Psychological intervention in coronary heart disease: a review

Psychosocial interventions in adult patients with coronary heart disease and cancer. A literature review

A growing body of evidence suggests that chronic medical illness is associated with an increased prevalence and incidence of psychiatric and psychological disturbances. The present literature review is based on two theses: first, that chronic illness is viewed as a stressor and is associated with increased psychological distress, and secondly, that interventions can minimize the distress. A review of the studies conducted with adult patients diagnosed either with coronary heart disease or cancer suggests that psychosocial interventions are, in general, efficacious in relieving self-reported psychological distress. The review also recommends psychosocial interventions for high-risk patients rather than all patients, and that researchers need to identify other outcomes such as health care costs, disability, days in hospital, morbidity, and mortality in order to convince policy makers that these interventions are worthwhile. Recommendations for future research are also discussed.

A prospective evaluation of in-hospital counselling for first time myocardial infarction men

Self-ratings of anxiety and depression were studied over six months in 60 male patients, under 66 yr of age, who were admitted to a coronary care unit with a first time acute myocardial infarction. Patients were randomly assigned to either a treatment group, where they received a simple programme of in-hospital counselling in addition to routine care, or to a control group, where they received routine care only. All patients completed the Hospital Anxiety and Depression scale and a battery of visual analogue scales measuring anxiety on a range of topics related to recovery from a myocardial infarction. Patients who received in-hospital counselling reported statistically significantly less anxiety and depression than those who received routine care alone. This effect was sustained for six months after leaving hospital. It is concluded that a simple programme of in-hospital counselling, provided by a coronary care nurse, is efficacious and should be routinely offered to first myocardial infarction patients in hospital.

Educating the patient and family about depression

Hospitalization provides an opportunity for the patient and his or her family to have a comprehensive program of education about depression. They are seen alone, together, or in groups with other patients and families to learn about the illness and its treatment. This program reduces anxiety, enhances the patient's compliance, and increases family support for the patient.

The role of psychological intervention in the management of patients after myocardial infarction

A review of the literature suggests that it is neither appropriate nor cost-effective to involve as a routine all patients who have suffered a myocardial infarction in a traditional outpatient rehabilitation programme where physical conditioning is the principal (or only) ingredient. However, there is evidence to show that psychological intervention programmes that provide short-term psychological support, health education and intervention in coronary risk behaviour influence favourably both physical and psychosocial outcome. The case is put forward for intervention, during the first few days of the patient's admission to hospital, with a treatment package that comprises health education and relaxation therapy. The need for further interventions such as counselling, behavioural therapy, and physical conditioning may be assessed, depending on the patient's response to the initial programme.

Psychotherapeutic intervention in angina: II. Implications for research and practice

The second of a two-part series, this article draws on the clinical and research literature reviewed in the first article to formulate guidelines for research and clinical practice. In future research, the complex heterogeneity of coronary artery disease (CAD) must be recognized in more rigorous descriptive, comparative, and physiologic correlative studies of psychosocial etiology. Pseudoangina is largely unexamined by systematic study and therefore warrants research on several of its aspects. Similarly, systematic research on intervention in anginoid pain is virtually nonexistent and obviously warranted. Clinical guidelines include the emphasis of didactic, supportive approaches, detailed focus on several aspects of the pain, early and extended psychotherapeutic availability, recognition and treatment of underlying specific psychopathology, and somatic interventions aimed at presumed pathophysiologic mechanisms.

Measurement and prediction of recovery after myocardial infarction

Psychological tests were completed by myocardial infarct (MI) patients during their initial hospitalization, and further tests and a structured home interview occurred seven months later (N = 28). Self-reported health, symptoms, sexual activity, and psychosocial changes were found to form an inter-related cluster of outcome measures. Poor recovery was predicted by self-reports of high trait anxiety while in hospital, and by manual occupation. Poor recovery was also associated with in-hospital reports of dissatisfaction with work and few confiding relationships. The development of a brief pencil and paper screening instrument for MI patients in need of special rehabilitation support is discussed.