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Base rates of depressive and anxious symptoms in patients with coronary heart disease
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
Results: We included 26 RCTs, with 2159 participants. The duration of the studies ranged between two and 12 weeks. We found no significant difference between tricyclic antidepressants (TCAs) and placebo for severity of MUPS. For new-generation antidepressants (NGAs), there was very low-quality evidence showing they were effective in reducing the severity of MUPS. For natural products (NPs) there was low-quality evidence that they were effective in reducing the severity of MUPS. One meta-analysis showed no clear evidence of a difference between TCAs and NGAs for severity of MUPS. Finally, one meta-analysis comparing selective serotonin reuptake inhibitors (SSRIs) with a combination of SSRIs and antipsychotics showed low-quality evidence in favour of combined treatment for severity of MUPS. The risk of bias was high in many domains across studies. Conclusion: The current review found very low-quality evidence for NGAs and low-quality evidence for NPs being effective in treating somatoform symptoms in adults when compared with placebo. We found serious shortcomings such as the high risk of bias, strong heterogeneity in the data, small sample sizes and a short follow-up. Furthermore, the significant effects of antidepressant treatment have to be balanced against the relatively high rates of adverse effects. Future high-quality research should be carried out to determine the effectiveness of medications other than antidepressants, to compare antidepressants more thoroughly, and to follow-up participants over longer periods.
doi:10.1016/j.jpsychores.2015.03.070
Base rates of depressive and anxious symptoms in patients with coronary heart disease S. Kohlmann, B. Gierk, A. Scholl, A. Murray, M. Lehmann, B. Löwe University Medical Center Hamburg-Eppendorf, Dept. of Psychosomatic Medicine, Schoen Clinic Eilbek, Hamburg, Germany Background: Depression and anxiety disorders are frequent in patients with coronary heart disease (CHD) and are independent risk factors. Clinically, the diagnoses are challenging as somatic and functional symptoms often overlap in this patient population (e.g., fatigue, sleep disturbance, etc.). Normative data on the distribution of depressive and anxious symptoms could facilitate clinicians' judgement of individual's symptom severity and abnormality, and, thus, could give valuable insights into which symptoms CHD patients suffer most. As prevalence rates of the overall diagnoses are well studied, the aim of the present study is to determine the base rates of depressive and anxious symptoms. Method: In total, 1337 in- and outpatients with CHD were consecutively assessed with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7. The frequency and distribution of the nine depressive symptoms and seven anxious symptoms were analysed with respect to socio-demographic data (i.e. gender, age, education) but also cardiac factors (i.e. NYHA, CCSC, history of myocardial infarction or bypass, hospitalisation and setting). Results: The frequency and distribution of depressive and anxious symptoms varied widely. Sleep difficulties (69%) and loss of energy (75%) were the most frequently indicated depressive symptoms. In contrast, feelings of worthlessness (22%) and suicidal ideations (14%) were least frequent. In terms of anxiety, nervousness (51%) and irritability (53%) were most frequent. Not being able to stop worrying (38%) and restlessness (38%) were less frequent. Female gender and age were correlated with increased severity of anxious and depressive symptoms. Cardiac symptom severity showed the strongest association with
607
symptoms of anxiety and depression, however, no correlations were indicated for other cardiac factors. Conclusion: Depressive and anxious symptoms were very prevalent but ranged widely in frequency and in terms of socio-demographic and cardiac symptom severity. Presented base rates allow clinicians to easily categorize individual patients according to their symptom profile and judge abnormalities. A symptom based approach could overcome the challenge of diagnosing depression or anxiety disorders in patients with CHD.
