Posttraumatic Stress, Nonadherence, and Adverse Outcome in Survivors of a Myocardial Infarction

Shemesh, Eyal; Yehuda, Rachel; Milo, Olga; Dinur, Irit; Rudnick, Abraham; Vered, Zvi; Cotter, Gad

doi:10.1097/01.psy.0000126199.05189.86

Cited by 210 publications

(206 citation statements)

References 27 publications

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“…5 The PTSD is associated with poor compliance with cardiac therapy 6 and poor cardiovascular outcomes. 7 To meet the definition of PTSD, 8 patients must have experienced the MI as an event involving threatened death to which they responded with intense fear or helplessness. Patients must also have reexperienced the MI (e.g., in thoughts or dreams, avoided stimuli associated with the MI, and had symptoms of heightened arousal for at least 1 mo).…”

Section: Introductionmentioning

confidence: 99%

Clinical Diagnosis of Posttraumatic Stress Disorder After Myocardial Infarction

Guler¹,

Schmid

Wiedemar

et al. 2009

Clinical Cardiology

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Background: Clinician-rated large-scale studies estimating the prevalence of posttraumatic stress disorder (PTSD) related to myocardial infarction (MI) and identifying predictors of clinical PTSD are currently lacking. Hypotheses: We hypothesized that PTSD is prevalent in post-MI patients and that the subjective experience of the MI determines PTSD status. Methods: We approached 951 post-MI patients with a questionnaire screening for PTSD symptoms related to their MI. Those responding and meeting a cutoff of PTSD symptom levels were invited to participate in a structured clinical interview to diagnose PTSD following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Fear of dying, feelings of helplessness, and severity of pain perceived during the MI were also assessed by visual analog scales. Results: The screening questionnaire was completed by 394 patients, whereby 77 met the cutoff for the interview (8 patients declined the interview). Forty of 394 patients (10.2%) had clinical PTSD (subsyndromal and syndromal forms combined). Younger age (OR 0.95, 95% CI 0.91-0.99), greater fear of dying (OR 2.77, 95% CI 1.28-5.97), and more intense feelings of helplessness (OR 2.97, 95% CI 1.42-6.21) were independent predictors of PTSD status. Perceived pain intensity during MI, sex, type of index MI, left ventricular ejection fraction, number of coronary occlusions, and highest level of total creatinine kinase were not significant predictors. Conclusions: Clinical PTSD is prevalent in post-MI patients. Demographic and particularly psychological variables related to the subjective experience of the event were stronger predictors of PTSD status than were objective measures of MI severity.

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Section: Introductionmentioning

confidence: 99%

Clinical Diagnosis of Posttraumatic Stress Disorder After Myocardial Infarction

Guler¹,

Schmid

Wiedemar

et al. 2009

Clinical Cardiology

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“…6 When a child is ill, the traumatic emotional experience that is associated with this illness is frequently shared by the parent, too. 5,6,12 When PTSD symptoms develop in patients who are medically ill, they are associated with poor health outcomes [6][7][8]17 ; therefore, it is important to recognize these symptoms. 6 Hence, medically ill children are a particularly interesting group of traumatized youths in which one would wish to examine discrepancies between child and parent reports of PTSD symptoms that are experienced by the child.…”

Section: Abbreviations Ptsd Posttraumatic Stress Disorder; Dsm-iv-tmentioning

confidence: 99%

“…3 Significant PTSD symptoms have been reported to be present in 6% to 30% of surveyed children in various settings in the United States. 4,5 It is important to recognize and treat these symptoms, because PTSD is associated with increased rates of health care utilization, 5 disability, 6 and medical and psychiatric adversity [6][7][8] in affected patients.…”

Section: Abbreviations Ptsd Posttraumatic Stress Disorder; Dsm-iv-tmentioning

confidence: 99%

Comparison of Parent and Child Reports of Emotional Trauma Symptoms in Pediatric Outpatient Settings

Shemesh

Newcorn²,

Rockmore³

et al. 2005

Pediatrics

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108

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ABSTRACT.Objective. Exposure to emotionally traumatic events is common among children who are treated in pediatric medical care settings, and it is important to recognize the emotional reactions that children might develop as a response to the trauma. Practitioners sometimes rely on parental reports of the child's emotional reactions, but these reports may be biased by the parent's own posttraumatic symptoms. Understanding the differences between parent and child reports of the child's emotional symptoms is essential to guide proper diagnosis and care. This study evaluated discrepancies in parental versus child reports of the child's emotional trauma symptoms in pediatric medical care settings.Methods. We enrolled children and adolescents (age: 8 -19) who had not previously received a diagnosis of a psychiatric disorder and were treated in pediatric specialty care clinics at Mount Sinai Medical Center in New York. We used the UCLA posttraumatic stress reaction index, child, adolescent, and parent versions, to evaluate child and parent reports of symptoms of posttraumatic stress disorder (PTSD) in the child. The Impact of Event Scale was used to evaluate the parents' own posttraumatic symptoms. We conducted a "best estimate" psychiatric diagnostic procedure to determine whether the child met diagnostic criteria for PTSD and evaluated the association between the diagnostic status (as determined by the "best estimate" procedure) and the results of the questionnaires.Results. A total of 115 patients and parents consented to the study, and 76 completed the evaluation. Sixty-four percent of the parents identified the child's traumatic experience as their own most traumatic experience, too. The child's self-report of PTSD symptoms was significantly correlated with the diagnosis of PTSD in the child. In contrast, parents' reports of their child's PTSD symptoms were not significantly associated with the child's diagnosis. Parents' own posttraumatic symptoms were associated with parental reports of the child's overall PTSD symptoms (correlation coefficient: 0.283).Conclusions. When a child is emotionally traumatized, the parent's own posttraumatic stress may influence his or her report and interpretation of the child's symptoms. Clinicians who evaluate children and adolescents for PTSD in medical care settings should directly seek the child's report and should not rely exclusively on parental reports. Parental reports of a child's PTSD symptoms can offer insights into the parent's own level of posttraumatic stress. Pediatrics 2005;115:e582-e589. URL: www.pediatrics.org/cgi

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“…Not surprisingly, these same factors are often associated with discharge AMA. [25][26][27][28] In fact, nonadherence in discharge AMA and nonadherence elsewhere are fundamentally similar. Differences, where they exist, are often in the degree or imminency of health risk and in the ability of physicians to monitor the patient.…”

mentioning

confidence: 99%

Discharge against medical advice: Ethical considerations and professional obligations

Berger

2008

Journal of Hospital Medicine

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Posttraumatic Stress, Nonadherence, and Adverse Outcome in Survivors of a Myocardial Infarction

Abstract: PTSD symptoms predicted poor disease control in this cohort of MI survivors. The data suggest that screening MI survivors for symptoms of PTSD may be beneficial if this high-risk population is to be targeted for interventions.

Cited by 210 publications

References 27 publications

Clinical Diagnosis of Posttraumatic Stress Disorder After Myocardial Infarction

Clinical Diagnosis of Posttraumatic Stress Disorder After Myocardial Infarction

Comparison of Parent and Child Reports of Emotional Trauma Symptoms in Pediatric Outpatient Settings

Discharge against medical advice: Ethical considerations and professional obligations

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