Cognitive and emotional disorders in patients with chronic heart failure: prospects for detection and correction

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Psycho-emotional disorders, such as anxiety disorders, acute and chronic stress, are significant risk factors for the development and complicated course of both major cardiovascular and other common chronic non-communicable diseases. The psycho-emotional disorders significantly reduce patients’ motivation and adherence to lifestyle changes and drug therapy, significantly worse quality of life, increase the risk of disability and healthcare system expenditures. The topicality of the issues of diagnosis and management of psycho-emotional disorders in the general practitioner’s practice is caused, on the one hand, by high rates of these disorders in patients with cardiovascular and other chronic diseases, deterioration in quality of life and an increase in adverse outcomes, and on the other hand, inadequate awareness of the risks associated with the sphere of psycho-emotional status in patients. The management of psycho-emotional disorders includes both pharmacological and non-pharmacological treatments. Antidepressants that fall into the class of selective serotonin or serotonin and norepinephrine reuptake inhibitors are the first-line drugs used for the treatment of most of the disorders discussed. However, prescription of these drugs requires to take into account a wide range of possible side effects in patients with chronic diseases, including CVDs. Drugs that have fast onsets of sedative and anti-anxiety action, also known as tranquilizers, are more widely used in real-world clinical practice. Tofisopam is the most promising from this group of drugs in therapeutic and cardiological practice. The efficacy and safety of tofisopam have been studied in numerous studies in patients with chronic non-communicable diseases and a wide range of anxiety disorders, including the long-term use of the drug.

Strategy for the management and prevention of psycho-emotional disorders in the GP’s practice

Shishkova

2023

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Features of neuropsychological characteristics of patients with arterial hypertension

Shishkova,

Dranitsyna,

Ustarbekova

et al. 2023

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Introduction. The significant pathogenetic effect of arterial hypertension on the development of cognitive and psycho-emotional disorders, on the one hand, and the lack of algorithms for identifying and managing patients with comorbid neurocognitive disorders in therapeutic practice, on the other hand, determines the relevance of studying this problem.Aim. To study neuropsychological characteristics of patients with arterial hypertension in therapeutic practice. Materials and methods. A total of 508 patients with arterial hypertension were enrolled in the study. All study participants underwent the clinical examination and neuropsychological tests: Montreal Cognitive Assessment Scale (MoCA test), Schulte tables, Categorical Verbal Fluency Test, Tracking Test, MFI-20 asthenia self-assessment questionnaire, Reeder's Test, Maastricht Questionnaire, and Hospital Anxiety and Depression Scale (HADS). Results. The analysis of neuropsychological testing results of patients with hypertension showed that almost all the techniques identified deviations from the reference ranges in most of the study subjects. 85% of patients had decreased total score of cognitive functions assessed in terms of MoCA test scores, 83% of patients showed increased time in performing tracking test part A and 74% patients showed increased time in performing part B, and there was also a large difference between the time spent on performing parts B and A of the test; 49% of patients demonstrated decreased speed in performing the Schulte test. Th psycho-emotional state test results showed a high level of psycho-emotional stress in 80.5%, vital exhaustion in 78% and fatigue in 96% of patients. Conclusions. In this study, the neuropsychological testing results of patients with hypertension showed decreased total scores of cognitive functions and individual parameters of the cognitive spectrum, such as attention focusing, information processing speed, memory, speech function and executive functions combined with a high level of psycho-emotional stress, fatigue and anxiety.

Stress-related emotional disturbances in patients with cardiovascular diseases

Shishkova

2023

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Acute and chronic stress, as well as emotional disturbances as a consequence of stressful situations, are significant risk factors for the development and progression of some of acute and chronic non-communicable diseases, including cardiovascular diseases (CVD), among which the most common are arterial hypertension, chronic heart failure and atherosclerotic CVD. Specific emotional disturbances that arise after exposure to significant traumatic or stressful situations include acute and post-traumatic stress disorder. When a stress factor does not reach high intensity or significance, adjustment disorder may develop. Stress-related emotional disturbances significantly affect other CVD risk factors, reduce patients’ adherence to healthy lifestyle changes and drug therapy, deteriorate quality of life and increase the risk of disability. The urgency of identifying and managing post-stress emotional disturbances in the practice of internists is caused by high frequency of these disturbances in outpatient patients. It is especially important to manage and prevent these disturbances in patients with CVD due to increased number of adverse outcomes resulting from this combination. Treatment of emotional disturbances resulting from stressful situations includes both drug and non-drug methods. Antidepressants and benzo-diazepine anxiolytics are the main classes among the drugs used to treat post-stress emotional disorders. However, the prescription of these drugs requires taking into account a wide range of possible side effects, especially in patients with CVD. The choice of drugs with a favourable safety profile and a rapid onset of sedative and anti-anxiety effects is a key element in the modern effective patient management strategy. Tofisopam and buspirone are the most advanced of this group of drugs in therapeutic and cardiological practice.