Horticulture Improves Heart Rate, Stress Levels Of Mentally Challenged Adults

Main Category: Rehabilitation / Physical Therapy
Also Included In: Anxiety / Stress;  Mental Health
Article Date: 14 Dec 2011 - 1:00 PST

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Participation in horticultural activities can improve confidence and social skills, cultivate a positive attitude, and rejuvenate the mind and body. Many studies have emphasized the effects of horticultural activities in relation to physical and psychological rehabilitation, but few have considered the influence of these types of activities on mentally challenged people's autonomic nervous system (ANS) and on the stress hormone cortisol. A new study examined how activities such as pressing flowers, planting, creating flower arrangements, and making topiaries affect stress relief for patients who are mentally challenged.

In the first experiment of the study, the heart rate variation (HRV) was measured in 30 mentally challenged people at a rehabilitation center in Daegu, South Korea. Researchers in the second experiment measured the cortisol levels of 20 mentally challenged people from a residential home in Yeongcheon, South Korea. Min-Jung Lee from the Department of Horticultural Therapy at the Catholic University of Daegu (South Korea) published the results of both experiments in a report in HortTechnology.

For the first experiment, subjects participated in four indoor horticultural activities: a pressed flower activity, flower planting, flower arranging, and topiary crafting. Participants' heart rate variation was measured five minutes before and five minutes after each horticultural activity was performed. The pressed flower group and the planting group showed a significant improvement in the standard deviation of the normal-normal (SDNN) interval heart rate variation measurements. The planting group's SDNN and low frequency (LF) significantly improved; a significant improvement in total power (TP) and high frequency was also observed. The flower arrangement group displayed a significant difference in LF, while the topiary group showed a significant difference in TP.

The second experiment used the same four horticultural activities, but collected participants' saliva in order to analyze their cortisol levels. Compared with the baseline measurement, the pressed flower group displayed a significant decrease in cortisol density from the first to the seventh day of testing, however no significant difference was observed on the fourth day. The planting group showed a significantly decreasing difference in cortisol density on day seven compared with day four. The topiary group continued to show a significant decrease in cortisol density at each cortisol collection after the first day of topiary activities.

Interestingly, the participants in the flower arrangement group showed increased stress (as measured by low frequency), and showed no great change in cortisol density. "We inferred that activities such as cutting stems with shears and arranging the cut stems in the exact location are difficult jobs for mentally challenged people", Lee said.

The topiary group exhibited a significant difference in total power, and not only had the most significant difference in TP but also had the largest significant decrease in cortisol density among the four indoor horticultural activities. Lee noted that topiary activities are thought to be fairly valuable in aiding emotional stability and vocational rehabilitation for mentally challenged people.

The research supports previous studies that show that touching and mixing soil affects the activity of the autonomic nervous system (ANS) and relieves stress. Planting activities resulted not only in the greatest change in mentally challenged people's ANS but also in a significant gradual decrease in cortisol density.

Lee concluded that planting activities are the most effective horticultural activity for stress relief and added that the extension of indoor planting activities to outdoor planting activities targeted for mentally challenged individuals will have a greater effect not only on vocational rehabilitation, but also on emotional stability.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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American Society for Horticultural Science. "Horticulture Improves Heart Rate, Stress Levels Of Mentally Challenged Adults." Medical News Today. MediLexicon, Intl., 14 Dec. 2011. Web.
14 Dec. 2011. APA

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Disease Flares In Patients With Vasculitis Triggered By Stress

Main Category: Vascular
Also Included In: Anxiety / Stress;  Mental Health
Article Date: 07 Nov 2011 - 0:00 PST

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In patients with a devastating form of vasculitis who are in remission, stress can be associated with a greater likelihood of the disease flaring, according to a new study by investigators at Hospital for Special Surgery (HSS).

