Depression and Anxiety in Heart Failure: A Review.

Among patients with heart failure (HF), depression and anxiety disorders are common and associated with poor functioning, frequent hospitalizations, and increased rates of mortality. Despite these associations, depression and anxiety disorders are underdiagnosed and undertreated in this high-risk cohort. Diagnosing depression or anxiety disorders in patients with HF is challenging due to the overlap between cardiac and psychiatric symptoms. We recommend diagnosis through the use of a clinical interview and adherence to the Diagnostic and Statistical Manual of Mental Disorders , fifth edition, criteria. Once a psychiatric diagnosis is confirmed, both pharmacological and psychotherapeutic interventions are available. Selective serotonin reuptake inhibitors are well-tolerated in patients with cardiovascular disease but have limited efficacy in patients with HF. Cognitive-behavioral therapy improves mental health outcomes in patients with HF but has not been shown to improve physical health. Finally, collaborative care programs may be considered for the management of uncomplicated depression and anxiety disorders. [ Psychiatr Ann . 2016;46(12):691–701.]

The aim of this study is to analyze the occurrence of depressive and anxiety disorders in patients with COVID-19 and to study the relationship of these disorders with organic damage to the central nervous system.
 Material and methods. An analysis of occurrence of depressive and anxiety disorders in patients with COVID-19 was carried out at the infectious hospital of the KBGMU for the period June-August 2020. Depression and anxiety were identified using the Hospital Anxiety and Depression Scale (HADS) and compared with the MRI data of the brain. Statistical data processing was carried out using Microsoft Excel 7.0.
 Results. According to the analysis, out of 76 patients with COVID-19, depressive disorders were observed in 36 (46.3%) patients, anxiety disorders subclinical anxiety in 16 (21.05%), clinical anxiety in 19 (25%). The absence of depressive disorders was observed in 40 (52.63%), the absence of anxiety in 41 (53.94%). By gender differentiation of patients, depressive disorders in men 20 (46.5%), women 16 (48.48%). Anxiety disorders: subclinical anxiety in men 11 (25.5%), women 5 (15.15 %), clinical anxiety in men 7 (16.2%), women 12 (36.36%). The average age of patients at the time of the study was 45.7 years. When conducting MRI of brain, organic lesions were detected in 12 (16%) people, in 64 (84%) at the time of the study, organic lesions were not detected. When collecting a follow-up in 31 patients, depressive disorders were noted in 8 (25.8%), subclinical anxiety 2 (6.45%), clinical anxiety 2 (6.45%), no anxiety 27 (87.09%), no depression 23 (74.19%). No organic lesions were found at the time of MRI of brain.
 Conclusion. When studying the occurrence of depressive and anxious states and their organic substrates, we found that there is no clear relationship between them and rather have a functional character.

Background: Previous research on the prevalence of depression and anxiety disorders in patients with chronic kidney disease (CKD) has shown a high prevalence of both types of disorders. The aims of this study was to assess the prevalence of depression in anxiety disorders in CKD patients admitted at a tertiary care facility in Lahore, Pakistan. Materials and methods: All admitted patients at one of the medical wards at Jinnah hospital Lahore from December 2018 to December 2019 with a diagnosis of CKD were invited to participate in this study. Aga khan university anxiety and depression scale was used to assess the prevalence of anxiety and depressive disorders. Results: All patients scored above the cut-off points of 19 on the AKUADS. The mean score of study participants on AKUADS was 46 (range of possible scores from 0 to 75). There was no statistically significant difference between male and female study participants on AKUADS scores. Conclusions: The prevalence of depressive and anxiety disorders in patients with CKD is extremely high in the Pakistani population. The possible reasons for this high prevalence could be physical morbidities, lack of appropriate treatment facilities, financial burden, loss of bread winning roles as well as reduced quality of life associated with CKD. Keywords: Depression, Anxiety, Chronic kidney disease

Diagnosis and Treatment of Depression and Anxiety in Rural and Nonrural Primary Care: National Survey Results

