensory information back to the CNS. The peripheral nervous system is divided into the somatic nervous system and the autonomic nervous system (ANS) innervates the central organs of the body. The somatic system controls voluntary muscles ands the autonomic nervous system - involuntary muscles. The ANS is subdivided into sympathetic, which expends energy during the ‘fight or flight’ response and the parasympathetic system which conserves energy.(23)
During stress, the initial and swiftest reaction is generated by the sympathetic and parasympathetic components of the autonomic nervous system. Together, these systems attempt to adjust various body functions to meet the stressful situation. The next step is the response, moving from neurological to endocrine activity, occurs when the sympathetic system stimulates the production of adrenaline by the adrenal glands. This is in essence the fight or flight response. The entire body responds with a tremendous surge of energy. Such reactions sometimes enable people to perform feats of enormous physical strength which they would not normally be able to perform. Nor-adrenaline however, constricts the arterioles and raises blood pressure, with much less influence than adrenaline on blood glucose and heart rate.(24)
Sequelae of Stress
As I mentioned in the prior segment, the initial response to stress is the alarm reaction (the first stage of Selye’s General Adaptation Syndrome) or “fight or flight”. It is triggered by reactions in the brain which ultimately cause the adrenal medulla to secrete adrenaline and other stress - related hormones. The fight or flight response is designed to counteract danger by mobilizing the body’s resources for immediate physical activity. During fight or flight the following responses occur:
• The heart rate and force of contraction of the heart increases to provide blood to areas necessary for response to the stressful situation.
• Blood is shunted away from the skin and internal organs, except the heart and lung, while at the same time the amount of blood supplying needed oxygen and glucose to the muscles and brain is increased.
• The rate of breathing increases to supply necessary oxygen to the heart, brain and exercising muscle.
• Sweat production increases to eliminate toxic compounds produced by the body to lower body temperature.
• Production of digestive secretions is severely reduced since digestive activity is not critical for counteracting stress.
• Blood sugar levels are increased dramatically as the liver dumps stored glucose into the bloodstream.(25)
When stress accumulates in the body, over time, the result may be a conversion into severe physical and psychological symptoms. The psychological consequence can be depression. The physical system that is burdened most greatly by stress is the heart. The result can be dysfunction. The following segment will discuss depression and heart dysfunction as severe sequelae of stress.
Depression
If one is depressed, one thinks of someone who is sad. Major Depression is the inability or loss of interest in experiencing pleasure. Sadness is common to most people, but the sadness is manifested in an inability to perform activities consistent with everyday life such as going shopping or socializing. In extreme cases, the inability to care for oneself results in a lack of food intake, sleeping and self-grooming. People who experience major depression may have thoughts of suicide or homicide. They may be unable to concentrate. All of these perceptions, actions or lack of actions can have severe effects on the body. (26) One of the eventual results of this sequelae may be heart disease.
Heart Disease as a Sequelae of Depression
The heart has long been considered the emotional essence of man where feelings of love and caring originate. It is also well known to serve the function of pumping life-sustaining blood throughout the rest of the body. Therefore, when a person develops cardiac dysfunction, as a sequelae of stress, the feeling of loss and vulnerability are pronounced, since the effect is to both the mind and body.
