Psychiatric comorbidities in acute coronary syndromes: Six-month follow-up study
D Ramya Shruthi1, S Sunil Kumar2, Nagaraj Desai2
1Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India.
Insights
Psychiatric comorbidities like major depressive disorder and anxiety disorders are common in acute coronary syndrome (ACS) patients and persist long-term. Early intervention improves outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Acute coronary syndrome (ACS) encompasses myocardial infarction and unstable angina, conditions linked to psychosocial factors.
- While point prevalence of psychiatric disorders in ACS is known, follow-up data from India is limited.
Purpose of the Study:
- To assess psychiatric comorbidities in ACS patients.
- To evaluate the persistence of these comorbidities over a 6-month follow-up period.
Main Methods:
- A 6-month follow-up study of 248 consecutive ACS patients at JSS Hospital, Mysuru.
- Psychiatric screening using the Mini International Neuropsychiatric Interview PLUS 5.0.0 and depression assessment with the Hamilton Depression Rating Scale.
- Statistical analysis performed using ANOVA, Student's t-test, and SPSS 21.
Main Results:
- Major depressive disorder was the most common comorbidity (44%), persisting at 3 and 6 months (P < 0.001).
- Anxiety disorders, including panic disorder (12.10%) and others, were prevalent.
- Significant reductions in nicotine (66.1%) and alcohol (56.0%) use were observed at follow-up.
Conclusions:
- Depression, anxiety, and substance use are persistent comorbidities in ACS patients.
- Early identification of psychiatric issues at discharge and consistent follow-up counseling are crucial for improving clinical outcomes.
Introduction:
Acute coronary syndrome (ACS) caused by coronary atherosclerosis include ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. The relation between psychiatric disorders and coronary artery disease is a complex one which includes the effect of the psychosocial factors on heart and vice versa. Point prevalence studies have been reported, but there is paucity of follow-up studies from India.
Materials And Methods:
The study is a follow-up evaluation at discharge of 248 consecutive patients presented with ACS at JSS Hospital, Mysuru, Karnataka, over a period of 6 months to assess the psychiatric comorbidities. The patients were assessed on a structured and validated pro forma before discharge, at 3 months, and at 6 months. Screening of psychiatric disorders was done using Mini International Neuropsychiatric Interview PLUS 5.0.0 and assessment of depression was done using Hamilton Depression Rating Scale. ANOVA, Student's t-test, and SPSS 21 were used for statistical analysis.
Results:
The most common psychiatric comorbidities include major depressive disorder (44%), it persisted at the end of 3 (P < 0.001) and 6 (P < 0.001) months. A spectrum of anxiety disorders including panic disorder (12.10%), dysthymia (3.60%), agoraphobia (2.40%), social phobia (2%), obsessive-compulsive disorder (1.6%), specific phobia (1.2%), and posttraumatic stress disorder (0.8%) in descending order at the end of 6 months were found. Significant reduction in substance use of nicotine (66.1%) and alcohol (56.0%) was reported on follow-up.
Conclusion:
Depression, anxiety, and substance use occur in patients with ACS which persist on follow-up. Early recognition at discharge and appropriate counseling on follow-up improve the clinical outcomes.
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