Symptoms of Posttraumatic Stress Disorder in Patients Who Have Had a Myocardial Infarction

Shemesh, Eyal; Koren‐Michowitz, Maya; Yehuda, Rachel; Milo-Cotter, Olga; Murdock, Elmer; Vered, Zvi; Shneider, Benjamin L.; Gorman, Jack M.; Cotter, Gad

doi:10.1176/appi.psy.47.3.231

Cited by 66 publications

(56 citation statements)

References 33 publications

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“…9 We therefore would like to encourage clinicians to regularly evaluate post-MI patients in terms of PTSD symptoms related to acute MI. Although specific interventions for post-MI patients suffering of PTSD are only beginning to emerge, 46 there are established treatments available for PTSD due to other sources, broadly referring to counseling, cognitive-behavioral and interpersonal psychotherapy, and psychopharmacology. 43,44 However, in a busy cardiology setting, clinicians may also want to test whether an undemanding intervention aimed at reducing emotional distress (e.g.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

et al. 2008

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OBJECTIVE: We estimated the prevalence of posttraumatic stress disorder (PTSD) and identified predictors of self-rated PTSD symptoms in patients post-myocardial infarction (MI). METHODS: We recruited 400 patients (mean age 60 +/-12 years, 79% were men) with a previous acute index MI who were referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale, and self-rated severity of PTSD symptom levels were assessed by the Posttraumatic Diagnostic Scale. RESULTS: Of the 190 patients who completed the Posttraumatic Diagnostic Scale, 34 met the cutoff for clinically significant PTSD symptomatology and 32 agreed to be interviewed. Among these patients, the Clinician-administered PTSD Scale interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% confidence interval 7.4-11.6). Retrospectively rated feelings of helplessness (beta = .47, P < .001) and pain intensity during MI (beta = .15, P = .019) independently predicted PTSD symptom level. CONCLUSIONS: Approximately 10% of patients post-MI had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level. PREVALENCE AND PREDICTORS OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN ACUTE MYOCARDIAL INFARCTION PATIENTS Methods:We recruited 400 patients (mean age 60±12 years, 79% men) with a previous acute index MI referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale (CAPS) and self-rated severity of PTSD symptom levels by the Posttraumatic Diagnostic Scale (PDS). Results:Of the 190 patients who completed the PDS, 34 met the cut-off for clinically significant PTSD symptomatology and 32 agreed to be interviewed. In these, the CAPS interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% CI 7.4-11.6).Retrospectively rated feelings of helplessness (β=.47, p<.001) and pain intensity during MI (β=.15, p=.019) independently predicted PTSD symptom level.Conclusions: Almost 10% of post-MI patients had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level.2

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Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

et al. 2008

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“…Initially, the clinical significance of PTSD was established in myocardial infarction patients via its apparent link to adherence behaviors and subsequent cardiac hospital readmissions. 24 Moreover, ICD patients with elevated PTSD scores after device implantation were significantly more likely to have shock storm. 10 Furthermore, elevated PTSD scores were associated with a 3.2 times greater likelihood of mortality within 5 years compared with ICD patients with no to moderate symptom levels of PTSD, even after controlling for disease and demographic parameters.…”

Section: Prevalence and Clinical Impact Of Ptsdmentioning

confidence: 99%

“…55,56 A promising pilot study revealed success of CBT in a group of patients with myocardial infarction and PTSD symptomatology, which signals support of its applicability with the shocked ICD patient population. 24 Additionally, relaxation techniques are often used in those with PTSD, including diaphragmatic breathing, meditation, progressive muscle relaxation, and hypnosis. 57 Distraction techniques such as focal point, counting, and imagery are used as well.…”

