Delirium, depression, and other psychosocial and neurobehavioral issues in cardiovascular disease

Understanding relevant psychosocial (neural, behavioral, psychiatric) issues is essential to optimal care of individuals who have cardiovascular disorders. Delirium, a condition of diffuse cerebral dysfunction caused by underlying systemic or central nervous system pathology, and often requiring measures of acute neurobehavioral management with nonpharmacological and pharmacological means, in addition to treatment of the underlying medical disorder, often occurs in association with severe cardiovascular disease. Depression is a psychiatric disorder known to be associated with cardiovascular disease. Substantial improvement in understanding the nature of this association has occurred in the past 10 to 20 years, including very preliminary data suggesting that pharmacological treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants might improve postmyocardial infarction cardiac prognosis. Numerous other factors-anxiety, stress, social support, anger, and other personality factors-also are implicated in the relationship of psychosocial issues to cardiovascular disease.