This is the first study to suggest that mental health is a risk factor in patients with vasculitis, a group of autoimmune disorders characterized by the inflammatory destruction of blood vessels. The study, in a form of the disease known as Wegener's granulomatosis (WG), will be presented on Nov. 8 at the American College of Rheumatology's annual meeting.

"When this disease flares, people can be really sick. It often affects the lungs, kidneys, sinuses and nerves. It can cause fevers and rashes. People can die from this illness. It is a very robust, active, inflammatory disease when it is active," said Robert Spiera, M.D., director of the Vasculitis and Scleroderma Program at HSS, who led the study. "When patients are in remission, however, they can do very, very well."

He says that doctors caring for patients with this disease should be attentive to their psychological health. "This study points out that mental health should be part of your medical assessment," said Dr. Spiera. "You should pay attention to the patient's mental well being and be more aggressive about intervening if a patient is in a bad place. Make sure that patients take it seriously."

Prior to this report, a few small studies had suggested that psychological stress can trigger flares of lupus, another autoimmune disease, and doctors have observed that WG patients often say that stress in their lives, caused by perhaps a death of someone close or losing a job, made their disease flare. To investigate this anecdotal evidence in a more quantifiable way, researchers at HSS conducted a retrospective analysis of data from the Wegener's Granulomatosis Etanercept Trial (WGET). The primary objective of this randomized, placebo-controlled clinical trial was to evaluate the safety and efficacy of using etanercept (Enbrel; Immunex Corporation) to get patients with WG into remission and maintain that remission.

All patients in this multicenter trial had active disease at the beginning of the study and most patients went into remission. Checkups occurred every three months. "We assessed their disease activity at defined time intervals, in terms of how active their vasculitis was or whether they were in remission, and we also collected information at every visit regarding the patient's physical and mental health," Dr. Spiera said. Investigators measured disease activity using the Birmingham Vasculitis Activity Score for Wegener's Granulomatosis, a validated tool. At every visit, patients also filled out the Short Form 36 Health Survey, which includes a physical and mental component. Summary scores for each component are measured on a scale of 0 to 100, with 100 being the healthiest.

For their retrospective analysis of WGET, HSS investigators reviewed records of all patients who had a sustained remission of at least six months (143 patients). They then reviewed data from all checkups after the time of sustained remission to assess the relationship between flare status and the physical and mental health scores from the previous visit. They found that patients were 19 percent more likely to experience a disease flare if they had a five point lower mental health score (P<0.01) at the checkup immediately prior to the flare. The physical component score did not predict an activation of the disease.

"If you looked at patients who were in remission for six months or longer and assessed their mental health as captured by this mental health score, those with a lower mental health score at a given point in time would be more likely to be flaring at the next visit, within three months," Dr. Spiera said. "This is the first time that as an independent variable, stress seemed to predict a greater likelihood of flaring."

The study suggests that doctors need to be attentive to a patient's psychological state and be proactive about interventions to help them manage stress. "There are a lot of things that can be done proactively in stress management on the patient's side outside of seeing a psychiatrist," Dr. Spiera said. For example, exercise and yoga have been shown to be effective stress relievers.

The HSS researchers next hope to prospectively examine the association between psychological state and flares in upcoming trials of vasculitis and other autoimmune diseases. Some investigators have hypothesized that stress-related hormones lead to immune dysregulation, but research is needed to tease out the mechanisms.

"Going forward, we can even think of trials where you would take patients who have declined in their mental component score and randomize half of them to receive some sort of stress management program and half of them not to receive it, to see if it changes their outcomes," Dr. Spiera said.