Section: Sears Et Al Posttraumatic Stress In Icd Patients 247mentioning

confidence: 99%

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Sears

Hauf

Kirian

et al. 2011

Circ: Arrhythmia and Electrophysiology

115

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he implantable cardioverter-defibrillator (ICD) has revolutionized the care of patients at risk for life-threatening arrhythmias. Large-scale clinical trials established mortality benefits for the ICD over usual care or medications 1,2 and led to wider use for both primary and secondary prevention indications. More recent research confirms that the mortality benefits of the ICD extend over 8-year follow-up when compared with usual care. 3 These clinical trial successes, in terms of mortality, have allowed for greater focus on patientcentered outcomes, such as quality of life, device acceptance, psychological well-being, and trauma reactions in research and clinical care. 4 Shock has been a primary focus in this work because of its potentially traumatic impact on the patient experience. Although there is mixed evidence on the effect of single ICD shocks, 5,6 the literature consistently supports the negative impact of Ͼ5 shocks on quality of life and emotional distress. 7,8 ICD shock has been a focus of research interest because it is a unique experience for the ICD patient and can be perceived as a traumatic event. In addition, the existence of concomitant heart disease, angina, congestive heart failure, or previous sudden death may create sensitivity to traumatic stress that warrants improved understanding by attending electrophysiologists. Although psychological distress in ICD patients has been explored, the possibility that some ICD patients have trauma reactions, up to and including posttraumatic stress disorder (PTSD), has garnered increased attention recently. Therefore, the purposes of this report are to highlight the theory and research addressing psychological distress including PTSD in electrophysiology clinics, to discuss clinical management of these sequelae, and to suggest areas of future research and development. Psychosocial Distress of ICD Patients in Electrophysiology ClinicsPrevention and identification of distress in ICD patients represents comprehensive, high-quality care, regardless of the cause (eg, depression, anxiety, trauma), consistent with the biopsychosocial model of care. 9 This model of care entails the conceptualization and treatment of health problems as an interplay between biological factors, psychological factors, and social factors culminating in the manifestation of symptoms. For an electrophysiologist, these ambitious goals can include prevention of distress through cardiac care and education, recognition of distress warranting referral, optimizing quality-of-life (QoL) outcomes, and promoting patient acceptance of the ICD. Clearly, these are not easily accomplished without sufficient awareness, clinical support, and interdisciplinary expertise. Below are some key considerations for daily clinical practice. Prevalence and Impact of Psychosocial DistressGeneral or ICD-specific anxiety as a psychological morbidity has a point prevalence of 13% to 38% of ICD recipients in cross-sectional research. 4 Longitudinal assessment of anxiety has indicated that approximately 35% of pati...

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“…PTSD is defined according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) as an intense fear, helplessness, and horror occurring after an experienced traumatic event or life-threatening illness (American Psychiatric Association, 2000). Patients with PTSD have poorer medication-adherence and clinical outcomes after ACS; therefore, recognizing PTSD symptoms has important clinical implications (Edmondson et al, 2012;Shemesh et al, 2006). Thus, the European Society of Cardiology (ESC) guidelines on cardiovascular disease (CVD) The fear of dying and occurrence of posttraumatic stress symptoms after an acute coronary syndrome: A prospective observational study prevention in clinical practice recommend interventions to manage psychosocial stress and coping with illness (Perk et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

The fear of dying and occurrence of posttraumatic stress symptoms after an acute coronary syndrome: A prospective observational study

et al. 2016

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The purpose of the study was to investigate whether experiencing fear of dying after acute coronary syndrome predicts later posttraumatic stress symptoms. We enrolled 90 patients hospitalized with main diagnosis of acute coronary syndrome and assessed baseline characteristics. One month after discharge, we collected the Posttraumatic Stress Scale. A total of 24 patients (26.7%) developed posttraumatic stress symptoms 1 month after the acute coronary syndrome event. Patients with posttraumatic stress symptoms reported significantly greater fear of dying, helplessness, avoidance-focused coping, and severe anxiety. In our prospective study, fear of dying was associated with occurrence of posttraumatic stress symptoms in patients hospitalized with acute coronary syndrome.

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Symptoms of Posttraumatic Stress Disorder in Patients Who Have Had a Myocardial Infarction

Cited by 66 publications

References 33 publications

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

The fear of dying and occurrence of posttraumatic stress symptoms after an acute coronary syndrome: A prospective observational study

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