Emotional adjustment and catecholamine excretion during early recovery from myocardial infarction

Patterns of emotional reactions after a myocardial infarction

In a prospective study of 283 myocardial infarction (MI) patients, state-dependent feelings of anxiety, depression, and irritability were assessed twice during hospital stay, and four times during a 3-5 yr follow-up. A K-mean cluster analysis identified six subgroups of MI patients with different pattern of emotional reactions. Two groups, containing nearly half of the sample, had low average levels of emotional upset at all assessments. Two groups showed an intermediate long-term outcome: one of these had a high level of initial emotional upset that subsided during the first six months after discharge, whereas the other group showed increasing levels of emotional distress long-term follow-up. Finally, two groups failed to achieve long-term emotional readjustment. For one of these, a high level of emotional upset was evident from the first in-hospital assessment, whereas the other one had a sharp increase in emotional distress after discharge. In a series of psychological, social and medical variables, the former pattern was associated with more pre-MI medical and psychosocial problems, whereas the delayed emotional reaction was related to lower levels of cardiac health knowledge. Furthermore, high levels of emotional upset preceded both failure in resuming work and increased long-term rehospitalization. The findings indicate that emotional reactions after a MI should be monitored during convalescence to identify patients at risk for a failure in emotional readjustment. Furthermore, effective treatment of initial emotional reactions could promote resumption of work and reduce long-term morbidity.

Coping with myocardial infarction: a model with clinical applications, a literature review

Following a myocardial infarction any residual symptoms are likely to remind the patient of a possible fatal outcome and be detrimental to successful rehabilitation. Negative psychological attitudes need to be identified early. Intervention to improve the mental state should be introduced to restore self-confidence.

Life change and illness studies: past history and future directions

A selected review of life changes and illness studies is presented which illustrates both the diversity of samples that have been tests in these studies and the generally positive results which have been obtained. Although early (retrospective) work in this field led to simplistic explanations, later (prospective) studies have begun to document the several intervening variables which occur between subjects' recent life change experiences and their subsequent symptomatology and disease. A life change and illness model is presented to illustrate key intervening variables. The authors believe that future research in the field of life change and illness should concentrate on further delineations of these intervening variables--an effort necessitating active collaboration between social and medical scientists.