Case Presentation: A 71-year-old man with coronary artery disease, left ventricular (LV) systolic dysfunction (ejection fraction, 30%), and recent admission for heart failure presented with acute dyspnea and hypoxemia. A pro-brain–type natriuretic peptide level was elevated at 2450 pg/mL (normal <350 pg/mL). Chest x-ray demonstrated cardiomegaly and small bilateral pleural effusions. After an hour of diuresis, the patient developed systemic arterial hypotension and worsened hypoxemia, prompting cardiology consultation. Based on the absence of rales on physical examination and lack of pulmonary edema on chest x-ray, an alternative diagnosis of pulmonary embolism (PE) was suggested, and contrast-enhanced chest tomography (CT) was obtained. Chest CT demonstrated large bilateral proximal PE. Venous thromboembolism (VTE), which encompasses deep vein thrombosis and PE, is an increasingly common and challenging complication of heart failure. The relative risk of PE is at least double that of patients without heart failure and increases as LV systolic function declines.1 PE patients with heart failure have a higher overall mortality rate than those without heart failure (17% versus 10%).2 In addition, PE is an independent predictor of death or rehospitalization among heart failure patients.3 ### Risk Factors Heart failure patients often have a high medical acuity and multiple risk factors that amplify the risk of VTE.4 The increased risk of VTE observed with heart failure itself has been attributed to reduced flow caused by low cardiac output and abnormalities of hemostasis, platelet function, and endothelial function. Central venous catheters and leads from implantable cardiac defibrillators and pacemakers are common among heart failure patients and have been shown to increase the risk of upper-extremity deep vein thrombosis. Heart failure patients tend to be older, and VTE in the elderly is problematic.5 ### Hemodynamics Acute PE increases pulmonary vascular resistance and right ventricular (RV) afterload through direct physical obstruction, hypoxemia, and pulmonary …

Atrial fibrillation (AF) is globally the most prevalent arrhythmia for which pulmonary vein isolation (PVI) is an effective intervention. A high comorbidity with mental disorders, in particular depressive and anxiety disorders, is described; however, a systematic synthesis of the existing literature is missing. This systematic review and meta-analysis aim to fill in this gap and to examine the prevalence of depressive and anxiety disorders with in-depth analyses of associated factors and predictors of recurrence of AF. A systematic search in PubMed, Web of Science, Trials, Embase, PsycInfo, and the Cochrane library was conducted. Articles on depressive and anxiety disorders according to the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM) in English-language in adults with AF undergoing PVI were included. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Prevalence rates were synthesized, and meta-analyses were conducted to calculate the pooled point prevalence of depressive and anxiety disorders applying generalized linear mixed-effects models. Subgroup analyses on the prevalence including the age, sex, AF type, comorbid cardiovascular; meta-correlations and meta-regressions were performed. Predictors of recurrence of AF were calculated using logistic regressions. Eighteen studies with a total of 9,691 observations for depressive disorders and 8,855 observations for anxiety disorders were included. The meta-analyses revealed an overall point prevalence of 20.10% [95% Confidence interval (CI): 13.31% to 29.18%] for depressive disorders and 25.18% [95% CI: 11.71% to 46.08%] for anxiety disorders in patients undergoing PVI. Subgroup analyses indicated higher prevalence rates of depressive disorders in younger patients, those with paroxysmal AF, and patients with comorbid conditions such as heart failure, diabetes, hypertension. Older patients and those with cardiovascular disorders showed a higher prevalence of anxiety disorder. The correlation between pre- and post-PVI mental health status was strong (r = .99 for depression), but neither pre-ablation depression (OR = 1.022, p = .638) nor anxiety (OR = 1.003, p = 0.830) significantly predicted AF recurrence. Meta-regression analyses did not identify significant moderators explaining existing between-study heterogeneity. Depressive and anxiety disorders are highly prevalent among patients with AF undergoing PVI, particularly with higher rates of depression in younger individuals, those with paroxysmal AF, and patients with comorbid cardiovascular conditions. While mental health status improved post-PVI, neither pre-ablation depression nor anxiety were significant predictors of AF recurrence. This suggests that mental health diagnostics and interventions should be integrated into routine care, although they may not directly impact AF recurrence after PVI. Current guidelines address the management of the psychosocial dimension and comorbid mental disorders of AF insufficiently, indicating an unmet need for structured psychosomatic co-management within an interdisciplinary, patient-centered care framework. Following a biopsychosocial approach may be beneficial and warrants further targeted investigation in AF populations.

Introduction. In Ukraine, on average, 30% of people are obese and 25% are overweight. In parallel with the increase in the number of overweight patients, the percentage of people with migraine is increasing. The prevalence of migraine is high, it affects 12-15% of the population. Both diseases negatively affect not only the function of internal organs, but also the nervous-psychological state of patients, leading to anxiety and depressive disorders.&#x0D; The aim of the study was to analyze the features of the structure of anxiety disorders in obese patients with chronic migraine.&#x0D; Materials and methods: 180 patients (90 women and 90 men) were examined and divided into two clinical groups: 1st group – 60 persons with chronic migraine with an average BMI=23.5.8±1.10 kg/m2; 2nd group – 60 obese patients with chronic migraine, BMI=34.6±1.42 kg/m2. The control group consisted of 60 patients without a headache and with averange BMI=19.5±0.7 kg/m2. The ICHD-3 criteria were used to diagnose migraine. The DSM-5 criteria were used to diagnose anxiety disorders. The patient's level of anxiety was measured using Taylor Manifest Anxiety Scale (TMAS). Statistical processing was performed using dispersion and correlation analysis.&#x0D; Results: Phobic anxiety disorders were in 1.5 times more common in 2nd group patients (c2=9.81, p&lt;0.001) than in 1st group patients; panic disorder was in 1.8 times more frequent in 2nd group (c2= 11.99, p&lt;0.001) than in the 1st group, generalized anxiety disorder was in 2 times (c2=13.08, p&lt;0.0001) less common in patients with chronic migraine than in comorbid patients. The total number of patients with anxiety disorders in patients with chronic migraine on the background of abdominal obesity was twice folds higher (c2=20.93, p=0.00001) than in 1st group patients.&#x0D; Conclusions: the presence of concomitant abdominal obesity in patients with chronic migrane, not only increases the total number of anxiety disorders, but also affects their structure. Therefore, in addition to basic anti-migraine therapy, non-medicinal therapy in the form of a balanced diet, an individual exercise program and 10-12 sessions of cognitive-behavioral therapy (CBT) should be supplemented for the treatment of such patients.