doi:10.1016/j.jpsychores.2015.03.071
Integrated care in cardiology: Needs, demands and therapeutic strategies E. Kunschitz, O. Friedrich, J. Sipötz Hanusch Krankenhaus & Karl Landsteiner Institut for Research in Clinical Cardiology, 2. Med. Abteilung, Vienna, Austria Background: Psychosocial factors play an important role in the pathogenesis of coronary artery disease (CAD). Because of limited resources in the current health care environment it is important not only to identify patients with psychosocial risk load but also to single out those, who are motivated to engage in additional therapy and therefore most likely will benefit from further treatment. An obvious way to identify patients with a potentially high level of commitment is to assess the patients' request for treatment. Our study aimed to assess patients' request for psychosomatic counseling (PC) with a patient self-administered questionnaire (ADAPT). Method: 233 patients (age: 54.5 ± 13.4, 57.5% male) referred for exercise stress testing to the outpatient cardiac care unit of Hanusch Hospital answered the ADAPT. The SF-36 Quality of Life and the Hospital Anxiety and Depression Questionnaire (HADS) were used to investigate if the request for PC is consistent to impairment of generic quality of life and the presence of mental distress. Results: 31.8% of the patients expressed moderate or strong demand for PC. They reported significantly lower scores in all SF-36 domains than the norm population except for General Health. Request for PC was strongly associated with positive indicators of mental distress: compared to patients without demand for PC patients demanding PC showed significantly more often SF-36 MCS-scores b 42 (55.0% vs. 17.4%; OR: 5.8), SF-36 Mental Health-scores b 53 (47.8% vs. 18.8%; OR: 4.0), HADS-Anxiety-scores N 7 (59.7% vs. 26.4%; OR: 4.1) and HADS-Depression-scores N 7 (32.8% vs. 14.3%; OR: 2.9). Conclusion: Our study shows that the patients' request for psychosomatic (PC) reflects impairment of generic health status and psychological risk load, thereby indicating that screening for patient's subjectively perceived demand for PC is an adequate method in order to select patients with a psychosomatic need, to optimize the allocation of health care resources and to improve therapeutic strategies in a patient-centred way especially integrated psychocardio-logical care in hospital. doi:10.1016/j.jpsychores.2015.03.072
Prevention, diagnosis and healing of complex trauma: Applying the Great 8 competencies R. Kurz Outstanding Achievements, London, UK Background: Complex trauma is a relatively young field in the health sciences. The ground-breaking ideas of Janet regarding trauma
Results: We included 26 RCTs, with 2159 participants. The duration of the studies ranged between two and 12 weeks. We found no significant difference between tricyclic antidepressants (TCAs) and placebo for severity of MUPS. For new-generation antidepressants (NGAs), there was very low-quality evidence showing they were effective in reducing the severity of MUPS. For natural products (NPs) there was low-quality evidence that they were effective in reducing the severity of MUPS. One meta-analysis showed no clear evidence of a difference between TCAs and NGAs for severity of MUPS. Finally, one meta-analysis comparing selective serotonin reuptake inhibitors (SSRIs) with a combination of SSRIs and antipsychotics showed low-quality evidence in favour of combined treatment for severity of MUPS. The risk of bias was high in many domains across studies. Conclusion: The current review found very low-quality evidence for NGAs and low-quality evidence for NPs being effective in treating somatoform symptoms in adults when compared with placebo. We found serious shortcomings such as the high risk of bias, strong heterogeneity in the data, small sample sizes and a short follow-up. Furthermore, the significant effects of antidepressant treatment have to be balanced against the relatively high rates of adverse effects. Future high-quality research should be carried out to determine the effectiveness of medications other than antidepressants, to compare antidepressants more thoroughly, and to follow-up participants over longer periods.
