[Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment]

Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia

BACKGROUND

The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD).

METHODS

This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants.

RESULTS

Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735-7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259-5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status.

CONCLUSION

The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.

Effect of Comprehensive Psychological Intervention on Negative Emotions and Quality of Life in Patients with Acute Myocardial Infarction

Although acute myocardial infarction (AMI) currently has a high survival rate, the treatment and prognosis are still diffuse negative life events for patients, which will affect their quality of life (QOL) and psychological health. Based on an integrated physiological-psychological-social-medical model, it is necessary to design an intervention program for safeguarding the physical and mental health of AMI patients.This study aimed to explore the influence of psychological intervention on negative emotions and QOL of AMI patients using a randomized controlled trial (RCT) design.Based on convenience sampling and double-blinded group assignment, 101 patients from August 2019 to January 2020 were randomly divided into 2 groups. An intervention group received comprehensive psychological intervention, while a control group received general supportive nursing. Both groups answered questionnaires before and after the intervention, including assessments of anxiety, depression, and QOL.Before the intervention, there were no significant differences between the groups. After intervention, anxiety and depression in the intervention group (n = 48) were significantly lower (P < 0.001) and QOL was markedly improved (P < 0.05) compared to that of the control group (n = 53).Comprehensive psychological intervention contributed to ameliorate negative emotions, enhance confidence in treatment, and improve the QOL of AMI patients.

Sleep restriction alters physiological and emotional responses to emotion induction

NEW FINDINGS

What is the central question of this study? The aim of the present study was to assess the effects of sleep restriction on self-report and autonomic responses to neutral and sad film clips. What is the main finding and its importance? Ratings of sadness and heart rate deceleration were greater while watching the sad clip, with no effect of sleep restriction, whereas heart rate variability and skin conductance were impacted by sleep restriction and, to a lesser extent, by film clips. The results suggest that autonomic function was adaptively altered by sleep restriction, in order to maintain a 'normal' response to emotional cues, despite mounting fatigue.

ABSTRACT

Habitual insufficient sleep has long-term health consequences via its impact on autonomic nervous system (ANS) function and on regulation of emotion. To our knowledge, the effects of insufficient sleep on emotion-induced ANS function have not been tested. The present study aimed to address this lacuna. Using an emotion induction procedure, the effects of sleep restriction on physiological responses to validated neutral and sad film clips were assessed in a two-by-two, pseudo-randomized, cross-over design. Thirty-one participants, aged 20-33 years, were assessed after sleeping for either 5 h (sleep restricted, SR) or 8 h (well rested, WR) per night, for three consecutive nights. Physiological measures included heart rate, heart rate variability, skin conductance response (SCR) and participants' ratings of affect and fatigue. There was no effect of sleep conditions on self-reported negative affect, but watching the sad clip reduced self-reported fatigue in the SR condition. There was greater heart rate deceleration while watching sad relative to neutral clips, independent of the sleep condition. Sleep restriction increased heart rate variability measures, with no effect of emotion induction. There was an interaction of emotion induction with sleep condition for SCR, with more SCRs to sad relative to neutral clips in the WR condition, and the opposite effect in the SR condition. Combined, the results suggest that the ANS response to an emotional cue was altered by sleep restriction. The results suggest an adaptive ANS response to mild, chronic sleep restriction, resulting in constant heart rate response and self-reported experience across WR and SR conditions, despite mounting fatigue.

Emotional Dysregulation as a Factor of Psychosomatic Disturbances in Depression and Cardiovascular Pathology (Analytical Review of Foreign Literature)

The review presents data on cognitive processes of emotional regulation, which are the result of the interaction of the activity of the prefrontal cortex and emotional centers, as the most important pathogenetic link in the psychosomatic relations of depressive and cardiovascular diseases. The neuroanatomical substrate of emotional regulation is the connection between emotional and cognitive processes, which are carried out through bidirectional neuronal interactions between the neocortex and emotional centers. This connection allows emotional centers to modulate cortical activity, and cognitive centers, through descending cortical influences, to modulate the processing of emotions. At present, direct and indirect connections of the frontal cortex with the centers of the autonomic nervous system and its stimulating sympathetic and inhibitory parasympathetic influences have been confirmed. Pathogenetic links of emotional dysregulation include neurobiological and cognitive (rumination, fixation on negative information) processes. The pathophysiological mechanisms of depression and cardiovascular diseases have common links - the dysregulation of the metabolic, immunological and hypothalamus-pituitary-adrenal systems. The tendency to negative emotional response, the prevalence of negative emotions and alexithymia (low awareness of emotions) stand out as predictors of the development of both cardiovascular diseases and depression. Studies aimed at studying the typology and meaning of emotional dysregulation in various forms of psychopathological disorders in the aspect of comorbidity and psychosomatic relationships with somatic diseases can be fruitful in terms of finding new approaches to diagnosis and therapy.