“..... approximately 66 million Americans have some form of cardiovascular disease. Each year nearly 1 million deaths are attributed to cardiovascular disease. Of these, more than 500,000 result from heart attacks, and most of them are sudden deaths.”(27)
A Myocardial Infarction – Physiological Aspects:
An acute myocardial infarction refers to the ischemic necrosis of a portion of the myocardium produced by an abrupt decrease in the coronary blood supply. The necrosis results in a permanent loss of contraction of the portion of the myocardium involved. Resulting clinical results are the following:
1. chest pain
2. ECG abnormalities
3. elevation of serum levels of cardiac enzymes(28)
The course of treatment is designed to help the person and his/her heart begin the process of recovery of function. This may include the use of thrombolytic agents, morphine to reduce pain, oxygen therapy, fluids and medications. From the patient’s perspective, he sees a great deal of activity, if he’s awake. He’s probably hooked up to a respirator, a heart monitor, a pulse oximeter and whatever else, including a spaghetti mound of wires and tubes in his nose and any or all other orifices available. The result of all this activity, the people, the tubes, the wires, the sounds of monitors, the bright lights, etc. creates a list of psychological issues for the patient. There has been much investigation about the effect of depression relative to a myocardial infarction:
• Using the Beck Depression Inventory (BDI) (29) and National Institutes of Mental Health Diagnostic Interview Schedule (DIS) (30) scales - patients diagnosed as being depressed prior to hospitalization, who continued to be depressed post hospitalization, had more severe depressions (according to the BDI scale).
• Patients that experienced recurrent depression in the hospital were at a higher risk of death during the 18 months post hospitalization. 40% of the patients died within 18 months compared with 10% where depression in the hospital was the first episode experienced.
• Patients with a previous history of depression, who did not become depressed during the hospitalization for the MI, had the lowest mortality rate of the group.
• The authors speculate that if one has a history of depression and has developed resources to deal with the depression prior to the MI, these additional physical or psychic resources are available to maintain the patient through the stresses of the MI event.(31)
Glassman and Shapiro (1998) in their study state,“....there is no question that depression is associated with both developing cardiovascular disease and death.” (32) They came to this conclusion after studying the following information: A study by Carney et al (33) found that when 52 patients who had confirming tests for coronary artery disease met the criteria for major depression (20% met the criteria) the group with this psychiatric diagnosis was 250% more likely to develop cardiac complications over the next year.
Conclusion
As stated in the beginning of this paper, a holistic psychiatric nurse practitioner utilizing the skills of the Naturopath along with those of the Psychiatric Nurse Practitioner has an opportunity to make a dramatic change in health care to treat the stress and defer the resulting sequelae.
Depression is cited in the literature as among the 10 most common indicators for alternative therapies.(34) The most frequently used alternatives for depression are relaxation, exercise and herbal preparations. Patients cite the reason for using herbals and other alternatives is they have tried all the alternatives and these are the only remaining options. Indeed, a daughter of one of my patients died of Hodgkin’s Lymphoma. Just prior to her death she attempted herbals and “Chinese techniques” as her last means of fighting her illness. It was her hope when all was gone.
Of great importance is the person who has multiple symptoms and is putting multiple “preparations” into his body that could interact. A medication may have similar properties to an herbal, but the drug may be more concentrated. An example is - patients on heart medication should be careful with the use of Kava Kava. There is a documented drug - drug interaction with heart medication which can result in arrhythmias.(35)
So what is the intelligent modern healthcare consumer to do to relieve stress? What is the alternative-to-alternative medicine? This may be an appropriate answer:
In order to achieve a state of wellness the body must be cleansed of toxic substances and the person needs to change behaviors to begin to live - life in harmony with nature. The practices of fasting, eating natural, whole foods, exercise, and living a reduced stress life can help the person to achieve a higher level of wellness through achieving balance in his life.
Stress can be reduced by many methods. Some methods that the traditional medical model embrace are anti - anxiety medications such as benzodiazepines, tricyclics and SSRI’s. There are many other methods, some involve belief systems, but all have had a measure of success. Therefore, if one method doesn’t meet the person’s expectations, there are others that may be a better fit. Any or all may be used to achieve the aforementioned goal.
As a holistic psychiatric nurse practitioner, I develop stress management treatment programs including these many modalities. Since the article suggests how the mind is directly integrated with the body, one may consider a suggestion for counseling or psychotherapy. In addition, there are modalities of acupressure, massage therapy, relaxation techniques, aromatic oils, dance therapy and exercise (as well as others as appropriate). These components along with an appropriate diet may provide a method helping people to modify their lives to reducing stress and anxiety and helping improve the quality of life.