Wegener's granulomatosis was recently renamed granulomatosis with polyangiitis. The rare disease, in which inflamed blood vessels interfere with blood circulation, mainly affects vessels in the nose, sinuses, ears, lungs and kidneys, although other areas may be involved. It is most common in middle-aged adults.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our vascular section for the latest news on this subject. Other authors of the study are Morgana Davids and Huong Do at HSS; Gunnar Tomasson, M.D., Boston University School of Medicine; John Davis Jr., M.D., MPH, Genentech; Gary Hoffman, M.D., Cleveland Clinic; W. Joseph McCune, M.D., University of Michigan; Ulrich Specks, M.D., Mayo Clinic; E. William St Clair, M.D., Duke University Medical Center; John Stone, M.D., MPH, Massachusetts General Hospital; and Peter Merkel, M.D., Ph.D., Boston University.
Hospital for Special Surgery Please use one of the following formats to cite this article in your essay, paper or report:

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Hospital for Special Surgery. "Disease Flares In Patients With Vasculitis Triggered By Stress." Medical News Today. MediLexicon, Intl., 7 Nov. 2011. Web.
9 Dec. 2011. APA

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Stress Response In Police Officers May Indicate Risk For PTSD

Editor's Choice
Academic Journal
Main Category: Anxiety / Stress
Also Included In: Psychology / Psychiatry;  Mental Health
Article Date: 01 Dec 2011 - 8:00 PST

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Often stress-related disorders are linked to individuals who work in the firing line. In an investigation led by Dr. Charles Marmar, professor and chair of the Department of Psychiatry at the NYU Langone Medical Center in collaboration with the San Francisco VA Medical Center and the University of California, San Francisco, the researchers examined police recruits during academy training prior to critical incident exposure. They provided the recruits with salivary cortisol at first awakening and after 30 minutes. According to the study results, recruits with the greatest increase of the stress hormone cortisol after awakening were more likely to display acute stress symptoms in response to trauma years later as police officers.

The investigation is one of the largest to identify a potential technique for predicting vulnerability to stress either during or following a traumatic experience. Results of this investigation are published in the December, 2011 issue of Biological Psychiatry.

Dr. Marmar, explained:

"This study is significant as a potential indicator in determining when people may exhibit stress symptoms in the future. Few studies have prospectively examined the relationship among pre-exposure hypothalamic-pituitary-adrenal activity, acute stress reactions and post-traumatic stress disorder (PTSD). The findings may lead us to new insights on how to identify those who are at a higher risk of PTSD."

The 296 police recruits enrolled in the study had their cortisol levels measured after waking up and again 30 minutes later. The difference between the two levels is known as cortisol awakening response (CAR). The researchers discovered the greater CAR during academy training predicted greater peritraumatic dissociation and acute stress disorder symptoms over the initial 3 years of police service.

The study showed that stronger CAR predicted two particular stress responses. In one the person was dissociated, experiencing the traumatic event in a dreamlike state of unreality, and in the other, the individuals showed acute stress disorder symptoms following the event, such as increased heart rate, faster breathing, intrusive memories of the event and conscious avoidance of thoughts or feelings related to the event.

Dr. Marmar, stated:

"This research is just the tip of the iceberg. We need additional studies to determine if early identification of these risk factors will result in intervention which could help reduce or minimize the long-term effects of trauma exposure."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our anxiety / stress section for the latest news on this subject. Biological Psychiatry

Source: New York University Langone Medical Center.

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Grace Rattue. "Stress Response In Police Officers May Indicate Risk For PTSD." Medical News Today. MediLexicon, Intl., 1 Dec. 2011. Web.
9 Dec. 2011. APA

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During REM Sleep Stress Chemicals Shut Down And The Brain Processes Emotional Experiences

Main Category: Sleep / Sleep Disorders / Insomnia
Also Included In: Mental Health;  Anxiety / Stress;  Veterans / Ex-Servicemen
Article Date: 27 Nov 2011 - 0:00 PST

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They say time heals all wounds, and new research from the University of California, Berkeley, indicates that time spent in dream sleep can help.

UC Berkeley researchers have found that during the dream phase of sleep, also known as REM sleep, our stress chemistry shuts down and the brain processes emotional experiences and takes the painful edge off difficult memories.

The findings offer a compelling explanation for why people with post-traumatic stress disorder (PTSD), such as war veterans, have a hard time recovering from painful experiences and suffer reoccurring nightmares.They also offer clues into why we dream.

