Leopoldo Pozuelo

Depression and heart disease: what do we know, and where are we headed?

Depression and heart disease have an intricate association and perhaps a causal relationship. We review the current status of depression and heart disease and provide an algorithm for diagnosing and treating depression in cardiac patients that internists and cardiologists can use in their daily patient encounters. Depression is a risk factor for new cardiac disease and has a detrimental effect in established cardiac disease. Clinicians should routinely screen for it in cardiac patients and should not hesitate to treat it.

QT Interval Prolongation Associated With Quetiapine (Seroquel) Overdose

Received June 3, 1999; accepted June 14, 1999. From the Department of Psychology and Psychiatry, Cleveland Clinic Foundation (CCF), 9500 Euclid Avenue, Cleveland, OH 44195. Address correspondence and reprint requests to Dr. Tesar, Department of Psychiatry and Psychology, CCF, 9500 Euclid Avenue, Cleveland, OH 44195. Copyright 2000 The Academy of Psychosomatic Medicine. Haloperidol and other typical antipsychotics are known to cause cardiac conduction abnormalities, including QTc interval prolongation on an electrocardiogram (ECG). Newer antipsychotics, such as olanzapine, risperidol, and quetiapine, have a reputation for cardiovascular safety. We report a case of quetiapine overdose that was associated with clinically significant QT interval prolongation.

What the Psychiatrist Needs to Know About Ventricular Assist Devices: A Comprehensive Review

BACKGROUND The number of patients with end-stage heart failure using mechanical circulatory support has dramatically increased over the past decade. Left ventricular assist devices, the most common type of mechanical circulatory support, can be used as a bridge to transplant, destination therapy, and as a bridge to recovery. As this patient population continues to grow, consultation-liaison psychiatrists will become increasingly involved in their care. A thorough biopsychosocial assessment is required to ensure adequate recognition and management of medical, psychiatric, social, and ethical challenges posed by this population. METHODS We performed a literature review to identify key issues relevant to the practice of consultation-liaison psychiatrists. RESULTS General functioning of left ventricular assist devices, device types, system components, life with a left ventricular assist device, preoperative evaluation, treatment of psychiatric comorbidities, and end-of-life decision-making are discussed. CONCLUSIONS Consultation-liaison psychiatrists need to be familiar with the high prevalence of psychopathology in patients implanted with left ventricular assist devices. A detailed biopsychosocial formulation is required to adequately identify and, if possible, resolve a myriad of medical, psychiatric, social, and ethical challenges presented by this population. Future efforts should accurately identify and report specific psychiatric disorders and adverse events within this cohort.

Fine-Tuning a Heart-Brain Connection Anxiety in Atrial Fibrillation

The field of behavioral cardiology has detailed various associations that exist between the heart and the brain. Studies have evolved from the Type A personality in the 1970s, to the landmark study of depression increasing mortality in the post–myocardial infarction setting in the 1990s,1 to the new wave of anxiety studies in the past couple of years that have shown anxiety to be a risk factor for development of coronary artery disease as well as being cardiotoxic in established heart disease.2 Even though the mechanistic pathways as to why these associations occur still elude us, the impact of personality traits, depression, and anxiety on heart disease is undeniable. Article see p 322 Emotions have also been strongly associated with arrhythmias as a whole. In earthquake scenarios, sudden increases in cardiovascular deaths are known to occur,3 and cardiovascular events increase in presumably more “benign” scenarios, such as World Cup Soccer matches.4 Transient cardiac dysfunction has been well described with strong emotional events, referred to as Tako-tsubo cardiomyopathy.5 Implantable cardioverter-defibrillator patients who demonstrate anger-induced T-wave alternans during mental stress are at higher risk for ventricular arrhythmias, prompting further interventional studies and the editorial article, “Anger Management May Save Your Life.”6 Clinically, atrial fibrillation is the most common cardiac arrhythmia and can cause in some patients psychological distress and a negative impact on quality of life.7 “Doc, I know I have heart disease, but if you can fix this afib, I know I will …

A Malignant Neuroleptic Spectrum: Review of Diagnostic Criteria and Treatment Implications in Three Case Reports

Prompt identification of cases of Neuroleptic Malignant Syndrome (NMS) pose a diagnostic and treatment challenge. Three hospital cases of neuroleptic toxicity were reviewed and compared across five published diagnostic criteria sets for NMS. Of these criteria sets, only Levensons criteria led to the detection of NMS in two out of our three patients. This criteria set supports a NMS spectrum concept, allowing earlier diagnosis and intervention. Lorazepam was used as initial treatment, which provided significant improvement. Use of Levensons criteria for early diagnosis of NMS and lorazepam for its treatment may be useful tools for the early management of NMS.

Evaluation of the Patient Health Questionnaire-2 as a Screening Tool for Depression during the Acute Stroke Admission

BACKGROUND The ideal time to screen for poststroke depression remains uncertain. We evaluated the 2-item Patient Health Questionnaire (PHQ-2) as a screening tool for depression during the acute stroke admission by determining the prevalence of positive depression screen during admission and by calculating the level of agreement between positive screens during admission and follow-up. METHODS This was a retrospective cohort of adult stroke survivors discharged January to December 2013 with principal discharge diagnosis of acute ischemic stroke or intracerebral hemorrhage. Depression screening was systematically performed during the hospital admission using the PHQ-2. The 9-item Patient Health Questionnaire (PHQ-9), which includes the PHQ-2, was completed by patients at outpatient follow-up. RESULTS The study cohort consisted of 337 patients with mean age of 66.3 years. Median time from admission to PHQ-2 was 3 days (interquartile range 1-4 days). The screen was positive for depression in 4.7% (95% confidence interval 2.7%-7.6%) of patients. Of the 150 patients with PHQ-9 data at outpatient follow up, 19.3% screened positive for depression. In both the inpatient setting and at outpatient follow-up, the prevalence of a positive depression screen was similar between patients with and without a history of depression or antidepressant use. CONCLUSIONS Systematic screening for depression using PHQ-2 during hospitalization for acute stroke identified few patients. Most patients with depressive symptoms were identified only at the time of outpatient follow-up. Further study is needed to evaluate the usefulness of other depression screens for stroke patients in the acute hospital setting and the optimal timing for depression screening after stroke.