Stress and anxiety are pervasive. One may experience a form of stress at any time. This paper has explored the variety of levels of anxiety. From mild anxiety, that is felt as the palpitations one gets from crossing a busy road, to the severe anxiety that can cause the disabling effects of clinical depression or heart disease. Since it is all around us, and a part of our daily lives - it is important to have tools and methods available to deal with stress. The article discusses strategies to help patients heal. Some patients may require ongoing intervention by a practitioner; others may employ self-healing practices. An important concept one needs to remember is that healing will be more successful if the client is receptive and brings a positive attitude to any healing session. His / her own belief of any healing process is extremely important.
Therefore, a suggestion: allopathic and complimentary practitioners of mental and physical health are urged to encourage your patients to seek out and use non - invasive methods as a first line to help your patients. Develop contacts in the healing community with providers of ‘therapies’ such as massage and acupuncture that have proven successful.
Endnotes – will be provided upon request
Alternative health is no longer on the fringe of healthcare. More than 30 % of patients seeking treatment are using alternative practitioners for their care.(1) The literature is rich with articles discussing complimentary/alternative care. One of the most common uses for complimentary/alternative treatment modalities is depression.(2).
Depression is significant sequelae of stress. Stress is the inherent variable in a person’s life. It can result from a burden or challenge depending on the individual’s response to the cause. Depression caused by stress can have devastating consequences. It can lead to heart disease. A methodology is suggested in this article is the use of complimentary/alternative methods by a psychiatric nurse practitioner. The belief is suggested that the psychiatric nurse practitioner, with the specific training in complimentary/holistic methods, can provide an improved level of psychiatric care over conventional (Western based) psychiatric care. Having this combined training, I envision other psychiatric nurse practitioners that can utilize both schools of thought for improved client outcomes.
Literature Search
While preparing this article the traditional and the alternative care literature was reviewed. One notices more and more is being published about the benefit of nurses performing non-invasive, complimentary methods. Dossey has written about the benefit of complimentary practices used by nurses in a general hospital setting (3) . Richardson suggests traditional and alternative methods benefits patients in a geriatric psychiatry unit in Massachusetts (4). Other articles discuss the use of herbs (5) and whether therapeutic touch has benefits.(6) Indeed there is an interesting article written by Clark which gives an overview of complimentary options.(7) An article, by Earnst, Rand and Stevinson specifically discussed the relationship between alternative methodologies and depression.(8). Although discussing the benefit for the described methods, these articles were geared toward an understanding of complimentary methods and their possible use. This article attempts to make the argument that the psychiatric nurse practitioner is best able, due to his/her specific training in nursing practice, to be the guide for implementation of these complimentary protocols along with the traditional methodologies to best serve the psychiatric patient to achieve balance and maintain balance in his/her life. Therefore, the psychiatric nurse practitioner, with the specific training in complimentary care can provide psychiatric care beyond what has been offered heretofore.
Natural Health not on the fringe anymore.
According to the Natural Center for Complementary and Alternative Medicine, only 10 to 30 per cent of healthcare is provided by conventional, bio-medically oriented practitioners. The balance of healthcare is provided by alternative practitioners.(9) Alternative therapies are no longer on the fringe as they were only a decade ago. Since these methods are being sought out by millions and millions of patients a year it is important for the prudent practitioner to consider all methods to meet these identified patient needs.
Alternative practitioners may lack the ability to incorporate the treatment strategies of modern psychiatric care. The psychiatric nurse practitioner has the potential to rise to the occasion. Nursing care places its’ focus on the person , not the illness. (The latter suggests the medical model. Physicians have been trained to focus on their patients’ symptoms; not a whole person.) Psychiatric NP’s have specific training to treat patients with medication and therapy (in collaboration with a physician). Blending the two roles; that of the Psychiatric NP with training of a Naturopath provides a forum for insight into holistic treatment modalities not often considered as treatment options by allopathic (western medical) practitioners.
