Indian Write-Ups
| Diagnosis |
| Cardiac Diseases that Lead to Psychiatric Disorders - Dr. S. R. Tarlekar Cardiologist, New Mumbai. |
| Research over the last two decades shows depression/anxiety and heart diseases are common companions. It appears now that depression is an important risk factor for heart disease along with other risk factors. This article expounds these facts and searches for a solution. Introduction That there exists an association between anxiety and cardiac disorders has been hypothesized for as long as the history of medicine has been documented. However, despite a wide spread public perception that stress and anxiety are significant risk factors for coronary heart disease (CHD), conceptual and methodological difficulties in studying whether a relationship between anxiety and CHD exists have made it next to impossible to many researchers even attempting such studies. It is only very recently, with advances in methodology, those possible associations between certain types of anxiety and CHD have been uncovered. Anxiety and cardiovascular disorders – the link that exists incognito A range of medical conditions is associated with depression and/or anxiety, highlighting the importance of thorough physical examinations and basic investigations. Most standard textbooks include a long list for both anxiety and depression. The more common conditions associated with depression include endocrine disorders (hypothyroidism, hyperthyroidism, Cushing's disease and Addison's disease), infections (infectious mononucleosis, influenza, tertiary syphilis and AIDS), neurological disorders (multiple sclerosis, Parkinson's disease) and cerebrovascular disorders. Underlying malignancies should also be considered. There are a number of physical conditions that can cause panic disorder, a type of anxiety disorder. These include a number of cardiac disorders such as angina, mitral valve prolapse, atrial fibrillation, multifocal atrial tachycardia and atrial flutter. Studies show that a depressed person is four times more prone for heart attack than those who are not. Depression or heart disease; which came first-the egg or the chicken? Depression may make it harder to take the medications needed and to carry out the treatment for heart diseases. Depression also may result in chronically elevated levels of stress hormones such as cortisol and adrenaline and the activation of the sympathetic nervous system (part of the fight and flight reasons), which can have a deterious effect on the heart. There are multiple studies indicating that heart disease can follow depression. Psychological distress may cause rapid heartbeat, high blood pressure and faster blood clotting. It can also lead to elevated insulin and cholesterol levels. These risk factors, with obesity, form a constellation of symptoms and often serve as a predictor of and response to heart disease. People with depression may feel slowed down and still have high levels of stress hormones. This can increase the work of the heart as high levels of stress hormones signal a fight or flight reaction, the body metabolism is diverted from type of tissue repair needed in heart disease. Studies on heart disease and depression found that people with heart disease were more likely to suffer from depression than otherwise healthy people. Furthermore, other researches have found that most heart patients with depression do not receive appropriate treatment as the cardiologist and primary care physician tends to miss the diagnosis of depression, and even when they do recognize it, they often do not treat it adequately. Studies indicate that depression can appear after heart disease and/or cardiac surgery. In one investigation half of the patients studied one week after bypass surgery experienced serious cognitive problems, which may contribute to clinical depression in some individuals. A diagnostic and clinical dilemma Pharmacological and cognitive behavioural therapy treatment for depression are relatively well developed and play an important role in reducing. The adverse impact of depression on heart diseases. Furthermore, preventive interventions based on cognitive behaviour therapies of depression also merit attention as approaches for avoiding adverse outcomes associated with both cardiac and psychiatric disorders are essential. These interventions may help promote adherence and behaviour change may increase the impact of available pharmacological and behavioural approaches to both diseases. The cornerstone of detection is an understanding of the common presenting symptoms and syndromes.
Summary There is a large area yet to be explored concerning the conflicting results in the literature regarding the hypothesized link between high levels of anxiety and cardiovascular disorders. Recent research for the most part supports that the relationship exists to some extent. There is an obvious need for finding better ways to assess anxiety. Possibly, associations will be easier to distinguish if more consideration is taken into what situations are best used to elicit the dimensions of anxiety being studied. References
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