Katrin Zimmermann

Heart-focused anxiety before and after cardiac surgery

OBJECTIVE We investigated the degree and course of heart-focused anxiety (HFA) in patients with cardiac diseases before and after cardiac surgery. METHODS We examined 90 patients undergoing coronary bypass, valve replacement, or combined surgery before surgery, 6 weeks after surgery, and 6 months after surgery. Patients completed the Cardiac Anxiety Questionnaire (CAQ), which assesses heart-focused fear, attention, and avoidance, and a set of other questionnaires assessing general anxiety, depression, and quality of life. Data were compared with an age- and sex-controlled contrast group of 72 orthopedic patients with no history of cardiac disease. RESULTS All dimensions of HFA were elevated in patients before surgery. CAQ-Fear was significantly reduced 6 weeks after surgery and at 6-month follow-up. CAQ-Avoidance was stable after surgery but declined on follow-up, while there was only a statistical tendency indicating reduction in CAQ-Attention. Approximately 20% of patients continued to experience clinically elevated levels of HFA at 6-month follow-up. Furthermore, we found decreases in global anxiety and depression, and an increase in quality of life after surgery. CONCLUSIONS In contrast to global psychosocial indicators, the more specific assessment of HFA may help identify individuals with elevated levels of HFA who might benefit from interventions to help them adjust to the effects of surgery and lingering cardiac problems.

Is type-D a stable construct? An examination of type-D personality in patients before and after cardiac surgery

OBJECTIVE Type-D personality-negative affectivity and social inhibition-are related to poor prognosis in cardiovascular diseases. At present, little is known about type-D personality and its stability before and after cardiac surgery. METHODS One hundred twenty-six patients recommended for coronary bypass and/or valve surgery were examined at pre-surgery and 6 months post-surgery to investigate the stability of type-D (14-item Type-D Scale) and its relationship to anxiety, depression (Hospital Anxiety and Depression Scale) and quality of life (Short Form 12). RESULTS Preoperatively, 26% were assessed to have type-D, while only 11% fulfilled type-D criteria both pre- and post-surgery. Patients were assessed and identified as belonging to one of the four type-D groups: Stable type-D (11%), non-type-D (61%), type-D pre (15%), and type-D post (13%). In comparison to the stable non-type D group, the stable type-D reported more symptoms of anxiety, depression, lower physical quality of life post-surgery, and lower mental quality of life both pre- and post-surgery. When compared to the population at large, stable type-D had more symptoms of depression pre-surgery, and more anxiety as well as lower physical and mental quality of life pre- and post-surgery. CONCLUSION Type-D diagnosis changed in nearly 60% of the cases post-surgery. Only those patients with stable type-D exhibited a relationship to emotional distress, such as anxiety and depression and reduced quality of life. Additional research on the critical cut-off scores and stability of type-D as it relates to critical life events would likely enhance our ability to more effectively diagnose and treat patients who are at high risk for insufficient coping.

A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks

Purpose. This study examined whether a short-term psychosomatic intervention during pregnancy had effects on characteristics of labour and delivery as well as on the long-term course of anxiety, depression and physical complaints in pregnant in-patient women. Methods. All gynaecological and obstetric inpatients of a university hospital, who had either exhibited complications during their pregnancy or were considered high-risk pregnancies, were examined. Symptoms of anxiety and depression (HADS) and physical symptoms (GBB) were assessed by standardised questionnaires. Women with elevated scores on either the HADS or the GBB were randomly assigned to either a treatment group, which had received a psychosomatic intervention or an untreated control group. Of the n = 238 women who were assessed during their stay in our hospital, n = 135 were included in the follow-up 1-year later. Results. More than one-third of the participants (38.7%) had elevated scores of anxiety, depression and/or physical symptoms. The psychosomatic intervention had a significant effect on anxiety scores (p = 0.006), but not on depression scores, physical complaints and characteristics of labour and delivery. Conclusions. Findings suggest that a short-term psychosomatic intervention can have a positive long-term effect on anxiety symptoms. Future studies are needed to show whether the reduction of anxiety symptoms in turn can lead to a reduction of postnatal complications and lower rates of disturbed mother–child interactions.

Which gynecological and obstetric patients want to attend psychosomatic services

Objective. The aim of this study is to explore the wish of gynecological and obstetric inpatients to attend psychosomatic services. Predictors influencing this wish are evaluated. Method. Three groups of patients participated in the study. The groups consisted of patients diagnosed with malignant gynecological diseases (n = 175), benign gynecological diseases (n = 302), and obstetric diseases (n = 238). The following domains were assessed in a cross-sectional design: symptoms of anxiety and depression (HADS), physical complaints (GBB-24), health-related quality of life (SF-12), and the wish to attend psychosomatic services. Results. 34% of the participants indicated that they wanted to attend psychosomatic services during their stay in the hospital. The group of patients diagnosed with malignant gynecological diseases had the highest proportion of women who stated that wish (43%). Multiple logistic regression models showed that former psychotherapeutic experiences as well as low psychological quality of life predicted the wish to attend psychosomatic services in patients diagnosed with malignant gynecological or obstetric diseases. Conclusion. It was shown that a considerable proportion of patients wanted to attend psychosomatic care during their hospitalization. Contrary to physical and sociodemographic variables, psychological factors were significant predictors of the inpatients wish to attend psychosomatic services. This suggests that the subjective estimation of impairments is a major predictor of the wish to attend psychosomatic care.

