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Dr. johnson slide presentation 12.13

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Dr. johnson slide presentation 12.13

  1. 1.      Women are effected twice as often as men The lifetime prevalence of depression is 14% In general younger people are effected more than those over 65 However, older people with chronic illness like lupus have a high rate of depression. Depression effects people of many backgrounds; rich and poor, famous and every day people.
  2. 2. At Eternity’s Gate: Vincent Van Gogh
  3. 3. Feeling sad or down for more than two weeks  Crying, feeling hopeless  Poor sleep  Loss of interest in doing normal activities  Poor concentration  Decreased appetite or weight loss  Feeling tired and lacking energy 
  4. 4.      In the US, it is estimated as many as 1.5 million people have lupus. 1.8 to 7.6 people per 100,000 are diagnosed with lupus each year. Most cases are diagnosed between age 15 and 40. Primarily women are affected (6-10 F:1 M) African Americans (and possibly Latinos, Asians and Native Americans) are affected more than whites.
  5. 5. Lupus is an chronic disease.  It is autoimmune disease, its cause is not well known.  Lupus patients frequently complain of both memory problems and depression.  There is currently research being done to look into why this is the case. 
  6. 6.          Skin rash and photosensitivity Joint pain and swelling Tiredness Fever Shortness of breath Hair loss Sores in the mouth Fatigue Seizure, psychosis
  7. 7.  This is a description of memory problems which is reported by 21-80% of lupus patients. › Another way of describing this is memory problems that come and go. › Cause is not known; may be due to medications or lupus itself. There is research in this area.  Symptoms include: › › › › Difficulty remembering things Problems making decisions Difficulty finding words Personality changes
  8. 8.   Talk to your doctor about these symptoms so that the appropriate tests are done to see why you are having this problem. Behavior modification: › Make yourself lists of what needs to be done so you do not forget › Keep a calendar of your events and appointments to remind yourself. › Use family members and friends to remind you of important events.
  9. 9.       Pain from the joints Weight gain from medications such as prednisone Medications make you feel sick or “crazy” Change in how you look due to hair loss and skin problems Feeling unable to do what you want to do such as work or care for children/family members Frustration that a family member does not understand or thinks you are lying about your condition
  10. 10. Having a chronic illness is a risk factor for depression.  Some of the lupus medications can cause depression, such as prednisone.  › If depression is thought to be due to prednisone one option to decrease the dose.
  11. 11. Talk with your doctor about how you are feeling.  Ask your doctor if she thinks further tests are needed to see if lupus is causing your depression.  Try to get psychiatric help with counseling and medication as soon as possible.  If you feel suicidal go to the emergency room. 
  12. 12.     Depression is common in patients with lupus. You can talk with your doctor if you are feeling sad or down; there is good treatment for depression. Your doctor wants to help you feel your best. Don’t be embarrassed to talk with your doctor about your feelings if you are feeling down. You can also ask your doctor to talk with your family if this would help them to better understand your condition and concerns.
  13. 13. Talk therapy with a mental health provider.  Improving sleep  Medications such as:  › › › › Prozac Zoloft Lexapro Cymbalta
  14. 14. Keep your lupus in control by taking your medications and seeing your rheumatologist for regular check ups and blood work.  Lifestyle modifications:  › › › › Eat healthy Exercise Get enough sleep Try to decrease stress in your life
  15. 15. Can lupus affect the brain? Yes.  What are symptoms?  › Depression › Coma › Psychosis (hearing things or seeing things that are not there) › Seizure › Stroke
  16. 16. Yes, but the tests are not always definitive.  MRI will show brain lesions.  Two blood tests have been studied and are thought to possibly be associated with neuropsychiatric lupus: Antiribosomal P antibodies and NMDA receptors.  However, it possible to have negative tests and have neuropsychiatric lupus. 
  17. 17. Yes.  Medications are strong and include:  › High dose prednisone › Cytoxan › Azathioprine
  18. 18.     Depression and memory problems (sometimes referred to as lupus fog) are common in patients with lupus. Reasons for depression in lupus patients are multifactorial and may be due partly due to the symptoms of lupus, as well as the disease itself. Lupus also can effect the brain itself. The cause of memory problems is not well understood and is undergoing further study.
  19. 19. There will be better days ahead.  Just because you have lupus does not mean that you will develop depression or problems with your brain.  Patients with lupus are leading happy and successful lives now.  With advances in research the future will be even brighter. 
  20. 20. There is a lot being done to study lupus currently and to improve treatment.  A listing of current trials can be found at: http://clinicaltrials.gov  Currently there are studies being done to learn more using particularly using brain imaging (MRI) and neuropsychiatric testing. 
  21. 21. Yasmin Santiago and the SLE Lupus Foundation.  Urban Health Plan.  My colleagues at Montefiore including Dr. Irene Blanco and Dr. Barbara Mendez.  My colleagues at Hospital for Special Surgery including Dr. Michael Lockshin and Doruk Erkan. 

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