Depression as a Risk Factor of Organic Diseases:An International Integrative Review

PURPOSE AND DESIGN

This integrative review offers a systematic synthesis of the international literature regarding the role of depression as a risk factor in physical illnesses and the mechanisms of this connection. Special attention is paid to those modifiable factors.

FINDINGS

Published studies of depression and physical illness and disease(N = 24) from five countries that were indexed in PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNET, Scopus, Dialnet, and CUIDEN were examined. Results suggest that depression is a significant risk factor for the development of physical illnesses and diseases. More commonly studied were the connections between depression and cardiovascular disease, metabolic syndrome, biochemical alterations, diabetes, dementia, cognitive impairment, Alzheimer's disease, somatization and chronic pain, asthma, arthritis, and hyperlipidemia. Less frequently studied conditions connected to depression were cancer, infections, allergies, autoimmune disease, gastric ulcer, rhinitis, thyroiditis, bronchitis, migraines, fractures, and osteoporosis.

CONCLUSIONS

Mechanisms connecting depression to physical illness appear to involve alterations in the hypothalamic-pituitary axis, unhealthy lifestyle, chronic or acute stressors including posttraumatic stress, an increase in C-reactive protein (CRP) in men, taking antidepressant medication, and social and emotional loneliness.

CLINICAL RELEVANCE

A good patient-provider relationship can help to promote decreased acute or chronic stressors, increased family and social support, decreased loneliness, modification of unhealthy lifestyles such as smoking, obesity, physical inactivity, alcohol, control of CRP, and antidepressant medication. Nurses are well placed to help prevent physical diseases through detection and referral of patients who are depressed or undiagnosed and not receiving adequate mental health treatment.

Infective endocarditis and thoracic aortic disease: A review on forgotten psychological aspects

AIM

To summarize the current evidence on psychological issues in thoracic aortic disease (TAD) and infective endocarditis (IE) setting.

METHODS

We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, PubMed and PsycINFO, we searched full manuscripts in English and published until September 1, 2014.

RESULTS

We found sixteen studies exploring psychological issues in patients with IE (six studies) and in TAD (ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE (four papers) and in TAD (eight papers). Depression and anxiety were analyzed in TAD only (five papers). Post-traumatic stress disorder was assessed in IE (one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ.

CONCLUSION

Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.

Correlation Between Hypertension, C-Reactive Protein and Serum Uric Acid With Psychological Well-being

BACKGROUND

Multiple population-based human studies have established a strong association between increasing levels of serum C-reactive protein, uric acid and subsequent development of hypertension.

OBJECTIVES

We aimed to investigate the association between mental well-being with presence of hypertension, hyperuricemia and hs-CRP levels. ‬‬

PATIENTS AND METHODS

This was a cross sectional study of 801 individuals aged 35-85 years old in Broujerd, Iran, included by randomized cluster sampling. General Health Questionnaire (GHQ-12) for assessing mental health/distress level, MONICA standard questions for evaluating hypertension history, serum hs-CRP and Serum Uric Acid (SUA) were evaluated Data were analyzed by appropriate statistical test such as chi-square, T-test and correlation.

RESULTS

One hundred eighty five patients (23.1%) had high distress/minor psychiatric disorders. SUA had significant association with hypertension (r = 0.64, P = 0.034). No significant relation was observed between hs-CRP and hypertension. The correlation between GHQ and hs-CRP was not significant but a weak and negative correlation was found between GHQ and SUA SUA (P = 0.012, r = -0.089).

CONCLUSIONS

The weak and strong correlation among these parameters indicate that mental wellbeing relays on physical wellness and interact with each other; therefore, controlling hypertension along with uric acid control may effect mental health of any kind of patients.