Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Cologne, Germany.
Ann Med. 2010 Oct;42(7):487-94. doi: 10.3109/07853890.2010.515605.
More than six decades of empirical research have shown that psychosocial risk factors like low socio-economic status, lack of social support, stress at work and family life, depression, anxiety, and hostility contribute both to the risk of developing coronary heart disease (CHD) and the worsening of clinical course and prognosis in patients with CHD. These factors may act as barriers to treatment adherence and efforts to improve life-style in patients and populations. In addition, distinct psychobiological mechanisms have been identified, which are directly involved into the pathogenesis of CHD. In clinical practice, psychosocial risk factors should be assessed by clinical interview or standardized questionnaires, and relevance with respect to quality of life and medical outcome should be discussed with the patient. In case of elevated risk, multimodal, behavioural intervention, integrating counselling for psychosocial risk factors and coping with illness, should be prescribed. In case of clinically significant symptoms of depression and anxiety, patients should be referred for psychotherapy, and/or medication according to established standards (especially selective serotonin reuptake inhibitors (SSRIs)) should be prescribed. Psychotherapy and SSRIs appear to be safe and effective with respect to emotional disturbances; however, a definite beneficial effect on cardiac end-points has not been documented.
六十多年的实证研究表明，社会心理风险因素，如社会经济地位低、缺乏社会支持、工作和家庭生活压力、抑郁、焦虑和敌意，既会增加患冠心病 (CHD) 的风险，也会使 CHD 患者的临床病程和预后恶化。这些因素可能成为患者和人群治疗依从性以及改善生活方式努力的障碍。此外，还确定了明确的心理生物学机制，这些机制直接参与 CHD 的发病机制。在临床实践中，应通过临床访谈或标准化问卷评估社会心理风险因素，并应与患者讨论其与生活质量和医疗结果的相关性。如果存在高风险，应规定采用多模式行为干预措施，将针对社会心理风险因素的咨询和应对疾病纳入其中。如果出现明显的抑郁和焦虑症状，应根据既定标准（特别是选择性 5-羟色胺再摄取抑制剂 (SSRIs)）将患者转介进行心理治疗和/或药物治疗。心理治疗和 SSRIs 似乎在情绪障碍方面是安全有效的；然而，尚未记录到对心脏终点有明确的有益影响。