"The dream stage of sleep, based on its unique neurochemical composition, provides us with a form of overnight therapy, a soothing balm that removes the sharp edges from the prior day's emotional experiences," said Matthew Walker, associate professor of psychology and neuroscience at UC Berkeley and senior author of the study published in the journal Current Biology.

For people with PTSD, Walker said, this overnight therapy may not be working effectively, so when a "flashback is triggered by, say, a car backfiring, they relive the whole visceral experience once again because the emotion has not been properly stripped away from the memory during sleep."

The results offer some of the first insights into the emotional function of Rapid Eye Movement (REM) sleep, which typically takes up 20 percent of a healthy human's sleeping hours. Previous brain studies indicate that sleep patterns are disrupted in people with mood disorders such as PTSD and depression.

While humans spend one-third of their lives sleeping, there is no scientific consensus on the function of sleep. However, Walker and his research team have unlocked many of these mysteries linking sleep to learning, memory and mood regulation. The latest study shows the importance of the REM dream state.

"During REM sleep, memories are being reactivated, put in perspective and connected and integrated, but in a state where stress neurochemicals are beneficially suppressed," said Els van der Helm, a doctoral student in psychology at UC Berkeley and lead author of the study.

Thirty-five healthy young adults participated in the study. They were divided into two groups, each of whose members viewed 150 emotional images, twice and 12 hours apart, while an MRI scanner measured their brain activity.

Half of the participants viewed the images in the morning and again in the evening, staying awake between the two viewings. The remaining half viewed the images in the evening and again the next morning after a full night of sleep.

Those who slept in between image viewings reported a significant decrease in their emotional reaction to the images. In addition, MRI scans showed a dramatic reduction in reactivity in the amygdala, a part of the brain that processes emotions, allowing the brain's "rational" prefrontal cortex to regain control of the participants' emotional reactions.

In addition, the researchers recorded the electrical brain activity of the participants while they slept, using electroencephalograms. They found that during REM dream sleep, certain electrical activity patterns decreased, showing that reduced levels of stress neurochemicals in the brain soothed emotional reactions to the previous day's experiences.

"We know that during REM sleep there is a sharp decrease in levels of norepinephrine, a brain chemical associated with stress," Walker said. "By reprocessing previous emotional experiences in this neuro-chemically safe environment of low norepinephrine during REM sleep, we wake up the next day, and those experiences have been softened in their emotional strength. We feel better about them, we feel we can cope."

Walker said he was tipped off to the possible beneficial effects of REM sleep on PTSD patients when a physician at a U.S. Department of Veterans Affairs hospital in the Seattle area told him of a blood pressure drug that was inadvertently preventing reoccurring nightmares in PTSD patients.

It turns out that the generic blood pressure drug had a side effect of suppressing norepinephrine in the brain, thereby creating a more stress-free brain during REM, reducing nightmares and promoting a better quality of sleep. This suggested a link between PTSD and REM sleep, Walker said.

"This study can help explain the mysteries of why these medications help some PTSD patients and their symptoms as well as their sleep," Walker said. "It may also unlock new treatment avenues regarding sleep and mental illness."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our sleep / sleep disorders / insomnia section for the latest news on this subject. Other co-authors of the study are UC Berkeley sleep researchers Justin Yao, Shubir Dutt, Vikram Rao and Jared Saletin.
University of California - Berkeley Please use one of the following formats to cite this article in your essay, paper or report:

MLA

University of California - Berkeley. "During REM Sleep Stress Chemicals Shut Down And The Brain Processes Emotional Experiences." Medical News Today. MediLexicon, Intl., 27 Nov. 2011. Web.
9 Dec. 2011. APA

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View the original article here

During REM Sleep Stress Chemicals Shut Down And The Brain Processes Emotional Experiences

Main Category: Sleep / Sleep Disorders / Insomnia
Also Included In: Mental Health;  Anxiety / Stress;  Veterans / Ex-Servicemen
Article Date: 27 Nov 2011 - 0:00 PST

email to a friend   printer friendly   opinions  

They say time heals all wounds, and new research from the University of California, Berkeley, indicates that time spent in dream sleep can help.

