心力衰竭中的抑郁和焦虑：综述。
Depression and Anxiety in Heart Failure: A Review.
机构信息
From Harvard Medical School (Drs. Celano, Gaggin, and Huffman); Departments of Psychiatry (Drs. Celano, Villegas, and Huffman, and Ms. Albanese) and Medicine, Division of Cardiology (Dr. Gaggin), Massachusetts General Hospital, Boston, MA.
出版信息
Harv Rev Psychiatry. 2018 Jul/Aug;26(4):175-184. doi: 10.1097/HRP.0000000000000162.
LEARNING OBJECTIVES
After participating in this activity, learners should be better able to:• Identify the relationships between depression, anxiety, and heart failure (HF).• Assess methods for accurately diagnosing depression and anxiety disorders in patients with HF.• Evaluate current evidence for treatment of anxiety and depression in patients with HF.
BACKGROUND
In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes such as reduced adherence to treatment, poor function, increased hospitalizations, and elevated mortality. Despite the adverse impact of these disorders, anxiety and depression remain underdiagnosed and undertreated in HF patients.
METHODS
We performed a targeted literature review to (1) identify associations between depression, anxiety, and HF, (2) examine mechanisms mediating relationships between these conditions and medical outcomes, (3) identify methods for accurately diagnosing depression and anxiety disorders in HF, and (4) review current evidence for treatments of these conditions in this population.
RESULTS
Both depression and anxiety disorders are associated with the development and progression of HF, including increased rates of mortality, likely mediated through both physiologic and behavioral mechanisms. Given the overlap between cardiac and psychiatric symptoms, accurately diagnosing depression or anxiety disorders in HF patients can be challenging. Adherence to formal diagnostic criteria and utilization of a clinical interview are the best courses of action in the evaluation process. There is limited evidence for the efficacy of pharmacologic and psychotherapy in patients with HF. However, cognitive-behavioral therapy has been shown to improve mental health outcomes in patients with HF, and selective serotonin reuptake inhibitors appear safe in this cohort.
CONCLUSIONS
Depression and anxiety disorders in HF patients are common, underrecognized, and linked to adverse outcomes. Further research to improve detection and develop effective treatments for these disorders in HF patients is badly needed.
学习目标
在参与此活动后，学习者应能够：
识别抑郁、焦虑和心力衰竭（HF）之间的关系。
评估在 HF 患者中准确诊断抑郁和焦虑障碍的方法。
评估 HF 患者焦虑和抑郁治疗的现有证据。
背景
在心力衰竭（HF）患者中，抑郁和焦虑障碍很常见，并与不良结局相关，例如降低对治疗的依从性、功能下降、住院增加和死亡率升高。尽管这些疾病有不良影响，但 HF 患者的焦虑和抑郁仍然未被充分诊断和治疗。
方法
我们进行了有针对性的文献回顾，以：
（1）确定抑郁、焦虑和 HF 之间的关联，
（2）研究介导这些疾病与医疗结果之间关系的机制，
（3）识别在 HF 中准确诊断抑郁和焦虑障碍的方法，
（4）回顾该人群中治疗这些疾病的现有证据。
结果
抑郁和焦虑障碍均与 HF 的发生和进展相关，包括死亡率增加，可能通过生理和行为机制介导。鉴于心脏和精神症状之间存在重叠，在 HF 患者中准确诊断抑郁或焦虑障碍具有挑战性。遵循正式诊断标准并使用临床访谈是评估过程中的最佳方法。HF 患者中药物和心理治疗的疗效证据有限。然而，认知行为疗法已被证明可改善 HF 患者的心理健康结局，选择性 5-羟色胺再摄取抑制剂在该队列中似乎安全。
结论
HF 患者的抑郁和焦虑障碍很常见，未被充分认识，与不良结局相关。迫切需要进一步研究以提高对这些疾病的检测，并为 HF 患者开发有效的治疗方法。
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