Neues aus der Psychokardiologie: Depression und koronare Herzkrankheit

The prevalence of a major depressive disorder in patients after myocardial infarction is 20%. Depression is a risk factor for incident coronary heart disease and poor prognosis after myocardial infarction. Poor lifestyle habits and adherence to cardiac therapy as well as metabolic and pathophysiologic changes may partially explain this link. The threatening experience of an acute coronary event and immune and inflammatory changes may be unique features contributing to incident depression after myocardial infarction. While psychotherapy, antidepressants, and physical exercise may alleviate depressive symptoms in patients with coronary heart disease, cardiac rehabilitation additionally reduces mortality risk. Attempts are being undertaken to identify the cardiotoxic characteristics of depression to develop even more effective therapies in the future

Regional origin and decrease of pain in patients with depressive symptoms under treatment with venlafaxine

Objective: Patient's language, tradition, conventions, and customs may all determine integration into a society and are also part of the doctor-patient relationship that influences diagnostic and therapeutic outcome. Language barrier and sociocultural disparity of Eastern and Southern European patients may hamper recovery from pain and depression compared to Middle European patients in Switzerland. Methods: In a prospective naturalistic observational trial we investigated the influence of regional origin on treatment outcome in 420 pain sufferers with depressive symptoms from all over Switzerland who were treated with venlafaxine by 122 physicians in primary care. Physicians rated severity of depressive symptoms using the clinical global impression severity scale and pain intensity by means of visual analogue scales. We hypothesized that in Eastern and Southern European patients the magnitude of pain reduction under treatment with venlafaxine is less compared to Middle European patients. Results: Three months after study entry, Middle European patients were found to profit more from treatment with venlafaxine in terms of severity of depression and pain intensity than patients from Eastern Europe and Southern Europe. Conclusion: Regional origin may contribute to the magnitude of pain reduction in patients with depressive symptoms under treatment with venlafaxine. Our results provide a rational for care provider educational programs aimed at improving capacities in treating patients from different regional origin with psychosomatic complaints such as depression and comorbid pai

Charakteristika chronischer Schmerzpatienten mit depressiver Begleitsymptomatik in drei unterschiedlichen Behandlungssettings

Zusammenfassung : Hintergrund: : Über demographische und medizinische Charakteristika von chronischen Schmerzpatienten mit depressiven Symptomen in der Praxis ist bisher wenig bekannt. Methodik: : Die Charakteristika hinsichtlich regionaler Herkunft und Schmerz intensität zu Beginn einer antidepressiven Behandlung werden von 585 chronischen Schmerzpatienten mit depressiver Symptomatik aus 122 Arztpraxen der ganzen Schweiz (Innere Medizin, Allgemeinmedizin, Psychiatrie) beschrieben. Aufgrund der klinischen Erfahrungen im Schweizer Gesundheitssystem wurde vermutet, dass Internisten und Allgemeinpraktiker im Vergleich zu Psychiatern eher ältere und geringergradig depressive Patienten mit weniger intensiven chronischen Schmerzen behandeln, die vermehrt aus mitteleuropäischen Ländern stammen. Ergebnisse: : Tatsächlich behandelten Internisten (und Allgemeinpraktiker) gegenüber Psychiatern häufiger ältere Patienten aus Mitteleuropa mit leichteren depressiven Symptomen und geringerer Schmerzintensität sowie seltener Schmerzen im Kopfbereich. Weiter litten Patienten aus Ost- und Südeuropa gegenüber Mitteleuropäern unter intensiveren Gesamtschmerzen, und dies vor allem im Kopf-, Extremitäten-, Rücken- und Brustbereich, während Südeuropäer gegenüber Mitteleuropäern zusätzlich auch vermehrt unter Brustschmerzen litten. Schlussfolgerung: : Es handelt sich um eine vergleichsweise große Stichprobe, die praxisnah und aus allen Regionen der Schweiz niedergelassene, in Schmerzbehandlungen involvierte Internisten, Allgemeinpraktiker und Psychiater einbezieht und damit die Verhältnisse von Patienten mit körperlichen Schmerzen und einer depressiven Begleitsymptomatik hinsichtlich regionaler Herkunft und Schmerzintensität gut repräsentier

Heart rate variability and biomarkers of systemic inflammation in patients with stable coronary heart disease: findings from the Heart and Soul Study

Background: Chronic low-grade systemic inflammation is a key component in atherogenesis. Decreased heart rate variability (HRV), a strong predictor of cardiovascular events, has been associated with elevations in circulating levels of C-reactive protein (CRP), interleukin (IL)-6, and fibrinogen in apparently healthy individuals. We investigated whether decreased HRV is associated with inflammatory markers in patients with coronary heart disease (CHD). Methods: We studied the relationship between HRV and CRP, IL-6, and fibrinogen in 862 outpatients with CHD. All participants provided fasting blood samples and underwent 24-h ambulatory monitoring to assess time-domain measures of HRV (MeanNN, SDNN, SDANN, and RMSSD). Regression analyses were adjusted for age, sex, ethnicity, body mass index, smoking, diabetes, beta blocker use, and cardiopulmonary history. Results: MeanNN, SDNN, and SDANN were significantly and inversely associated with CRP and IL-6 levels in age-adjusted models and after adjustment for all covariates (p≤0.02). MeanNN, SDNN, and SDANN were also inversely associated with fibrinogen levels in age-adjusted models (p<0.03), but not significantly so in multivariable-adjusted models. Reduced vagal modulation of heart rate (RMSSD) was not significantly associated with any inflammatory measures. Conclusions: Reduced cardiac autonomic control is associated with increased systemic inflammation in patients with stable CHD. This relationship was largely independent of important covariate