UC Berkeley researchers have found that during the dream phase of sleep, also known as REM sleep, our stress chemistry shuts down and the brain processes emotional experiences and takes the painful edge off difficult memories.

The findings offer a compelling explanation for why people with post-traumatic stress disorder (PTSD), such as war veterans, have a hard time recovering from painful experiences and suffer reoccurring nightmares.They also offer clues into why we dream.

"The dream stage of sleep, based on its unique neurochemical composition, provides us with a form of overnight therapy, a soothing balm that removes the sharp edges from the prior day's emotional experiences," said Matthew Walker, associate professor of psychology and neuroscience at UC Berkeley and senior author of the study published in the journal Current Biology.

For people with PTSD, Walker said, this overnight therapy may not be working effectively, so when a "flashback is triggered by, say, a car backfiring, they relive the whole visceral experience once again because the emotion has not been properly stripped away from the memory during sleep."

The results offer some of the first insights into the emotional function of Rapid Eye Movement (REM) sleep, which typically takes up 20 percent of a healthy human's sleeping hours. Previous brain studies indicate that sleep patterns are disrupted in people with mood disorders such as PTSD and depression.

While humans spend one-third of their lives sleeping, there is no scientific consensus on the function of sleep. However, Walker and his research team have unlocked many of these mysteries linking sleep to learning, memory and mood regulation. The latest study shows the importance of the REM dream state.

"During REM sleep, memories are being reactivated, put in perspective and connected and integrated, but in a state where stress neurochemicals are beneficially suppressed," said Els van der Helm, a doctoral student in psychology at UC Berkeley and lead author of the study.

Thirty-five healthy young adults participated in the study. They were divided into two groups, each of whose members viewed 150 emotional images, twice and 12 hours apart, while an MRI scanner measured their brain activity.

Half of the participants viewed the images in the morning and again in the evening, staying awake between the two viewings. The remaining half viewed the images in the evening and again the next morning after a full night of sleep.

Those who slept in between image viewings reported a significant decrease in their emotional reaction to the images. In addition, MRI scans showed a dramatic reduction in reactivity in the amygdala, a part of the brain that processes emotions, allowing the brain's "rational" prefrontal cortex to regain control of the participants' emotional reactions.

In addition, the researchers recorded the electrical brain activity of the participants while they slept, using electroencephalograms. They found that during REM dream sleep, certain electrical activity patterns decreased, showing that reduced levels of stress neurochemicals in the brain soothed emotional reactions to the previous day's experiences.

"We know that during REM sleep there is a sharp decrease in levels of norepinephrine, a brain chemical associated with stress," Walker said. "By reprocessing previous emotional experiences in this neuro-chemically safe environment of low norepinephrine during REM sleep, we wake up the next day, and those experiences have been softened in their emotional strength. We feel better about them, we feel we can cope."

Walker said he was tipped off to the possible beneficial effects of REM sleep on PTSD patients when a physician at a U.S. Department of Veterans Affairs hospital in the Seattle area told him of a blood pressure drug that was inadvertently preventing reoccurring nightmares in PTSD patients.

It turns out that the generic blood pressure drug had a side effect of suppressing norepinephrine in the brain, thereby creating a more stress-free brain during REM, reducing nightmares and promoting a better quality of sleep. This suggested a link between PTSD and REM sleep, Walker said.