Psychische und physische Befindlichkeit von Patienten mit Thoraxschmerzen in der kardiologischen Ambulanz

OBJECTIVES The aim of this cross-sectional study was to explore the psychological and physical well-being of patients with chest pain depending on availability cardiological disease (coronary heart disease, different cardiological disease, no cardiological disease, unclear diagnose). METHODS In a total of 383 cardiological outpatients, anxiety and depression (HADS) as well as physical complaints (B-L) were assessed. RESULTS For half of the outpatients, no cardiological diagnose was found that explained the symptoms of chest pain. In comparison to the general population, outpatients with various cardiological symptoms exhibited a lower psychological and physical well-being independent of availability cardiological disease. 50.9% of the outpatients showed elevated anxiety scores, 35.2% showed elevated depression scores and 71.7% felt impaired by physical complaints. In comparison to males, females were more anxious and exhibited a lower physical well-being. In general, physical impairment increased with age, while anxiety decreased. CONCLUSIONS The present study discovered a very high psychological comorbidity in cardiological outpatients with chest pain that underlines the necessity of an integrated psychosomatic care regardless of clinical finding. In order to understand the symptom of chest pain it is not indicated to differentiate between cardiologically vs. psychologically ill patients.

Analysis of gastrin-releasing peptide gene and gastrin-releasing peptide receptor gene in patients with agoraphobia.

A gastrin-releasing peptide receptor (GRPR) knock-out mouse model provided evidence that the gastrin-releasing peptide (GRP) and its neural circuitry operate as a negative feedback-loop regulating fear, suggesting a novel candidate mechanism contributing to individual differences in fear-conditioning and associated psychiatric disorders such as agoraphobia with/without panic disorder. Studies in humans, however, provided inconclusive evidence on the association of GRP and GRPR variations in agoraphobia with/without panic disorder. Based on these findings, we investigated whether GRP and GRPR variants are associated with agoraphobia. Mental disorders were assessed via the Munich-Composite International Diagnostic Interview (M-CIDI) in 95 patients with agoraphobia with/without panic disorder and 119 controls without any mental disorders. A complete sequence analysis of GRP and GRPR was performed in all participants. We found no association of 16 GRP and 7 GRPR variants with agoraphobia with/without panic disorder.

Analysis of Stathmin gene variation in patients with panic disorder and agoraphobia.

Institute of Clinical Psychology and Psychotherapy, Institute of Psychology II, Technische Universitaet Dresden, Departments of Surgical Research, Psychotherapy and Psychosomatic Medicine, Periodontology, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Institute of Medical Biometry and Statistics, University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Clinic of Psychosomatic Medicine, Mediclin-Bliestal Clinics, Blieskastel and Faculty of Medicine, Saarland University, Homburg, Germany Correspondence to David Bräuer, Diploma-Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Hohe Strasse 53, 01187 Dresden, Germany Tel: + 49 351 463 36954; fax: + 49 351 463 36955; e-mail: braeuer@psychologie.tu-dresden.de

Herzangst bei Patienten vor und nach Bypass- bzw. Klappenoperation

Einleitung: Herzangst ist ein Symptom, welches moglicherweise unabhangig von allgemeiner Angstlichkeit auftritt und die Lebensqualitat von kardiologischen Patienten beeintrachtigen kann. Nichtsdestotrotz gibt es bisher kaum Untersuchungen zur Herzangst vor und nach Herzoperationen sowie dem Zusammenhang mit der Wahrnehmung thorakaler Beschwerden. Ziel dieser Studie war es, Haufigkeit und Auspragung herzbezogener Angste und thorakaler Beschwerden bei Patienten vor und nach Bypass- und/oder Klappenersatz-Operation zu erfassen. Methoden: 197 Patienten wurden vor und 6 Wochen nach einer Herzoperation zur Herzangst befragt. Insgesamt standen fur die Untersuchung 106 Teilnehmer (MW-Alter: 67 Jahre; 73% Manner) mit vollstandigen Datensatzen zur Verfugung. Die Herzangst wurde mit der deutschen Version des Cardiac Anxiety Questionnaire (CAQ, Eifert et al.; 2000; Ubersetzung von Hoyer und Eifert, 2001) erfasst. Zusatzlich wurde die Lebensqualitat mittels Fragebogen (SF-12) erhoben. Haufigkeit und Auspragung von thorakalen Schmerzen wurden mit selbstentwickelten Fragen erfasst. Ergebnisse: Hinsichtlich der Herzangst konnte eine signifikante Symptomreduktion nach der Herzoperation nachgewiesen werden. Die drei Operationsgruppen (Bypass- [N=73], Klappenersatz- [N=24] und kombinierter Eingriff [N=9]) unterscheiden sich hierbei nicht signifikant bezuglich einer Veranderung in der Herzangst. Signifikante positive Korrelationen wurden jeweils zwischen der Haufigkeit sowie der Auspragung des Brustschmerzes und der Herzangst gefunden. Diskussion: Die Ergebnisse zeigen eine Veranderung der Herzangst vor und nach einer Herzoperation. Die Operationsart hat dabei keinen Einfluss auf die Veranderung der Herzangst, wohingegen der Brustschmerz diesbezuglich deutliche Zusammenhange aufweist. Fur zukunftige Forschungsvorhaben ist es wichtig, zu untersuchen, welche Faktoren die Herzangst beeinflussen und wie man Risikopatienten eruieren kann.