A significant issue that the psychiatric nurse practitioner and the Naturopath deal with is - stress. It can lead to the psychological malady of depression and physiological diseases including heart dysfunction(10). Therefore, I will discuss stress in terms of psychological and physical dysfunction and the resultant sequelae.
What is Stress?
Stress has an initial effect on the mind. It is a psychological (and subsequently physiological) inherent variable in a person’s life. It can result from a burden or challenge depending on the individual’s response to the cause. Responses to stress differ due to the variables associated with personalities and temperaments. Additionally, the method of effective or ineffective coping can also determine the response to stress. (11)
Anxiety is an alerting signal of stress. It produces such physiological features as dry mouth, accelerated heart rate, high levels of stress hormones and increased muscular tension. Physical, social and psychological stressors can trigger anxiety reactions. Fear is a similar alerting signal, however, it differs from anxiety in the following aspects: fear is in response to a threat that is known, external, definite or non-conflicting in origin. Anxiety is in response to a threat that is unknown, internal, vague or conflicting in origin.(12)
Coping is a method that one uses to deal with stress and anxiety. Coping involves the defenses of the ego.(13) If the person’s ego is functioning properly, it is an adaptive process that helps a person maintain the balance of both the external events and internal drives. If the defenses of the ego are not functioning properly and the imbalance continues the person could develop chronic anxiety.(14)
Defenses are the ego’s protective mechanism. They protect the individual from threats or anxiety and help to reduce or eliminate the anxiety (or stress). Defense mechanisms operate on an unconscious level.(15) Anxiety has adaptive features. It can be considered the same basic emotion as fear in that it can warn of an external or internal threat. Anxiety can have life saving qualities. At lower levels, anxiety warns of threats of bodily damage, pain or possible punishment. This allows the person to take action to prevent the threat or lessen its consequences. Actions resulting from anxiety can be constructive, such as studying for an examination reduces test anxiety. However, it can also be destructive- such as when anxiety is heightened and the impulse is fight or flight.
Analysis of Anxiety
There are four major schools of thought regarding the causes of anxiety: psychoanalytic, behavioral, existential and biological. In addition, physical and psychological models are cited in the literature. (16,17,18)
The three major neurotransmitters associated with anxiety are nor epinephrine, GABA (gamma-amino-butyric-acid) and seratonin. Norepinephrine is produced in the locus ceruleus of the brain. GABA is an inhibitory neurotransmitter and is the most abundant neurotransmitter in the brain. Seratonin is produced in the raphe nuclei.(19)
Hans Selye wrote about a physical model where stress occurs in every living organism. He also believed that ‘stressors’ are stimuli that cause stress. Selye is known for the General Adaptation Syndrome (GAS) of somatic symptoms produced by nonspecific stress. The GAS consists of three stages, the alarm reaction, resistance and exhaustion phases. (20,21,22)
The human nervous system is divided into the central nervous system (CNS) and the peripheral nervous system. The central nervous system consists of the brain stem and spinal cord. The peripheral nervous system consists of the cranial and spinal nerves and peripheral ganglia. The peripheral nervous system sends sensory information back to the CNS. The peripheral nervous system is divided into the somatic nervous system and the autonomic nervous system (ANS) innervates the central organs of the body. The somatic system controls voluntary muscles ands the autonomic nervous system - involuntary muscles. The ANS is subdivided into sympathetic, which expends energy during the ‘fight or flight’ response and the parasympathetic system which conserves energy.(23)
During stress, the initial and swiftest reaction is generated by the sympathetic and parasympathetic components of the autonomic nervous system. Together, these systems attempt to adjust various body functions to meet the stressful situation. The next step is the response, moving from neurological to endocrine activity, occurs when the sympathetic system stimulates the production of adrenaline by the adrenal glands. This is in essence the fight or flight response. The entire body responds with a tremendous surge of energy. Such reactions sometimes enable people to perform feats of enormous physical strength which they would not normally be able to perform. Nor-adrenaline however, constricts the arterioles and raises blood pressure, with much less influence than adrenaline on blood glucose and heart rate.(24)
Sequelae of Stress
As I mentioned in the prior segment, the initial response to stress is the alarm reaction (the first stage of Selye’s General Adaptation Syndrome) or “fight or flight”. It is triggered by reactions in the brain which ultimately cause the adrenal medulla to secrete adrenaline and other stress - related hormones. The fight or flight response is designed to counteract danger by mobilizing the body’s resources for immediate physical activity. During fight or flight the following responses occur:
• The heart rate and force of contraction of the heart increases to provide blood to areas necessary for response to the stressful situation.
