An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome

Abstract

Background The clinical value of the identification of mood disorders in patients with acute coronary syndrome (ACS) is well established. However, assessment based on DSM criteria presents some limitations. This study aimed to provide an innovative strategy for evaluating the spectrum of mood disturbances in ACS. Methods A total of 288 patients with a first episode of ACS underwent interviews based on DSM-IV-TR criteria (major depressive disorder, minor depression, and dysthymia), Diagnostic Criteria for Psychosomatic Research-DCPR (demoralization and type A behavior), and the Clinical Interview for Depression-CID. Additional self-report inventories (psychological well-being and distress) were administered. A total of 100 consecutive patients who satisfied criteria for DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlled trial on a sequential combination of cognitive-behavioral and well-being therapy (CBT/WBT) vs clinical management (CM) and reassessed up to 30-month post-intervention. Results A total of 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion of demoralization and type A identified psychological distress in 58% of the sample. According to CID, reactivity to social environment, fatigue, depressed mood, and somatic anxiety were the most common symptoms. Somatic symptoms were significantly associated with DSM-IV-TR depression (fatigue and changes of appetite), whereas environmental reactivity with demoralization. Both depression and demoralization were associated with higher distress and lower well-being. Unlike CM, CBT/WBT was significantly associated with decrease of guilt, pessimism, fatigue, and early insomnia (CID). Conclusions The findings indicate that standard psychiatric approach identifies only a narrow part of mood disturbances affecting ACS patients. A more articulated assessment unravels specific clinical configurations that may entail prognostic and therapeutic implications.

Clinical utility of the Diagnostic Criteria for Psychosomatic Research for a comprehensive assessment of the elderly

“…Elderly subjects with at least one DCPR‐R diagnosis showed lower PWB Personal growth and Purpose in life than those without DCPR‐R diagnoses, suggesting that the use of DCPR‐R in the elderly allows identifying clinical differences as also observed in the general population (Mangelli et al, 2006), in migraine patients (Cosci et al, 2019) and in those with acute coronary syndrome (Gostoli et al, 2021). No differences were found between elderly subjects with or without DCPR‐R diagnoses on GAS Somatic symptoms, suggesting that this subscale might poorly discriminate between elderly subjects with or without psychosomatic syndrome, probably because only few items (i.e., 4) explore the somatic area of anxiety.…”

Mental Illness and Work-Related Limitations in Healthcare Workers: A Preliminary Retrospective Study

“…It advocates for including within a frame of reference the patient him or herself as a whole, and not simply his/her disorder [ 54 ]. It follows that it would be important to conduct a clinimetric assessment that could integrate the problem not only from a categorical nosographic point of view but also from a dimensional perspective considering the various factors mentioned above [ 55 ].…”

Clinical Characterization of Demoralization

“…The interviews were performed before discharge to minimize the contaminating effects of hospitalization. There were 43% of cases of DCPR demoralization and only 3% of major depressive disorder [43]. The CID [15] was used for rating depression, and its item concerned with abnormal reactivity to social environment was significantly associated with demoralization [43].…”

“…There is only one randomized controlled trial (RCT) that used demoralization according to the DCPR [5] as an entry criterion. A total of 288 patients with a first episode of acute coronary syndrome underwent semi-structured interviews for mood disorders and demoralization [43]. The interviews were performed before discharge to minimize the contaminating effects of hospitalization.…”

“…There were 43% of cases of DCPR demoralization and only 3% of major depressive disorder [43]. The CID [15] was used for rating depression, and its item concerned with abnormal reactivity to social environment was significantly associated with demoralization [43]. A total of 100 consecutive patients (mostly with demoralization) were enrolled in a RCT on the sequential combination of cognitive behavior therapy (CBT) and Well-Being Therapy (WBT) [44, 45] compared to clinical management (CM), with assessments up to 30 months after intervention [46].…”