Counseling Points - November 2008 - (Page 5)

lated by stress.5 Stress may contribute to depression, and RA patients who are depressed have significantly worse disease severity, disability, and pain than RA patients without depression.5,7 Until recently, researchers have paid little attention to depression and its relationship to RA symptoms. However, it is now recognized that depressive symptoms are highly comorbid with RA. Occurring in up to 42% of patients, depression is associated with a decreased quality of life, as well as increased health care costs and mortality risk.1 Current clinical investigations are helping to identify factors that mediate the pain-depression relationship and are evaluating whether pain is a predictor of depression or if depression influences pain.8 The chronic stress of RA can override the brain’s normal circuitry and intensify neurological distress signals. Inflammation in RA may influence neurotransmitter metabolism, neuroendocrine function, synaptic plasticity, and growth factor production, all of which can modify neural circuitry and contribute to depressive symptoms.8 Treatment with antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), along with individual, group, or family psychotherapy has been found to improve depressive symptoms and increase quality of life in RA patients.5 Nurses should educate patients about the causes of depression and help individuals become aware of the benefits of pharmacological depression treatment and psychosocial interventions. Good online sources that provide information on depressive disorders, mental illness, and psychotherapy appear in Table 1. In addition, many health care organizations offer arthritis disease management programs that include a mental health component that nurses may want to suggest to their patients. Table 1. Sources that Provide Information on Depressive Disorders, Mental Illness, and Psychotherapy American Association for Marriage and Family Therapy www.aamft.org; 703-838-9808 American Psychiatric Association www.psych.org; 703-907-7300 American Psychological Association www.apa.org; 800-374-2721 Depression and Bipolar Support Alliance (DBSA) www.dbsalliance.org; 800-826-3632 International Foundation for Research and Education on Depression (iFRED) www.depression.org; 410-268-0044 National Institute of Mental Health www.nimh.nih.gov/health/topics/depression/index.shtml; 866-615-6464 Ways to Help Patients Improve Quality of Life Along with pharmacological treatment and a good diet, exercise, and rest regimen, patients with RA may also find other ideas listed in Table 2 helpful to cope with the various components of their disease. 5 For example, results from a number of clinical trials have found that when RA patients participate in mind-body exercises such as meditation, tai chi, yoga, and relaxation strategies, significant 5 improvements are reported in their degree of pain and disability, overall psychological state, coping ability, and self-efficacy.9 Additionally, specific programs that teach RA patients self-efficacy have a meaningful impact on well-being. One such program, the Arthritis Foundation Self-Help Program, has not only been demonstrated to reduce pain, physician visits, and stiffness and increase physical function, but has consistently been associated with an improvement in patient quality of life.10 The program is a group education course that is designed to complement RA pharmacotherapy and clinical care. The program is available nationally and takes place in many communities across the United States. Local programs are typically 6 weeks long and consist of weekly 2-hour sessions guided by trained instructors who follow a detailed protocol.5,10 These programs discuss the most up-to-date pain management techniques, provide information on diet and nutrition, and help participants develop an individualized exercise rouNOVEMBER 2008 http://www.aamft.org http://www.psych.org http://www.apa.org http://www.dbsalliance.org http://www.depression.org http://www.nimh.nih.gov/health/topics/depression/index.shtml

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Counseling Points - November 2008 Welcome Quality of Life and Treatment Options in Rheumatoid Arthritis Counseling Points

Counseling Points - November 2008

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