Ottolini Fedra, Modena Maria Grazia, Rigatelli Marco
Department of Psychiatry and Mental Health, University of Modena and Reggio Emilia, Modena, Italy.
Psychother Psychosom. 2005;74(5):323-7. doi: 10.1159/000086324.
Little is known about the prodromal phase of myocardial infarction (MI). The aim of this study was to explore this phase with methodologies which have been standardized in affective disorders. The psychological evaluation of patients with MI diagnosis is currently based on DSM-IV criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. In this study, we are going to compare these new criteria, i.e. the Diagnostic Criteria for Psychosomatic Research (DCPR), with DSM-IV in a population where a high prevalence of psychological problems is expected.
A semistructured research interview based on Paykel's Clinical Interview for Depression for eliciting prodromal symptoms was administered to a consecutive series of 92 patients with a first episode MI diagnosis. Two interviews for the evaluation of psychological problems were administered according to DSM-IV and DCPR criteria.
Most of the patients reported prodromal symptoms. Irritability, depressed mood and somatic anxiety were the most common prodromal symptoms. The results also show that the number of DCPR diagnoses was higher than the number of DSM-IV diagnoses. At least one DCPR diagnosis was found in all patients, whereas at least one DSM-IV diagnosis was present in 42 (46%) patients.
The prodromal phase of MI was found to be characterized by prodromal symptoms of affective type. The joint use of DSM-IV and DCPR criteria was found to improve the identification of psychological factors which could affect this phase. The results should alert the physician to the fact that patients presenting with irritability, depressed mood (including demoralization), anxiety and insomnia may be at risk of developing coronary artery disease.
关于心肌梗死（MI）的前驱期，人们了解甚少。本研究旨在运用在情感障碍中已标准化的方法来探索这一阶段。目前对心肌梗死患者的心理评估基于《精神疾病诊断与统计手册》第四版（DSM-IV）标准。一个国际心身研究小组提出了另一种诊断和概念框架。在本研究中，我们将在一个预计心理问题患病率较高的人群中，比较这些新标准，即心身研究诊断标准（DCPR）与DSM-IV。
对连续92例首次诊断为心肌梗死的患者进行了基于佩克尔抑郁临床访谈以引出前驱症状的半结构化研究访谈。根据DSM-IV和DCPR标准进行了两次心理问题评估访谈。
大多数患者报告了前驱症状。易怒、情绪低落和躯体焦虑是最常见的前驱症状。结果还表明，DCPR诊断的数量高于DSM-IV诊断的数量。所有患者中至少有一项DCPR诊断，而42例（46%）患者中至少有一项DSM-IV诊断。
发现心肌梗死的前驱期以情感类型的前驱症状为特征。发现联合使用DSM-IV和DCPR标准可改善对可能影响这一阶段的心理因素的识别。这些结果应提醒医生，出现易怒、情绪低落（包括士气低落）、焦虑和失眠的患者可能有患冠状动脉疾病的风险。
