Psychiatric comorbidities in acute coronary syndromes: Six-month follow-up study

Abstract

Introduction:Acute coronary syndrome (ACS) caused by coronary atherosclerosis include ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. The relation between psychiatric disorders and coronary artery disease is a complex one which includes the effect of the psychosocial factors on heart and vice versa. Point prevalence studies have been reported, but there is paucity of follow-up studies from India.Materials and Methods:The study is a follow-up evaluation at discharge of 248 consecutive patients presented with ACS at JSS Hospital, Mysuru, Karnataka, over a period of 6 months to assess the psychiatric comorbidities. The patients were assessed on a structured and validated pro forma before discharge, at 3 months, and at 6 months. Screening of psychiatric disorders was done using Mini International Neuropsychiatric Interview PLUS 5.0.0 and assessment of depression was done using Hamilton Depression Rating Scale. ANOVA, Student's t-test, and SPSS 21 were used for statistical analysis.Results:The most common psychiatric comorbidities include major depressive disorder (44%), it persisted at the end of 3 (P < 0.001) and 6 (P < 0.001) months. A spectrum of anxiety disorders including panic disorder (12.10%), dysthymia (3.60%), agoraphobia (2.40%), social phobia (2%), obsessive-compulsive disorder (1.6%), specific phobia (1.2%), and posttraumatic stress disorder (0.8%) in descending order at the end of 6 months were found. Significant reduction in substance use of nicotine (66.1%) and alcohol (56.0%) was reported on follow-up.Conclusion:Depression, anxiety, and substance use occur in patients with ACS which persist on follow-up. Early recognition at discharge and appropriate counseling on follow-up improve the clinical outcomes.

Quality of Life, Anxiety, and Depression in Peruvian Patients with Acute Coronary Syndrome

“…The prevalence of depression in patients after ACS events is significantly increased compared to the general population because it has been shown that patients with ACS have a greater predisposition to present stressful events, as well as being more exposed to the threat of death and the loss of autonomy, which become stressors that generate depression. In this investigation, almost 8 out of 10 patients presented depression, which is consistent with what has been described in previous studies [24,25]. However, these results are higher than those described by Jayakumar et al [26], who found that 46.1% of patients with myocardial infarction presented depression.…”

Assessment Of Depression, Anxiety, and Quality Of Life in Patients with Coronary Artery Disease

“…Our ndings reveal that the most common anxiety disorder diagnosis was generalized anxiety disorder (11.5%) followed by panic disorder (8.3%) which is similar to a systematic review and meta-regression by Tully et al in 2014 (25). Likewise, another study from India in 2018 found panic disorder (12.10%) as the most common anxiety disorder in CAD patients followed by agoraphobia (2.40%) which is slightly different from our nding (11). Our ndings suggest that the majority of depressive disorders are mild in severity which is consistent with the nding by Altino et al,2017 and Yeshun et al 2019 who found that the majority of CAD patients had mild depression (26) (23).…”

“…CAD patients with depression and anxiety co-morbidities are associated with worse cardiac outcomes (5). The prevalence rates of depression and anxiety varied among studies and ranged from 15-60% across the globe (6) , ( 7) , (8) , ( 9) , (10) , (11). Depressive symptoms are frequently masked by physical illness and manifest as severe somatic symptoms inconsistent with disease severity, making a diagnosis and intervention di cult for clinicians (4).…”

Prevalence and pattern of psychiatric morbidity in patients with first-episode acute coronary syndrome

“…Psychological and social elements both play important roles in the etiology, course, and outcome of CAD. A bidirectional relationship exists between cardiovascular diseases and psychiatric co-morbidities [10]. Depressive and anxiety disorders, anger, and post-traumatic stress are identifiable markers of psychological distress that have been significantly associated with CAD [11].…”

“…The relationship between the risk of CAD and the severity of depression is direct, with reported increases of 1-2 times for minor depression and 3-5 times for major depression [15]. Anxiety has also been linked to negative illness outcomes [10]. The elevated risk posed by these psychological factors is comparable to more conventional CAD risk factors like smoking, dyslipidemia, and hypertension [16].…”