Browsing by Author "Albus, C."

Zusammenfassung Psychosoziale Risikofaktoren (Arbeitsstress, niedrige Sozialschicht, mangelnde soziale Unterstutzung, Arger, Angst, Depressivitat), uberdauernde Personlichkeitsmuster (z.B. Feindseligkeit) sowie die posttraumatische Belastungsstorung konnen die Entwicklung und den Verlauf zahlreicher Herz-Kreislauf-Erkrankungen negativ beeinflussen. Eine systematische Erfassung dieser Faktoren hilft, das Risiko angemessen einzuschatzen und bei der Behandlung zu berucksichtigen. Die vorgestellten Behandlungsempfehlungen stutzen sich auf aktuelle Positionspapiere und Leitlinien. Der Arzt-Patienten-Kontakt sollte grundsatzlich nach den Prinzipien einer patientenzentrierten Kommunikation erfolgen und alters- sowie geschlechtsspezifische Besonderheiten berucksichtigen. Die psychosomatische Grundversorgung ist eine wirksame, niedrigschwellige Option zur Behandlung psychosozialer Risikofaktoren und sollte regelma ss ig angeboten werden. Bluthochdruckpatienten konnen (allerdings mit ma ss igem Effekt) von Entspannungsverfahren oder Biofeedback profitieren. Patienten mit koronarer Herzerkrankung, Herzinsuffizienz oder nach Herzoperationen soll ein individuell angepasstes, multimodales Behandlungskonzept angeboten werden, das Wissensvermittlung, Sport- und Bewegungstherapie, Motivationsforderung, Entspannungsverfahren und Stressmanagement umfasst. Bei einer psychischen Komorbiditat ist oft zusatzlich eine psychotherapeutische Behandlung indiziert. Eine antidepressive Pharmakotherapie sollte bei einer mindestens mittelschweren depressiven Storung angeboten werden, wobei bevorzugt selektiven Serotonin-Wiederaufnahme-Hemmer (SSRI) eingesetzt werden sollten. Psychotherapie und SSRI, insbesondere Sertralin, sind bei bestimmungsgema ss em Gebrauch sicher und wirksam hinsichtlich einer Verbesserung der Lebensqualitat. Eine Prognoseverbesserung ist nicht eindeutig belegt. Patienten mit implantiertem Defibrillator sollten im Rahmen der psychosomatischen Grundversorgung, bei psychischer Komorbiditat mit Psychotherapie und ggf. auch SSRI, behandelt werden. Trizyklische Antidepressiva sollten wegen unerwunschter kardialer Wirkungen bei Herzpatienten moglichst vermieden werden. Abstract Psychosocial risk factors (work stress, low socioeconomic status, impaired social support, anger, anxiety and depression), certain personality traits (e.g. hostility) and post-traumatic stress disorders may negatively influence the incidence and course of multiple cardiovascular disease conditions. Systematic screening for these factors may help to adequately assess the psychosocial risk pattern of a given patient and may also contribute to the treatment of these patients. Recommendations for treatment are based on current guidelines. The physician-patient interaction should basically follow the principle of a patient centered communication and should gender and age specific aspects into consideration. Integrated biopsychosocial care is an effective, low threshold option to treat psycho-social risk factors and should be offered on a regular basis. Patients with high blood pressure may profit from relaxation programs and biofeedback procedures (however with moderate success). An individually adjusted multimodal treatment strategy should be offered to patients with coronary heart disease, heart failure and after heart surgery. It may incorporate educational tools, exercise therapy, motivational modules, relaxation and stress management programs. In case of affective comorbidity, psychotherapy may be indicated. Anti-depressant pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) in the first line should only be offered to patients with at least moderate severe depressive episodes. Psychotherapy and SSRIs, particularly sertraline, have been proven to be safe and effective with regard to improvements of the patient's quality of life. A prognostic benefit has not been clearly proven so far. Patients with an implanted cardioverter/defibrillator (ICD) should receive psychosocial support on a regular basis. Concomitant psychotherapy and/or psychopharmacotherapy (SSRIs) should be offered in case of a severe mental comorbidity. Generally, tricyclic antidepressants should be avoided in cardiac patients because of adverse side effects.

The International Society of Behavioral Medicine (ISBM) was one of eight societies that comprised the Third Task Force of European and Other Societies on Prevention of Cardiovascular Disease in Clinical Practice (2003-2004). This task force considered published knowledge from diverse fields related to preventive cardiology including behavioral medicine to improve risk estimation and risk factor management. The scientific evidence supporting the guidelines included findings on low socioeconomic status, social isolation, psychosocial stress, hostility, depression and negative affect, the clustering of psychosocial and lifestyle risk factors, and lifestyle psychosocial interventions. Recommendations for promoting behavior change and management of psychosocial and lifestyle factors in clinical practice include strategies for promoting healthy lifestyle, improving health care provider-patient interactions, implementing multimodal interventions, and managing psychosocial risk factors.

Psychosocial risk factors like low socio-economic status, lack of social support and social isolation, chronic work or family stress, as well as negative emotions, e. g. depression and hostility, contribute significantly to the development and adverse outcome of coronary heart disease (CHD). Negative effects of psychosocial risk factors are conveyed via behavioural pathways including unhealthy lifestyle, e. g. food choice, smoking, sedentary life, inadequate utilisation of medical resources, and psychobiological mechanisms like disturbed autonomic and hormonal regulation: all these factors contribute to metabolic dysfunction and inflammatory and haemostatic processes, which are directly involved in the pathogenesis of CHD. Interventions to improve pychosocial factors are available and have demonstrated positive effects on risk factors and - at least in part - on CHD morbidity and mortality. The prevention of CHD should therefore include screening for psychosocial risk factors and adequate interventions. Recommendations for the screening of risk factors, behavioural change and further management of psychosocial risk factors in clinical practice are pointed out.

Psychosocial risk factors like low socio-economic status, chronic family or work stress, social isolation, negative emotions (e.g., chronic depression or acute anxiety), and negative personality patterns such as Type-D-pattern or hostility, may contribute significantly to the development and adverse outcome of coronary heart disease. Therefore, systematic screening for psychosocial risk factors in cardiological practice is recommended in order to initiate adequate intervention strategies, e.g., to involve additional psychosocial counselling or treatment. Reliable methods to assess psychosocial risk factors are: (1) standardized, structured interviews; (2) standardized questionnaires, and (3) 'single-item' questions to be included into the cardiologist clinical interviews. While structured interviews should be restricted to trained professionals, questionnaires are easily to administer, and have frequently been used in the field of cardiology. 'Single item' questions are sufficiently reliable and the most timesaving way to screen for psychosocial factors. For clinical practice, a two-step evaluation is recommended: firstly, cardiologists should include 'single-item' questions into their routine interview and/or use questionnaires in order to screen for a potential problem. Secondly, if problems are indicated, patients should be passed to qualified professionals for structured clinical interview. Instruments of all three methods are briefly presented, and implications for further treatment are discussed. (C) 2004 The European Society of Cardiology.