Objective. The clinical value of the identification of mood disorders in patients with acute coronary syndrome (ACS) is well established. However, assessment based on DSM criteria presents some limitations. This study aimed to provide an innovative strategy for evaluating the spectrum of mood disturbances in ACS. Methods. 288 patients with a fust episode of ACS underwent interviews based on DSM-IY-TR criteria (major depressive disorder, minor depression, dysthymia). Diagnostic Criteria for Psychosomatic Research-DCPR (demoralization, type A behavior), and the Clinical Interview for Depression-CID. Additional self-report inventories (psychological well-being, distress) were administered. 100 consecutive patients who satisfied criteria for DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlled trial on a sequential combination of cognitive-behavioral and well-being therapy (CBTAVBT) versus clinical management (C'M) and re-assessed up to 30-month post-intervention. Results. 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion of demoralization and type A identified psychological distress in 58% of the sample. According to CED. reactivity to social environment, fatigue, depressed mood and somatic anxiety were the most common symptoms. Somatic symptoms were significantly associated with DSM-IV-TR depression (fatigue, changes of appetite), whereas environmental reactivity with demoralization. Both depression and demoralization were associated with higher distress and lower well-being. Unlike CM. CBT/WBT was significantly associated with decrease of guilt, pessimism, fatigue and early insomnia (CID). Conclusion. The findings indicate that standard psychiatric approach identifies only a narrow part of mood disturbances affecting ACS patients. A more articulated assessment unravels specific clinical configurations that may entail prognostic and therapeutic implications.
An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome
Buzzichelli S.;Marzola E.;Abbate-Daga G.;
2023-01-01
Abstract
Objective. The clinical value of the identification of mood disorders in patients with acute coronary syndrome (ACS) is well established. However, assessment based on DSM criteria presents some limitations. This study aimed to provide an innovative strategy for evaluating the spectrum of mood disturbances in ACS. Methods. 288 patients with a fust episode of ACS underwent interviews based on DSM-IY-TR criteria (major depressive disorder, minor depression, dysthymia). Diagnostic Criteria for Psychosomatic Research-DCPR (demoralization, type A behavior), and the Clinical Interview for Depression-CID. Additional self-report inventories (psychological well-being, distress) were administered. 100 consecutive patients who satisfied criteria for DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlled trial on a sequential combination of cognitive-behavioral and well-being therapy (CBTAVBT) versus clinical management (C'M) and re-assessed up to 30-month post-intervention. Results. 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion of demoralization and type A identified psychological distress in 58% of the sample. According to CED. reactivity to social environment, fatigue, depressed mood and somatic anxiety were the most common symptoms. Somatic symptoms were significantly associated with DSM-IV-TR depression (fatigue, changes of appetite), whereas environmental reactivity with demoralization. Both depression and demoralization were associated with higher distress and lower well-being. Unlike CM. CBT/WBT was significantly associated with decrease of guilt, pessimism, fatigue and early insomnia (CID). Conclusion. The findings indicate that standard psychiatric approach identifies only a narrow part of mood disturbances affecting ACS patients. A more articulated assessment unravels specific clinical configurations that may entail prognostic and therapeutic implications.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