• Blood is shunted away from the skin and internal organs, except the heart and lung, while at the same time the amount of blood supplying needed oxygen and glucose to the muscles and brain is increased.
• The rate of breathing increases to supply necessary oxygen to the heart, brain and exercising muscle.
• Sweat production increases to eliminate toxic compounds produced by the body to lower body temperature.
• Production of digestive secretions is severely reduced since digestive activity is not critical for counteracting stress.
• Blood sugar levels are increased dramatically as the liver dumps stored glucose into the bloodstream.(25)
When stress accumulates in the body, over time, the result may be a conversion into severe physical and psychological symptoms. The psychological consequence can be depression. The physical system that is burdened most greatly by stress is the heart. The result can be dysfunction. The following segment will discuss depression and heart dysfunction as severe sequelae of stress.
Depression
If one is depressed, one thinks of someone who is sad. Major Depression is the inability or loss of interest in experiencing pleasure. Sadness is common to most people, but the sadness is manifested in an inability to perform activities consistent with everyday life such as going shopping or socializing. In extreme cases, the inability to care for oneself results in a lack of food intake, sleeping and self-grooming. People who experience major depression may have thoughts of suicide or homicide. They may be unable to concentrate. All of these perceptions, actions or lack of actions can have severe effects on the body. (26) One of the eventual results of this sequelae may be heart disease.
Heart Disease as a Sequelae of Depression
The heart has long been considered the emotional essence of man where feelings of love and caring originate. It is also well known to serve the function of pumping life-sustaining blood throughout the rest of the body. Therefore, when a person develops cardiac dysfunction, as a sequelae of stress, the feeling of loss and vulnerability are pronounced, since the effect is to both the mind and body.
“..... approximately 66 million Americans have some form of cardiovascular disease. Each year nearly 1 million deaths are attributed to cardiovascular disease. Of these, more than 500,000 result from heart attacks, and most of them are sudden deaths.”(27)
A Myocardial Infarction – Physiological Aspects:
An acute myocardial infarction refers to the ischemic necrosis of a portion of the myocardium produced by an abrupt decrease in the coronary blood supply. The necrosis results in a permanent loss of contraction of the portion of the myocardium involved. Resulting clinical results are the following:
1. chest pain
2. ECG abnormalities
3. elevation of serum levels of cardiac enzymes(28)
The course of treatment is designed to help the person and his/her heart begin the process of recovery of function. This may include the use of thrombolytic agents, morphine to reduce pain, oxygen therapy, fluids and medications. From the patient’s perspective, he sees a great deal of activity, if he’s awake. He’s probably hooked up to a respirator, a heart monitor, a pulse oximeter and whatever else, including a spaghetti mound of wires and tubes in his nose and any or all other orifices available. The result of all this activity, the people, the tubes, the wires, the sounds of monitors, the bright lights, etc. creates a list of psychological issues for the patient. There has been much investigation about the effect of depression relative to a myocardial infarction:
• Using the Beck Depression Inventory (BDI) (29) and National Institutes of Mental Health Diagnostic Interview Schedule (DIS) (30) scales - patients diagnosed as being depressed prior to hospitalization, who continued to be depressed post hospitalization, had more severe depressions (according to the BDI scale).
• Patients that experienced recurrent depression in the hospital were at a higher risk of death during the 18 months post hospitalization. 40% of the patients died within 18 months compared with 10% where depression in the hospital was the first episode experienced.
