Professional Documents
Culture Documents
Common
2nd most important of disability worldwide Life time prevalence 1:20 1/3 of physically ill
WHO
Classification
A spectrum of mood disturbance
Adjustment disorder
Major depressive disorder
Dysthymia
Manic depressive illness
Feelings of worthlessness or Diminished ability to think or concentrate inappropriate guilt Recurrent thoughts of death or suicide or suicide attempt
Risk Factors
Biopsychosocial
Direction of causality
Stroke, multiple sclorsis, parkinsonism, cancer pancreas.
Difficulty distinguishing psychological symptoms of depression, such as sadness and loss of interest, from a "realistic" response to stressful physical illness Confusion over whether physical symptoms of depression are due to an underlying medical condition Negative attitudes to diagnosis of depression Unsuitability of clinical setting for discussion of personal and emotional matters Patients' unwillingness to report symptoms of depression
Hospital patients
particularly those experiencing psychological difficulties in the face of a physical health problem.
on
Healthy and ill populations and on the psychological processes that influence their level of health or their degree of adaptation to disease.
Concerned with
The diagnosis and treatment of either unexplained symptoms or psychiatric disorders occuring in people with medical conditions.
Developing theoretically based explanations for health related and illness related behaviour.
protective Health-risk
Stressful situations:
novel
unpredictable
un-controllable those involving change or loss
changes. disease
effects: Levels of risk behaviour Direct effects: physiological mechanisms (BP) suppression of the immune system triggering a disease process in vulnerable individuals.
autonomic
neuro-endocrine immunological changes
Type A Personality
Hardiness:
Optimism
Concept of Hardiness
Depression is a risk factor in the survival of cardiovascular disease, Has an unfavourable evolution in diagnosed heart disease, Is an independent prognostic factor in cardiac mortality.
Epidemiology
Depression in the coronary patient often follows a prolonged course, which distinguishes it from a simple reactive depression.
Study
DIS
18
DIS
16
Gonzalez et al 99 patients hospitalized for (1996) coronary heart disease Hance et al (1996) Koenig (1998) 200 coronary patients eligible for angiography 107 elderly patients (>60 years) with heart failure
23 17 36.5
SADS = Schedule for Affective Disorders and Schizophrenia DIS = Diagnostic Interview Schedule
Epidemiological studies have shown an increase in cardiovascular morbidity and mortality in patients with depression (Anda et al, 1993). In the absence of antidepressant treatment, the increase in cardiac risk appears to be correlated with the severity of symptoms of depression and seems to be noticeably prolonged and stable over time (Barefoot et al, 1996).
(hypertension): depression is associated with an increased risk of the target organs being affected (heart, brain)
Simon Sick et al, 1995. Stroke 2.3 -2.7 times greater in HTN with depression
Unstable
angina: associated depression (BDI score 10) considerably increases the risk of infarction in the following year (p<0.001) (Frasure-Smith et al, JAMA 1995).
Post-infarction,
depression is an independent predictor of cardiac mortality in the short and long term. of the depression at the outset is a major prognostic factor in the cardiac mortality risk at 5 years.
Severity
Pathophysiology
1. Psychological factors
Depression causes a number of psychological problems which may be involved in an unfavourable evolution of the coronary heart disease:
- it affects ones ability to face the illness; - it reduces compliance with drug treatment and
rehabilitation;
Hyperactivity of the sympathetic nervous system is one of the somatic markers of depression
3.Hypertension
Symptoms of depression are associated with the development of HT and complications arising from this myocardial infarction
of cardiac rhythm which accompany depression expose patients to the risk of serious ventricular arrhythmia.
Clinical considerations
1. Clinical screening
A series of symptoms will indicate depression in patients suffering from ischemic heart disease : unusual fatigue anxiety irritability sleeping disorders difficulty coping with everyday stress unusual somatic symptoms, in particular atypical precordial pain difficulty rehabilitating difficulty complying with treatments and lifestyle changes
During hospitalization, the nursing staff must remain vigilant to symptoms of depression. Depression is often underestimated as it is considered to be normal when recovering from an acute cardiac event.
2. Systematic screening
The HAD scale might be especially appropriate in screening depression in the context of acute care units since this simple questionnaire, which is filled in by the patient, evaluates symptoms of depression as well as anxiety.
Recent evidence has suggested that Depressive symptomatology is a risk factor for the development of coronary heart disease (CHD) in patients with diabetes mellitus, although little is understood about mechanisms that may explain this association. Epidemiological studies show participants who reported the fewest depressive symptoms on the Beck Depression inventory at baseline examination were least likely to develop CHD over 10 years.
Health psychol. 2002; 21: 543-552
Action
Refer to mental health professional, to be seen as soon as possible
Therapeutic approach
Effective
1.Choice of treatment
Psychotherapy
Drug treatments
3. 4.
5.
efficacy cardiac side effects e.g. tricyclic antidepressants weight gain anxiolytic action (Benzodiazepines ?!! ) SSRIs
hyponatremia hemorrhage interference of some cytochrome P450 isoenzymes
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