Pre-existing major depression predicts in-hospital cardiac complications after acute myocardial infarction
ABSTRACT Depression (MDD) and anxiety have been associated with negative long-term outcomes among patients with acute myocardial infarction (MI).
The objective of the study was to determine whether MDD and anxiety preceding MI were associated with in-hospital post-MI cardiac complications.
Subjects (N=129) underwent psychiatric interviews within 72 hours of MI and were evaluated for five in-hospital cardiac complications (recurrent ischemia, ventricular arrhythmia, ventricular arrhythmia requiring intervention, congestive heart failure, and reinfarction).
Current (pre-MI) MDD was a significant and independent predictor of all complications except recurrent ischemia on multivariate regression analysis. In contrast, pre-MI anxiety was not associated with complications.
These findings underscore the importance of identifying and treating MDD in post-MI patients and those at risk for MI.
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ABSTRACT: Psychological services in health care have expanded beyond traditional areas of mental health to the full spectrum of health disorders, as research has increasingly shown the importance of psychological processes in health outcomes. Behavioural and psychological factors can contribute to the onset, course, or severity of many chronic diseases, and psychology has much to offer with clinically and cost-effective interventions. Good principles of care, involving appropriate assessment, evidence-based interventions, and close collaboration with other health care providers, are vital for effective chronic disease management, but can be difficult to realise given issues of timely access, patient volumes, and availability of psychological services in publicly funded health care. This article provides an overview of psychological interventions in diverse areas of health psychology, with examples of innovative Canadian clinical service delivery models, particularly focussing on integrated screening and treatment for cardiac patients, computerized delivery of insomnia treatment, screening and brief intervention prior to joint replacement surgery, and on-site psychological consultation for family physicians. The case examples, developed and implemented in Winnipeg, Manitoba, demonstrate components for consideration when redesigning psychological service models, such as more systematic approaches to identifying patient needs, stepped levels of care that increase intensity of service relative to need, integration into systems already handling large patient volumes, innovative use of technology, and location of psychological resources “in situ” for timely, brief access. Although still in early stages of development and evaluation, these models show promise for improved access and enhanced ability to deliver psychological service to relevant patient volumes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)Canadian Psychology 07/2012; 53(3):165-177. DOI:10.1037/a0026635 · 1.54 Impact Factor
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ABSTRACT: The management of depression and other negative psychological states in cardiac patients has been a focus of multiple treatment trials, though such trials have not led to substantial improvements in cardiac outcomes. In contrast, there has been minimal focus on interventions to increase positive psychological states in cardiac patients, despite the fact that optimism and other positive states have been associated with superior cardiovascular outcomes. Our objective was to develop an 8-week, phone-based positive psychology intervention for patients hospitalized with acute cardiac disease (acute coronary syndrome or decompensated heart failure). Such an intervention would consist of positive psychology exercises adapted for this specific population, and it would need to be feasible for practitioners and patients in real-world settings. By adapting exercises that were previously validated in healthy individuals, we were able to generate a positive psychology telemedicine intervention for cardiac patients that focused on optimism, kindness, and gratitude. In addition, we successfully created a companion treatment manual for subjects to enhance the educational aspects of the intervention and facilitate completion of exercises. Finally, we successfully performed a small pilot trial of this intervention, and found that the positive psychology intervention appeared to be feasible and well-accepted in a cohort of patients with acute cardiac illness. Future studies should further develop this promising intervention and examine its impact on psychological and medical outcomes in this vulnerable population of cardiac patients.Heart International 09/2011; 6(2):e14. DOI:10.4081/hi.2011.e14
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ABSTRACT: Objective: Affective symptoms have adverse effects in hospital and long-term cardiac outcomes of post Acute Coronary Syndrome (ACS) patients. This study aims to identify personality traits and maladaptive coping strategies that could predict affective symptoms in early post-ACS patients. Methods: Seventy patients undergoing revascularization procedures were examined within a week after their admission by means of the Hospital Anxiety-Depression Scale. Personality was analyzed through the Type D Personality Scale and the Coping Inventory for Stressful Situation. Multiple logistic regression analysis was used to determine independent predictors of anxiety and depressed mood. Results: A high rate of depressive and anxious symptoms was found and 76% of patients resulted Type D personality. Depression was associated with b-blocker therapy, Type D personality, and specific coping strategies. Unmarried status, low education, unstable angina, Type D personality, emotion, and avoidance oriented coping independently predicted anxiety. Conclusion: These findings underlie the importance of assessment for Type D personality and coping strategies that could be useful to identify post-ACS patients at higher risk for affective symptoms. Using these brief instruments, as sensitive screening measures, we investigated the prevalence of depressive and anxiety symptoms in patients with ACS, we identified personality traits and coping strategies used to manage stress and estimated independent predictors of affectivity disorders after ACS.The International Journal of Psychiatry in Medicine 01/2012; 44(2):119-132. DOI:10.2190/PM.44.2.c · 1.15 Impact Factor