HighlightsThe article presents the analysis of anxiety and depressive disorders in patients who were followed as outpatients after surgery for chronic thromboembolic pulmonary hypertension in the long term, taking into account the study during the COVID–19 pandemic.The prevalence of clinically pronounced anxiety disorders in the group was 10.9%, depression - 18.6%, a combination of anxiety-depressive disorders was noted in 10.3% of cases.Multifactorial analysis revealed that the development of severe anxiety disorders in patients with chronic thromboembolic pulmonary hypertension in the long term is associated with a complicated postoperative course. Independent risk factors for clinically pronounced depressive disorders in these patients were older age, a history of cerebral circulation disorders, as well as pronounced post-COVID-19 functional disorders. Aim. To study the frequency and severity of anxiety-depressive disorders in patients with chronic thromboembolic pulmonary hypertension (CTEPH) in the long term after pulmonary thromboendarterectomy and to identify factors affecting their development.Methods. 156 patients with CTEPH were examined in the long term after surgery using the generalized anxiety disorder (GAD) questionnaire GAD-7 and the Beck`s Depression Inventory. In patients who suffered COVID-19, a “Post-COVID-19 Functional Status scale” (PCFS) was used to measure functional status over time after COVID-19. Logistic regression analysis was used to identify predictors of clinically pronounced GAD and depression in the long-term period after surgery.Results. In patients with CTEPH, clinically significant GAD and depression in the long term after surgery were observed in 10.9 and 18.6% of cases, respectively. A combination of anxiety and depressive disorders was noted in 10.3% of patients. The development of GAD was associated with cardiopulmonary insufficiency in the early postoperative period (ОR 3,1; CI 1,2–13,8; p = 0,009). Clinically pronounced depression was associated with older age (ОR 1,3; CI 1,04–2,0; p = 0,02), chronic cerebral circulatory insufficiency (ОR 7,6; CI 1,8–17,5; p = 0,02) and pronounced post-COVID-19 functional neurological disorders according to the PCFS scale (ОR 6,7; CI 1,9–14,5; p = 0,007). The combination of clinically expressed anxiety and depression was correlated with older age (ОR 1,1; CI 1,02–1,3; p = 0,04).Conclusion. The prevalence of clinically pronounced GAD in the group was 10.9%, depression was 18.6%, and a combination of anxiety and depressive disorders was noted in 10.3% of patients. The development of clinically significant GAD is associated with a complicated course of cardiac surgery. Independent risk factors for clinically significant depression were older age, a history of cerebral circulatory disorders and pronounced post-COVID-19 functional neurological disorders.

Objective: To evaluate the performance of the Hospital Anxiety and Depression Scale (HADS) for screening of depressive disorders and anxiety disorders in patients with rheumatoid arthritis (RA) in Hong Kong. Methods: Consecutive RA patients in the outpatient clinic of Pok Oi Hospital were invited to complete the validated Chinese-Cantonese version of the HADS questionnaire before clinical assessment by a psychiatrist for depressive disorders and anxiety disorders using the Chinese-bilingual Structured Clinical Interview for DSM-IV Axis I disorders, patient research version. Psychometric properties of the HADS were analyzed by the receiver operating characteristic (ROC) curve analysis. Results: For the HADS full scale, sensitivity and specificity at the optimal cut-off score of 16 for any psychiatric disorders were 83.0% and 81.0%, respectively (area under ROC curve [AUC] 0.91). For the depression subscale (HADS-D), sensitivity and specificity at the optimal cut-off score of 10 for any depressive disorders were 89.7% and 84.8%, respectively (AUC 0.93). For the anxiety subscale (HADS-A), sensitivity and specificity at the optimal cut-off score of 8 for any anxiety disorders were 88.5% and 74.1%, respectively (AUC 0.87). The HADS-D showed better screening properties for any depressive disorders than major depressive disorder. The HADS-A showed better screening properties for generalized anxiety disorder than any anxiety disorders. Conclusion: The HADS had good performance to screen for any psychiatric disorders and the HADS-D had good performance to screen for any depressive disorders. On the other hand, the HADS-A performed better for generalized anxiety disorder than for any anxiety disorders.