doi:10.1016/j.jpsychores.2015.03.070
Base rates of depressive and anxious symptoms in patients with coronary heart disease S. Kohlmann, B. Gierk, A. Scholl, A. Murray, M. Lehmann, B. Löwe University Medical Center Hamburg-Eppendorf, Dept. of Psychosomatic Medicine, Schoen Clinic Eilbek, Hamburg, Germany Background: Depression and anxiety disorders are frequent in patients with coronary heart disease (CHD) and are independent risk factors. Clinically, the diagnoses are challenging as somatic and functional symptoms often overlap in this patient population (e.g., fatigue, sleep disturbance, etc.). Normative data on the distribution of depressive and anxious symptoms could facilitate clinicians' judgement of individual's symptom severity and abnormality, and, thus, could give valuable insights into which symptoms CHD patients suffer most. As prevalence rates of the overall diagnoses are well studied, the aim of the present study is to determine the base rates of depressive and anxious symptoms. Method: In total, 1337 in- and outpatients with CHD were consecutively assessed with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7. The frequency and distribution of the nine depressive symptoms and seven anxious symptoms were analysed with respect to socio-demographic data (i.e. gender, age, education) but also cardiac factors (i.e. NYHA, CCSC, history of myocardial infarction or bypass, hospitalisation and setting). Results: The frequency and distribution of depressive and anxious symptoms varied widely. Sleep difficulties (69%) and loss of energy (75%) were the most frequently indicated depressive symptoms. In contrast, feelings of worthlessness (22%) and suicidal ideations (14%) were least frequent. In terms of anxiety, nervousness (51%) and irritability (53%) were most frequent. Not being able to stop worrying (38%) and restlessness (38%) were less frequent. Female gender and age were correlated with increased severity of anxious and depressive symptoms. Cardiac symptom severity showed the strongest association with
607
symptoms of anxiety and depression, however, no correlations were indicated for other cardiac factors. Conclusion: Depressive and anxious symptoms were very prevalent but ranged widely in frequency and in terms of socio-demographic and cardiac symptom severity. Presented base rates allow clinicians to easily categorize individual patients according to their symptom profile and judge abnormalities. A symptom based approach could overcome the challenge of diagnosing depression or anxiety disorders in patients with CHD.
doi:10.1016/j.jpsychores.2015.03.071
Integrated care in cardiology: Needs, demands and therapeutic strategies E. Kunschitz, O. Friedrich, J. Sipötz Hanusch Krankenhaus & Karl Landsteiner Institut for Research in Clinical Cardiology, 2. Med. Abteilung, Vienna, Austria Background: Psychosocial factors play an important role in the pathogenesis of coronary artery disease (CAD). Because of limited resources in the current health care environment it is important not only to identify patients with psychosocial risk load but also to single out those, who are motivated to engage in additional therapy and therefore most likely will benefit from further treatment. An obvious way to identify patients with a potentially high level of commitment is to assess the patients' request for treatment. Our study aimed to assess patients' request for psychosomatic counseling (PC) with a patient self-administered questionnaire (ADAPT). Method: 233 patients (age: 54.5 ± 13.4, 57.5% male) referred for exercise stress testing to the outpatient cardiac care unit of Hanusch Hospital answered the ADAPT. The SF-36 Quality of Life and the Hospital Anxiety and Depression Questionnaire (HADS) were used to investigate if the request for PC is consistent to impairment of generic quality of life and the presence of mental distress. Results: 31.8% of the patients expressed moderate or strong demand for PC. They reported significantly lower scores in all SF-36 domains than the norm population except for General Health. Request for PC was strongly associated with positive indicators of mental distress: compared to patients without demand for PC patients demanding PC showed significantly more often SF-36 MCS-scores b 42 (55.0% vs. 17.4%; OR: 5.8), SF-36 Mental Health-scores b 53 (47.8% vs. 18.8%; OR: 4.0), HADS-Anxiety-scores N 7 (59.7% vs. 26.4%; OR: 4.1) and HADS-Depression-scores N 7 (32.8% vs. 14.3%; OR: 2.9). Conclusion: Our study shows that the patients' request for psychosomatic (PC) reflects impairment of generic health status and psychological risk load, thereby indicating that screening for patient's subjectively perceived demand for PC is an adequate method in order to select patients with a psychosomatic need, to optimize the allocation of health care resources and to improve therapeutic strategies in a patient-centred way especially integrated psychocardio-logical care in hospital. doi:10.1016/j.jpsychores.2015.03.072
Prevention, diagnosis and healing of complex trauma: Applying the Great 8 competencies R. Kurz Outstanding Achievements, London, UK Background: Complex trauma is a relatively young field in the health sciences. The ground-breaking ideas of Janet regarding trauma