On the issue of allocation of a risk group for the presence of mental disorders in the practice of cardiology department

Differential diagnosis of somatic and somatoform pathology is a pressing issue in general practice. The aim of this study was to develop an algorithm for identification of the patients with indications for psychiatrist's consultation and possible psychotropic therapy at the stage of admission to multi-disciplinary hospital. Material and methods. Regression analysis of data of 1031 patient hospitalized in the cardiology department of a multiprofile hospital was done with the aim of identifying factors determining the recommendation for receiving psychotropic therapy at discharge. Results. An algorithm for allocation among patients of cardiological profile individuals that require a multidisciplinary approach to treatment involving experts in the field of mental health is proposed. Factors included in the formula were labile or paroxysmal hypertension, the number of associated (non-cardiological) diagnosis, female gender and heart rate or heart rhythm disorders with the debut at the age below 55 or 50 years: I = 8 х L + D + 3 х F + 3 (6) х H. Conclusion. The revealed pattern may be useful in the clinic of internal diseases for screening of patients with a high contribution of the emotional state the severity of the condition. The doctors of the hospitals of somatic (therapeutic) profile should pay more attention to the psycho-emotional condition of patients with labile hypertension, early onset of cardiac arrhythmias, and large number of comorbidities. Patients that meet the criteria are likely to need a consultation of a psychotherapist or psychiatrist because of the presence of psychosomatic or other mental disorders.

psychosomatic medicine, cardiology, mental disorders, screening, psychotropic medications

1. Любан-Плоцца Б., Пельдингер В., Крегер Ф. Психосоматические расстройства в общей медицинской практике. - СПб., 2000. - 287 с

2. Оганов Р.Г., Мамедов М.Н. Национальные клинические рекомендации Всероссийского научного общества кардиологов. - М., 2009. - 392 с

3. Петрова Н.Н., Кутузова А.Э., Коновалова А.В. Коррекция психических расстройств у больных в общесоматической сети // Медицина XXI век. - 2005. -№ 1 (1). - С. 22-29

4. Смулевич А.Б., Андрющенко А.В., Бескова Д.А. Клинико-эпидемиологическая программа «СИНТЕЗ»: распространенность и структура психических расстройств в общей медицине // Психические расстройства в клинической практике. - М.: Медпресс-информ, 2011. - С. 230-309

5. Aamland A, Malterud K, Werner EL. (2014). Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice. BMCFam Pract, 5 (1), 107.

6. Alexander F. (1950). Psychosomatic medicine. New York, 352 p.

7. Büchner B, Kleiber C, Stanske B, Herrmann-Lingen C. (2005). Stress and heart disease in women. Herz, 30 (5), 416-428.

8. De Jonge P, Spijkerman TA, van der Brink RHS, Ormel J. (2006). Depression after myocardial infarction is a risk factor for declining health related quality of life and increased disability and cardiac complaints at 12 months. Heart, (92), 32-39.

9. Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). (2011). DEGAM-Leitlinie Nr 15. AWMF-Registernummer 053-023.

10. Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J. (2013). Somatic symptom disorder: an important change in DSM. J Psychosom Res, 75 (3), 223-228.

11. Escobar J, Burnam M. (1987). Somatization in the community. Arch Gen Psychiatry, (44), 713-718.

12. Haller H, Cramer H, Lauche R, Dobos G. (2015). Somatoform disorders and medically unexplained symptoms in primary care: a systematic review and meta-analysis of prevalence. Dtsch Arztebl Int, (112), 279-287.

13. Hamilton JC, Eger M, Razzak S, Feldman MD, Hallmark N, Cheek S. (2013). Somatoform, factitious, and related diagnoses in the national hospital discharge survey: addressing the proposed DSM-5 revision. Psychosomatics, 54 (2), 142-148.

14. Hansen MS, Fink P, Frydenberg M, Oxh0j ML. (2002). Use of health services, mental illness, and self-rated disability and health in medical inpatients. Psychosom Med, 64, 668-675.

15. Kisely SR, Campbell LA, Yelland MJ, Paydar A. (2015). Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev, 6. CD004101. doi: 10.1002/14651858.CD004101.pub5

16. Krishna M, Lepping P, Sharma VK, Copeland JR, Lockwood L, Williams M. (2009). Epidemiological and clinical use of GMHAT-PC (Global Mental Health assessment tool - primary care) in cardiac patients. Clin Pract Epidemiol Ment Health, (5), 7.

17. Ladwig K-H, Lederbogen F, Albus C, Angermann C, Borggrefe M, Fischer D, Fritzsche K, Haass M, Jordan J, Jünger J, Kindermann I, Köllner V, Kuhn B, Scherer M, Seyfarth M, Völler H, Waller C, Herrmann-Lingen C. (2014). Position paper on the importance of psychosocial factors in cardiology. GMS German Medical Science, 12, Doc09. doi: 10.3205/000194.

18. Ladwig KH, Marten-Mittag B, Formanek B, Dammann G. (2000). Gender differences of symptom reporting and medical health care utilization in the German population. Eur J Epidemiol, 16 (6), 511-518.

19. Levenson JL. (2011). The somatoform disorders: 6 characters in search of an author. Psychiatr Clin N Am, 4 (3), 515-524.

20. Lichtman JH, Bigger J-T Jr., Blumenthal J A, Frasure-Smith N, Kaufmann PG, Lespérance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES; American Heart Association Prevention Committee of the Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Epidemiology and Prevention; American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research; American Psychiatric Association. (2008). Depression and coronary heart disease. Recommendations for screening, referral, and treatment. Circulation, 118, 1768-1775.

21. Mann SJ. (2015). Labile and paroxysmal hypertension: common clinical dilemmas in need of treatment studies. Curr Cardiol Rep, (17), 99.

22. Müller-Tasch T, Löwe B, Lossnitzer N, Frankenstein L, Täger T, Haass M, Katus H, Schultz JH, Herzog W. (2017). Anxiety and self-care behaviour in patients with chronic systolic heart failure: A multivariate model. Eur J Cardiovasc Nurs, 1474515117722255. doi: 10.1177/1474515117722255.

23. Olshansky B. (2005). Interrelationships between the autonomic nervous system and atrial fibrillation. Prog Cardiovasc Dis, 48 (1), 57-78.

24. Porcelli P, De Carne M, Fava GA. (2000). Assessing somatization in functional gastrointestinal disorders: Integration of different criteria. Psychother Psychosom, 69, 198-204.

25. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. (2006). Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol, 48 (8), 1527-1537.

26. Steinbrecher N, Koerber S, Frieser D, Hiller W. (2011). The prevalence of medically unexplained symptoms in primary care. Psychosomatics, 52 (3), 263-271.

27. Strik JJ, Denollet J, Lousberg R, Honig A. (2003). Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol, (42), 1801-1807.

28. Strik JJ, Honig A, Maes M. (2001). Depression and myocardial infarction: relationship between heart and mind. Prog Neuro-Psychopharmacol Psychiatr, (25), 879-892.

29. Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, Fauerbach JA, Bush DE, Ziegelstein RC. (2006). Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med, 21 (1), 30-38.

30. Van Boven K, Lucassen P, van Ravesteijn H, olde Hartman T, Bor H, van Weel-Baumgarten E. (2011). Do unexplained symptoms predict anxiety or depression? Ten-year data from a practice-based research network. Br J Gen Pract, (61), 316-325.

31. Warren JW, Langenberg P, Clauw DJ. (2013). The number of existing functional somatic syndromes (FSSs) is an important risk factor for new, different FSSs. J Psychosom Res, (74), 12-17.