"This study can help explain the mysteries of why these medications help some PTSD patients and their symptoms as well as their sleep," Walker said. "It may also unlock new treatment avenues regarding sleep and mental illness."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our sleep / sleep disorders / insomnia section for the latest news on this subject. Other co-authors of the study are UC Berkeley sleep researchers Justin Yao, Shubir Dutt, Vikram Rao and Jared Saletin.
University of California - Berkeley Please use one of the following formats to cite this article in your essay, paper or report:

MLA

University of California - Berkeley. "During REM Sleep Stress Chemicals Shut Down And The Brain Processes Emotional Experiences." Medical News Today. MediLexicon, Intl., 27 Nov. 2011. Web.
8 Dec. 2011. APA

Please note: If no author information is provided, the source is cited instead.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

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Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Stress Response In Police Officers May Indicate Risk For PTSD

Editor's Choice
Academic Journal
Main Category: Anxiety / Stress
Also Included In: Psychology / Psychiatry;  Mental Health
Article Date: 01 Dec 2011 - 8:00 PST

email to a friend   printer friendly   opinions  

Often stress-related disorders are linked to individuals who work in the firing line. In an investigation led by Dr. Charles Marmar, professor and chair of the Department of Psychiatry at the NYU Langone Medical Center in collaboration with the San Francisco VA Medical Center and the University of California, San Francisco, the researchers examined police recruits during academy training prior to critical incident exposure. They provided the recruits with salivary cortisol at first awakening and after 30 minutes. According to the study results, recruits with the greatest increase of the stress hormone cortisol after awakening were more likely to display acute stress symptoms in response to trauma years later as police officers.

The investigation is one of the largest to identify a potential technique for predicting vulnerability to stress either during or following a traumatic experience. Results of this investigation are published in the December, 2011 issue of Biological Psychiatry.

Dr. Marmar, explained:

"This study is significant as a potential indicator in determining when people may exhibit stress symptoms in the future. Few studies have prospectively examined the relationship among pre-exposure hypothalamic-pituitary-adrenal activity, acute stress reactions and post-traumatic stress disorder (PTSD). The findings may lead us to new insights on how to identify those who are at a higher risk of PTSD."

The 296 police recruits enrolled in the study had their cortisol levels measured after waking up and again 30 minutes later. The difference between the two levels is known as cortisol awakening response (CAR). The researchers discovered the greater CAR during academy training predicted greater peritraumatic dissociation and acute stress disorder symptoms over the initial 3 years of police service.

The study showed that stronger CAR predicted two particular stress responses. In one the person was dissociated, experiencing the traumatic event in a dreamlike state of unreality, and in the other, the individuals showed acute stress disorder symptoms following the event, such as increased heart rate, faster breathing, intrusive memories of the event and conscious avoidance of thoughts or feelings related to the event.

Dr. Marmar, stated:

"This research is just the tip of the iceberg. We need additional studies to determine if early identification of these risk factors will result in intervention which could help reduce or minimize the long-term effects of trauma exposure."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our anxiety / stress section for the latest news on this subject. Biological Psychiatry

Source: New York University Langone Medical Center.

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Grace Rattue. "Stress Response In Police Officers May Indicate Risk For PTSD." Medical News Today. MediLexicon, Intl., 1 Dec. 2011. Web.
8 Dec. 2011. APA

Please note: If no author information is provided, the source is cited instead.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Disease Flares In Patients With Vasculitis Triggered By Stress

Main Category: Vascular
Also Included In: Anxiety / Stress;  Mental Health
Article Date: 07 Nov 2011 - 0:00 PST

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In patients with a devastating form of vasculitis who are in remission, stress can be associated with a greater likelihood of the disease flaring, according to a new study by investigators at Hospital for Special Surgery (HSS).

This is the first study to suggest that mental health is a risk factor in patients with vasculitis, a group of autoimmune disorders characterized by the inflammatory destruction of blood vessels. The study, in a form of the disease known as Wegener's granulomatosis (WG), will be presented on Nov. 8 at the American College of Rheumatology's annual meeting.

"When this disease flares, people can be really sick. It often affects the lungs, kidneys, sinuses and nerves. It can cause fevers and rashes. People can die from this illness. It is a very robust, active, inflammatory disease when it is active," said Robert Spiera, M.D., director of the Vasculitis and Scleroderma Program at HSS, who led the study. "When patients are in remission, however, they can do very, very well."

