[Depression worsens the prognosis of infarct patients. Does psychotherapy prevent coronary death? (interview by Dr. Beate Schumacher)].
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Cognitive Behavioral Therapy↗
Biomedical subjects
C Herrmann-Lingen
Publications and source records attributed to C Herrmann-Lingen.
[Anxiety and depression in cardiology patients: how to diagnose, how to treat?].
IMPORTANCE: Anxiety and depression are frequent problems in patients with heart diseases. Prevalences vary between 15 and 50%, depending on diagnostic criteria as well as on sociodemographic and medical patient characteristics. During the last 10-15 years, a large number of studies have shown that anxiety and depression strongly affect overall well-being, cardiac and non-specific symptom reporting and overall quality of life. This leads to increased health care utilization, early retirement and imposes a financial burden on individuals and social security systems. In addition, anxious and especially depressed patients with heart disease tend to exhibit unhealthy illness behavior, low compliance and suboptimal risk factor control. Together with the known physiological effects of negative affect on cardiac autonomic balance, inflammation and platelet function, these behavioral mechanisms may lead to the frequently observed increase of cardiac event and mortality rates in depressed patients wit coronary artery disease. DIAGNOSIS: Despite their clinical relevance and unsatisfactory spontaneous remission rate, anxiety and depression still go unrecognized and undertreated in most cardiac patients. Case-identification can be improved by a graded approach. In the first step, symptoms of anxiety and depression should explicitly be asked for as part of a routine cardiological work-up. As an adjunct, validated self-rating questionnaires can be used for screening purposes. Patients screened positive should receive a thorough diagnostic interview and a criteria-based diagnosis. TREATMENT: Once a diagnosis has been obtained, several treatment options are available: In less severe cases (minor depression or adjustment disorders), supportive care by primary care physicians or cardiologists may be sufficient. Patients with major depression or panic disorder should receive structured psychotherapy and/or antidepressant medication. Exercise training can also improve symptoms of anxiety and depression. Although both psychotherapy and antidepressants, especially if integrated in a concept of comprehensive cardiac care, can be expected to result in marked subjective benefit for the majority of patients, the impact of these treatments on cardiac event and mortality rates still needs to be determined.
Antidepressive Agents↗
Depressed mood, physician-rated prognosis, and comorbidity as independent predictors of 1-year mortality in consecutive medical inpatients.
OBJECTIVE: To determine the independent effects of depressed mood and markers of medical disease severity on mortality in consecutive medical inpatients. METHODS: Consecutive general medical inpatients were asked to complete the Hospital Anxiety and Depression Scale (HADS) at admission. Prognostic indicators were obtained from patients' records and physicians' ratings. The study endpoint was mortality from all causes at 1 year. RESULTS: The baseline assessment was completed by 575 patients (87.7%). Survival data were available for 572 of these (86 deaths). HADS depression scores and several physical risk indicators predicted mortality. In multivariate analyses, physicians' rating of prognosis was the best predictor of mortality [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI), 2.5--5.4]. Other independent predictors included a principal diagnosis of hemato-oncological disease, comorbidity scores, and HADS depression (adjusted OR 1.75; 95% CI, 1.10--2.79). CONCLUSION: Our data demonstrate an independent prognostic effect of depressed mood on mortality in general medical inpatients. Screening for depression may improve risk stratification in these patients over and above that obtained by routinely available physical parameters and physicians' clinical judgement.
Adult↗
[Not Available].
Psychosocial factors have always been considered important causes of heart disease. Because of its extraordinary epidemiological and political relevance, coronary heart disease (CHD) has received Special scientific attention in this field. However, the abundance of literature dealing with its biological, psychological and social precursors is in sharp contrast with a lack of comprehensive modeis trying to integrate the results of different scientific traditions. This paper gives a brief overview of the present State of psychosocial research on etiological factors in CHD. Instead of solely relying on attempts to identify supposedly independent risk factors, it emphasizes the importance of dynamic biopsychosocial processes, which finally lead to manifest coronary disease. The paper outlines an approach which integrates clinical and empirical findings in a bio-psycho-sociodynamic model. This model is open to future extension. It may be helpful for better understanding individual patients as well as scientific findings. By providing hypotheses, which are suggested to go beyond the still predominating reductionistic, linear modeis, it may furthermore be a basis for future research in psychosocial cardiology.
Biopsychosocial model,↗