E-Book, Englisch, Band Vol. 2, 90 Seiten
E-Book, Englisch, Band Vol. 2, 90 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61334-313-5
Verlag: Hogrefe Verlag
Format: EPUB
Kopierschutz: Wasserzeichen (»Systemvoraussetzungen)
Autoren/Hrsg.
Fachgebiete
- Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Kardiologie, Angiologie, Phlebologie
Weitere Infos & Material
1 Description
1.1 Terminology
1.1.1 Heart Disease Many different terms are used to describe various aspects of heart disease. Some, such as coronary artery disease (CAD) and coronary heart disease (CHD) are often used interchangeably, while others are quite specific. CHD is an umbrella term for most forms of heart disease, but it does not exist as an International Classification of Diseases (ICD-10) code. The various ICD headings for heart disease can be found in the “Diseases of the Circulatory System” section coded 100 to 199. In order to work effectively with patients with heart disease, it is advisable to have a working knowledge of the following terms (ICD-10 code is given when applicable): chronic ischemic heart disease (125), historically called atherosclerotic heart disease or ASHD, now commonly referred to as CAD or CHD; congestive heart failure or CHF (150); cardiomyopathy, often written CMY (142); angina pectoris (120), which may be classified as stable, unstable, or with documented vasospasm (120.1); ischemia; myocardial infarction or MI (121); coronary valvular disorders, generally classified as valvular stenosis or insufficiency (134–137); cardiac arrhythmias, often more accurately called dysrhythmias (147–149); atherosclerosis (170); atherogenesis; and aneurysms of the heart (125.3). Common procedures include: cardiac catheterization, also called cardiac cath; percutaneous transluminal coronary angioplasty or PTCA, which now often includes insertion of one or more stents; coronary artery bypass graft or CABG surgery; and pacemaker insertion and/or insertion of an automated implantable coronary defibrillator or AICD. 1.1.2 Psychiatric Disorders and Psychosocial Problems in Heart Disease Introduction In this volume, we distinguish between psychiatric disorders, as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Text Revision (DSM-IV-TR), and psychosocial problems, which comprise a variety of other psychological, interpersonal, and social adjustment difficulties in patients with heart disease. In some instances, the distinction is clear. Type A behavior, for example, may be problematic for patients with heart disease, but it is not a DSM-IV psychiatric disorder. In other cases, it is not so clear. For example, a patient who has recently had a heart attack may be quite anxious yet not meet the criteria for any of the anxiety disorders listed in DSM-IV. Depending upon the context, we discuss these sorts of problems either as subsyndromal forms of psychiatric disorders, or simply as psychosocial problems. Phenomena such as Type A behavior that have no counterpart in DSM-IV will only be referred to as psychosocial problems, not as psychiatric disorders. Depression The hallmarks of depression are persistent sadness (dysphoric mood) and pervasive loss of interest or pleasure in usual activities (anhedonia). In clinically significant depressive disorders, these symptoms are accompanied by other symptoms of depression and by diminished ability to engage in everyday activities (functional impairment). Patients with subsyndromal depressive symptoms are at high risk of having a major depressive episode The term subsyndromal depression has taken on several different meanings. Depending upon the context, it can indicate that the cardinal symptoms of dysphoric mood and/or anhedonia are present but the criteria for a full-fledged DSM-IV depressive disorder are not met. It can also mean that the patient has a depressive disorder that is only in partial remission, whether or not dysphoric mood or anhedonia are among the persistent symptoms. In some instances, the term is used as though it were synonymous with DSM-IV minor depression, but this usage is incorrect. Nondysphoric depression is easily overlooked, as depression is often equated with sadness Some patients deny feeling sad despite having other symptoms of depression. This condition has been termed nondysphoric depression. In some cases, the patient may simply not be feeling sad but may have other manifestations of depression. In others, he or she may actually feel sad but deny it when asked, perhaps because of personal or cultural biases against expressing emotions or to admitting to feeling sad. This is often encountered when assessing depression in medically ill patients, especially in those who are not seeking treatment for depression. Some depressed patients present with anger or irritability, either instead of, or in addition to, sadness. Anger and irritability can prevent patients from being aware that their underlying mood is dysphoric. However, it is important not to assume that patients who are angry or irritable are necessarily depressed as well. Anger and irritability can be present for reasons unrelated to sadness or depression. “Depression” can refer to a mood, a symptom, or a syndrome If you use the National Library of Medicine’s Medline database to search for articles on depression, it helps to know that the Medical Subject Heading (MeSH) keyword “depression” refers to “depressive states, usually of moderate intensity, in contrast with major depression present in neurotic and psychotic disorders.” In contrast, the MeSH term “depressive disorder” refers to “an affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent.” This term encompasses major depression as defined by DSM-IV. However, the MeSH term “depressive disorder, major,” does not refer to ordinary DSM-IV major depression. Instead, it refers to “marked depression appearing in the involution period and characterized by hallucinations, delusions, paranoia, and agitation.” In other words, it pertains to psychotic depression in elderly individuals. This is unquestionably a confusing situation. To make matters worse, “depression” can also refer to certain medical problems that may have nothing to do with psychiatric depression. The best way to find what you’re looking for is to use the MeSH term “depression” when searching Medline for articles on mild forms of psychiatric depression such as subsyndromal depressive symptoms, minor depression, or dysthymia, and to use “depressive disorder” when searching for ones on DSM-IV major depression. Better still, use both terms in their exploded form (exp depression/OR exp depressive disorder/), as some articles about depression are classified in Medline in ways you might not expect. Anxiety The three dimensions of anxiety often differ in severity Anxiety has three dimensions: cognitive, affective, and physical (somatic). Worry is the chief cognitive manifestation of anxiety. Worrying refers to a repetitive pattern of apprehensive expectations about potential problems, threats to safety or security, or harmful events that might occur. Whereas medically ill patients who have good reason to worry about their health are said to have health anxiety, individuals who worry needlessly about less serious aches and pains are said to have hypochondriacal concerns. Worrying about other problems is also common among cardiac patients, particularly about ones that either indirectly result from or are worsened by the patient’s medical illness. The affective manifestations of anxiety include feeling fearful, ill at ease, restless, keyed up, or on edge. These are the sorts of feelings that people ordinarily experience when something frightening happens. Such feelings normally abate after the frightening experience ends, but “anxiety” implies that they persist even when the source of the fearfulness might not be readily apparent to an external observer. For that matter, it might not even be obvious to the patient. The physical manifestations of anxiety include muscle tension, nervousness, perspiration, insomnia, fatigue, gastrointestinal symptoms, and cardiovascular symptoms such as palpitations or tachycardia (rapid heart rate), and chest pain. The cardiovascular symptoms of anxiety often cause concern and confusion among cardiac patients, as well as among their families, caregivers, and physicians. It can be difficult, for example, to differentiate between benign chest pain due to anxiety and unstable angina due to coronary disease. This issue is addressed in greater detail in subsequent sections. Terms for searching for articles about anxiety The MeSH terms for anxiety are not quite as confusing as the ones for depression. Use the term “anxiety” to search in Medline for articles concerning “persistent feelings of dread, apprehension, and impending disaster.” In other words, use this term for subsyndromal forms of anxiety that fall short of the requirements for...