He says that doctors caring for patients with this disease should be attentive to their psychological health. "This study points out that mental health should be part of your medical assessment," said Dr. Spiera. "You should pay attention to the patient's mental well being and be more aggressive about intervening if a patient is in a bad place. Make sure that patients take it seriously."

Prior to this report, a few small studies had suggested that psychological stress can trigger flares of lupus, another autoimmune disease, and doctors have observed that WG patients often say that stress in their lives, caused by perhaps a death of someone close or losing a job, made their disease flare. To investigate this anecdotal evidence in a more quantifiable way, researchers at HSS conducted a retrospective analysis of data from the Wegener's Granulomatosis Etanercept Trial (WGET). The primary objective of this randomized, placebo-controlled clinical trial was to evaluate the safety and efficacy of using etanercept (Enbrel; Immunex Corporation) to get patients with WG into remission and maintain that remission.

All patients in this multicenter trial had active disease at the beginning of the study and most patients went into remission. Checkups occurred every three months. "We assessed their disease activity at defined time intervals, in terms of how active their vasculitis was or whether they were in remission, and we also collected information at every visit regarding the patient's physical and mental health," Dr. Spiera said. Investigators measured disease activity using the Birmingham Vasculitis Activity Score for Wegener's Granulomatosis, a validated tool. At every visit, patients also filled out the Short Form 36 Health Survey, which includes a physical and mental component. Summary scores for each component are measured on a scale of 0 to 100, with 100 being the healthiest.

For their retrospective analysis of WGET, HSS investigators reviewed records of all patients who had a sustained remission of at least six months (143 patients). They then reviewed data from all checkups after the time of sustained remission to assess the relationship between flare status and the physical and mental health scores from the previous visit. They found that patients were 19 percent more likely to experience a disease flare if they had a five point lower mental health score (P<0.01) at the checkup immediately prior to the flare. The physical component score did not predict an activation of the disease.

"If you looked at patients who were in remission for six months or longer and assessed their mental health as captured by this mental health score, those with a lower mental health score at a given point in time would be more likely to be flaring at the next visit, within three months," Dr. Spiera said. "This is the first time that as an independent variable, stress seemed to predict a greater likelihood of flaring."

The study suggests that doctors need to be attentive to a patient's psychological state and be proactive about interventions to help them manage stress. "There are a lot of things that can be done proactively in stress management on the patient's side outside of seeing a psychiatrist," Dr. Spiera said. For example, exercise and yoga have been shown to be effective stress relievers.

The HSS researchers next hope to prospectively examine the association between psychological state and flares in upcoming trials of vasculitis and other autoimmune diseases. Some investigators have hypothesized that stress-related hormones lead to immune dysregulation, but research is needed to tease out the mechanisms.

"Going forward, we can even think of trials where you would take patients who have declined in their mental component score and randomize half of them to receive some sort of stress management program and half of them not to receive it, to see if it changes their outcomes," Dr. Spiera said.

Wegener's granulomatosis was recently renamed granulomatosis with polyangiitis. The rare disease, in which inflamed blood vessels interfere with blood circulation, mainly affects vessels in the nose, sinuses, ears, lungs and kidneys, although other areas may be involved. It is most common in middle-aged adults.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our vascular section for the latest news on this subject. Other authors of the study are Morgana Davids and Huong Do at HSS; Gunnar Tomasson, M.D., Boston University School of Medicine; John Davis Jr., M.D., MPH, Genentech; Gary Hoffman, M.D., Cleveland Clinic; W. Joseph McCune, M.D., University of Michigan; Ulrich Specks, M.D., Mayo Clinic; E. William St Clair, M.D., Duke University Medical Center; John Stone, M.D., MPH, Massachusetts General Hospital; and Peter Merkel, M.D., Ph.D., Boston University.
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