Psychiatria Danubina, Vol. 23. No. 4., 2011.
Izlaganje sa skupa
THE RELATIONSHIP BETWEEN DEPRESSION, ANXIETY AND HEART DISEASE - A PSYCHOSOMATIC CHALLENGE
Hans-Peter Kapfhammer
; Klinik für Psychiatrie, Medizinische Universität Graz, Graz, Austria
Sažetak
Background: Depressive and cardiological disorders present
a major comorbidity. Their manifold interrelations may
be best analysed within a biopsychosocial model of disease.
Methods: A systematic research was done on empirical
studies published during the last 15 years and dealing with
epidemiological, etiopathogenetic and therapeutic dimensions
of the comorbidity of depression, anxiety and heart disease.
Results: From an epidemiological perspective recurrent
depressions are associated with a significantly increased risk
of coronary heart disease. Depressive disorders play a major
role in triggering critical cardiac events, e.g. myocardial
infarction. The prevalence rates of depressive disorders in
various cardiological conditions are significantly higher than
the frequencies that can be expected in healthy general
population. Depression shows a negative impact on the
somatic morbidity and mortality during the further course of
illness. Anxiety and posttraumatic stress disorders seem to be
interrelated with cardiological conditions in quite a similar
way, probably contributing even more negatively to critical
and lethal cardiological events than depression. From an
etiopathogenetic perspective some clusters of depressive
symptoms seem to be linked to cardiotoxicity more closely
than other, vital exhaustion, anhedonia, and hopelessness
probably mediating a special risk. In any case, postmyocardial
infarct depression that proves treatment-resistent
indicates a negative prognosis of the prevailing cardiological
condition. On a level of psychological and psychosocial
constructs type-A personality, anger/hostility, type-D
personality, and alexithymia have been explored regarding its
proper pathogenetic role. Psychological and psychopathological
variables have to be set into a context of psychosocial
stressors on the one hand, and have to be simultaneously
analysed with various underlying psycho-and neurobiological
variables on the other. Above all, HPA- and sympathicomedullary
dysfunctions, reduced heart rate variability, altered
functions of thrombocytes, and increased proinflammatory
processes have to be recognized as significantly contributing
to the pathophysiology both of depression and of heart
condition. Neurobiological aspects of anxiety and posttraumatic
stress disorders must be interlinked with these
underpinnings of depression. Differential effects on critical
cardiological events must be supposed. From a therapeutic
perspective several RCTs demonstrate that SSRIs may safely
and efficiently treat depressive disorders in cardiological
conditions, and may even improve the general somatic
prognosis. Cognitive-behavioural psychotherapies have been
empirically validated in treating depression and anxiety with
cardiological patients. So far, however, a differential
indication of psychopharmacological versus psychotherapeutic
approaches has not been proved yet.
Conclusions: Depression and anxiety disorders in patients
with heart disease paradigmatically define a psychosomaticsomatopsychic
challenge to any health delivery system. A
psychosomatic perspective may best be practised within a
Consultation-Liaison psychiatric service that cooperates
continuously and closely with cardiological departments and
experts.
Ključne riječi
heart disease; depression; anxiety; posttraumatic stress disorder; epidemiology; psychological; neurobiologcal; treatment
Hrčak ID:
76854
URI
Datum izdavanja:
31.12.2011.
Posjeta: 2.535 *