Relation of morning serum cortisol to prothrombotic activity in women with stable coronary artery disease

Background: Increased circulating cortisol levels have been associated with severity of atherosclerosis. Low-grade systemic thrombogenicity plays a major role in the initiation and progression of coronary disease. We hypothesized a direct relationship between cortisol and hemostasis factors related to a prothrombotic state in coronary artery disease. Methods: We measured morning serum cortisol and activated clotting factor VII, fibrinogen, von Willebrand factor antigen, and plasminogen activator inhibitor-1 activity in 285 women (56±7years) between 3 and 6months after an acute coronary event. To test whether the relationship between cortisol and hemostasis factors would be independent, statistical adjustment was made for demographic, biomedical, life style, and psychosocial variables. Results: Higher serum cortisol levels predicted higher fibrinogen (β=.17, P=.001) and higher von Willebrand factor (β=.16, P=.008), all independently of covariates, including C-reactive protein, which was also an independent predictor of fibrinogen (β=.20, P=.001) and von Willebrand factor (β=.16, P=.004). Higher levels of vital exhaustion were associated with higher levels of activated clotting factor VII independently of covariates and depression (β=.18, P=.045). Cortisol showed crude correlations with vital exhaustion (r=.14, P=.022) and with depression (r=.13, P=.043) but did not mediate the relationship between psychosocial variables and hemostatic factors. Conclusions: Morning serum cortisol showed a modest but independent association with prothrombotic activity in women with coronary artery disease suggesting that increased cortisol levels might contribute to atherosclerosis via eliciting a hypercoagulable stat

Association of Blood Pressure and Fitness With Levels of Atherosclerotic Risk Markers Pre-Exercise and Post-exercise

Background: Physical fitness may attenuate the increased atherosclerotic risk in patients with systemic hypertension. We investigated the association of screening blood pressure (BP) and cardiorespiratory fitness with baseline levels and exercise-induced changes in levels of soluble atherosclerotic risk markers. Methods: Twenty-six otherwise healthy and unmedicated subjects with elevated BP (systolic BP and/or diastolic BP ≥130/85 mm Hg) and 40 subjects with normal BP underwent 20-min treadmill exercise at 65% to 70% of predetermined peak oxygen consumption (VO2peak). Interleukin (IL)-6, soluble intercellular adhesion molecule (sICAM)-1, von Willebrand factor (VWF) antigen, and plasminogen activator inhibitor (PAI)-1 antigen were measured at baseline (ie, pre-exercise), early postexercise, and late postexercise (ie, 25 min after exercise). Results: At baseline, higher screening mean arterial BP (MAP) independently predicted higher sICAM-1 levels (P = .031), and lower VO2peak independently predicted higher IL-6 (P = .016) and PAI-1 (P < .001) levels. Early and late postexercise lower VO2peak was associated with higher mean PAI-1 (P ≤ .072) and IL-6 (P ≤ .026) levels, and higher screening MAP was associated with higher mean sICAM-1 levels (P ≤ .035). Higher VO2peak was associated with a greater PAI-1 increase from baseline to early postexercise in subjects with elevated BP (P = .045) but not in those with normal BP. Conclusions: Circulating levels of some atherosclerotic risk markers at baseline and with exercise were higher with elevated BP and lower with better fitness. Greater fitness did not particularly protect subjects with elevated BP from potentially harmful responses of atherosclerotic risk markers to acute physical exercise. Am J Hypertens 2007;20: 670-675 © 2007 American Journal of Hypertension, Lt

Validation of the collaborative outcomes study on health and functioning during infection times (COH-FIT) questionnaire for adults

Background: The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; www.coh-fit.com) is an anonymous and global online survey measuring health and functioning during COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology "P-score". Methods: The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1-4 items ("COH-FIT items") were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ≥ 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed. Results: From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (ω = 0.95). Factor structure was consistent across age and sex. Conclusions: COH-FIT is a valid instrument to globally measure mental health during infection times. The P-score is a valid measure of multidimensional mental health. Keywords: COH-FIT; Covid-19; Pandemic; Survey: P-factor: well-being: mental health: psychiatry: psychometri

Rey Visual Design Learning Test performance correlates with white matter structure

Objective: Studies exploring relation of visual memory to white matter are extensively lacking. The Rey Visual Design Learning Test (RVDLT) is an elementary motion, colour and word independent visual memory test. It avoids a significant contribution from as many additional higher order visual brain functions as possible to visual performance, such as three-dimensional, colour, motion or word-dependent brain operations. Based on previous results, we hypothesised that test performance would be related with white matter of dorsal hippocampal commissure, corpus callosum, posterior cingulate, superior longitudinal fascicle and internal capsule. Methods: In 14 healthy subjects, we measured intervoxel coherence (IC) by diffusion tensor imaging as an indication of connectivity and visual memory performance measured by the RVDLT. IC considers the orientation of the adjacent voxels and has a better signal-to-noise ratio than the commonly used fractional anisotropy index. Results: Using voxelwise linear regression analyses of the IC values, we found a significant and direct relationship between 11 clusters and visual memory test performance. The fact that memory performance correlated with white matter structure in left and right dorsal hippocampal commissure, left and right posterior cingulate, right callosal splenium, left and right superior longitudinal fascicle, right medial orbitofrontal region, left anterior cingulate, and left and right anterior limb of internal capsule emphasises our hypothesis. Conclusion: Our observations in healthy subjects suggest that individual differences in brain function related to the performance of a task of higher cognitive demands might partially be associated with structural variation of white matter region

Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&amp;A)

Background: The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial. Methods: The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life. Results: Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries. Limitations: Cross-sectional and anonymous design. Conclusions: Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth. Keywords: Adolescents; Children; Covid-19; Mental health; Pandemic; Physical health; Resilience