Aim To assess the association of six polymorphisms in serotonin-related genes with depressive or anxiety disorders in patients with irritable bowel syndrome (IBS). Methods The lifetime prevalence of depressive and anxiety disorders was assessed in 95 IBS patients (85% women) using the Munich version of the Composite International Diagnostic Interview (CIDI). IBS was diagnosed according to the Rome III criteria. SCL6A4 HTTLPR polymorphism (rs4795541) was determined using PCR-based method. Single-nucleotide polymorphisms in HTR1A (rs6295), HTR2A (rs6313 and rs6311), HTR2C (rs6318), and TPH1 (rs1800532) were detected by minisequencing method. Results IBS patients with depressive disorders were characterized by higher frequency of 5-HTTLPR L allele in comparison to IBS patients with anxiety disorders. The lower frequency of 1438 A allele in HTR2A was found in IBS patients with depressive disorders in comparison to IBS patients without mental disorders. The lower G allele frequency in HTR2C rs6318 polymorphism among IBS patients with anxiety disorders was also observed. Conclusions Our results provide further evidence for the involvement of SLC6A4 rs4795541 and HTR2A rs6311 polymorphisms in the pathophysiology of depressive disorders in IBS patients. The new findings indicate that HTR2C rs6318 polymorphism may be associated with the susceptibility to anxiety disorders in IBS patients.

Recognizing the Extent of Overlap Between Bipolar Disorder and Anxiety Disorders

Depression and anxiety are the most common mental illnesses encountered in patients visiting psychiatry outpatient clinics. The relative safety of majority of antidepressants and anxiolytics has increased their routine use. However, limited data is available on the prescribing patterns of these drugs, especially from the state of Telangana. The aim of this study was to assess the prescription pattern in depression and anxiety disorders in patients attending Psychiatry outpatient department of a tertiary care teaching hospital in Telangana. A prospective observational study was conducted in Psychiatry outpatient department in Government General Hospital (GGH), Nalgonda over a period of 6 months (March 2021 to August 2021). A total of 45 patients suffering from anxiety and depression, based on International Classification of Diseases-10th edition (ICD-10), were selected. Data was collected using a semi-structured proforma and analyzed. A total of 103 drugs were prescribed and the average number of drugs per prescription was 2.29. It was found that majority of patients were in 15-35 years age group (60%), female (62.22%), married (60%) and from urban background (82.2%). In the study population, 55.55% were suffering from anxiety disorders, out of which 31.11% had Generalized anxiety disorder. Among the depressive disorders (44.45%) majority had Severe depressive episode (26.67%) followed by Moderate depressive episode (17.78%). The duration of illness was less than 6 months in majority of patients (75.56%). Selective serotonin reuptake inhibitors (SSRIs) were the most common group of drugs prescribed. 41 prescriptions (91.11%) contained SSRIs, and Sertraline was the most common drug followed by Escitalopram. 93.33% of the prescriptions also included Benzodiazepines (Clonazepam). 35.55% of the prescriptions had fixed dose combinations, commonest being Escitalopram 10mg + Clonazepam 0.5mg.

In patients with heart failure (HF), depression is common and associated with adverse outcomes such as reduced adherence to treatment, poor quality of life, increased hospitalizations and elevated mortality. Despite these adverse impacts, depression remain underdiagnosed in HF patients. We performed a target review of the literature to identify the association between HF and depression, to examine the mechanisms that link these two conditions and to identify instruments for an accurate diagnosis and treatment of depression in HF patients. Depression is associated with the development and progression of HF, including increased rates of mortality, mediated by behavioral and pathophysiological mechanisms. The overlap of symptoms between depression and HF often makes the diagnosis of depression difficult and late. Currently, specific guidelines for depression screening in HF patients are lacking, partly because evidences showing that depression screening improves cardiac outcomes are insufficient. European guidelines suggest the early use of instruments such as the Beck Depression Inventory (BDI) and the Geriatric Depression Scale (GDS), both characterized by accuracy and administration simplicity. There is limited evidence of pharmacological treatment and psychotherapy efficacy in patients with HF. However, cognitive-behavioral therapy has been shown to improve outcomes HF patients, and selective serotonin reuptake inhibitors appear safe in this cohort.

Depressive and Anxiety Disorders in Patients Presenting With Physical Complaints: Clinical Predictors and Outcome

The relation between anger management style, mood and somatic symptoms in anxiety disorders and somatoform disorders