• Patients with a previous history of depression, who did not become depressed during the hospitalization for the MI, had the lowest mortality rate of the group.
• The authors speculate that if one has a history of depression and has developed resources to deal with the depression prior to the MI, these additional physical or psychic resources are available to maintain the patient through the stresses of the MI event.(31)
Glassman and Shapiro (1998) in their study state,“....there is no question that depression is associated with both developing cardiovascular disease and death.” (32) They came to this conclusion after studying the following information: A study by Carney et al (33) found that when 52 patients who had confirming tests for coronary artery disease met the criteria for major depression (20% met the criteria) the group with this psychiatric diagnosis was 250% more likely to develop cardiac complications over the next year.
Conclusion
As stated in the beginning of this paper, a holistic psychiatric nurse practitioner utilizing the skills of the Naturopath along with those of the Psychiatric Nurse Practitioner has an opportunity to make a dramatic change in health care to treat the stress and defer the resulting sequelae.
Depression is cited in the literature as among the 10 most common indicators for alternative therapies.(34) The most frequently used alternatives for depression are relaxation, exercise and herbal preparations. Patients cite the reason for using herbals and other alternatives is they have tried all the alternatives and these are the only remaining options. Indeed, a daughter of one of my patients died of Hodgkin’s Lymphoma. Just prior to her death she attempted herbals and “Chinese techniques” as her last means of fighting her illness. It was her hope when all was gone.
Of great importance is the person who has multiple symptoms and is putting multiple “preparations” into his body that could interact. A medication may have similar properties to an herbal, but the drug may be more concentrated. An example is - patients on heart medication should be careful with the use of Kava Kava. There is a documented drug - drug interaction with heart medication which can result in arrhythmias.(35)
So what is the intelligent modern healthcare consumer to do to relieve stress? What is the alternative-to-alternative medicine? This may be an appropriate answer:
In order to achieve a state of wellness the body must be cleansed of toxic substances and the person needs to change behaviors to begin to live - life in harmony with nature. The practices of fasting, eating natural, whole foods, exercise, and living a reduced stress life can help the person to achieve a higher level of wellness through achieving balance in his life.
Stress can be reduced by many methods. Some methods that the traditional medical model embrace are anti - anxiety medications such as benzodiazepines, tricyclics and SSRI’s. There are many other methods, some involve belief systems, but all have had a measure of success. Therefore, if one method doesn’t meet the person’s expectations, there are others that may be a better fit. Any or all may be used to achieve the aforementioned goal.
As a holistic psychiatric nurse practitioner, I develop stress management treatment programs including these many modalities. Since the article suggests how the mind is directly integrated with the body, one may consider a suggestion for counseling or psychotherapy. In addition, there are modalities of acupressure, massage therapy, relaxation techniques, aromatic oils, dance therapy and exercise (as well as others as appropriate). These components along with an appropriate diet may provide a method helping people to modify their lives to reducing stress and anxiety and helping improve the quality of life.
Stress and anxiety are pervasive. One may experience a form of stress at any time. This paper has explored the variety of levels of anxiety. From mild anxiety, that is felt as the palpitations one gets from crossing a busy road, to the severe anxiety that can cause the disabling effects of clinical depression or heart disease. Since it is all around us, and a part of our daily lives - it is important to have tools and methods available to deal with stress. The article discusses strategies to help patients heal. Some patients may require ongoing intervention by a practitioner; others may employ self-healing practices. An important concept one needs to remember is that healing will be more successful if the client is receptive and brings a positive attitude to any healing session. His / her own belief of any healing process is extremely important.
Therefore, a suggestion: allopathic and complimentary practitioners of mental and physical health are urged to encourage your patients to seek out and use non - invasive methods as a first line to help your patients. Develop contacts in the healing community with providers of ‘therapies’ such as massage and acupuncture that have proven successful.
Endnotes – will be provided upon request
posted by Eric Malz at 9:44 AM
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