Psychiatric management of acute myocardial infarction in the coronary care unit.

Failure to recognize and treat the psychiatric complications of myocardial infarction (MI) may aggravate the underlying cardiac condition and interfere with its treatment. The timing and manifestations of several distinct psychiatric conditions that commonly accompany the acute phase of MI (anxiety, depression, delirium, and behavioral abnormalities secondary to a person's premorbid character style) will be reviewed. In addition, the importance of psychological risk factors for the development of coronary artery disease (e.g., life stress and the Type A behavior pattern) and the impact of denial on the cardiac patient's condition will be discussed. Management strategies that include nonpharmacologic (i.e., support, reassurance, brief psychotherapy and cardiac rehabilitation) and psychopharmacologic interventions (e.g., the rational use of benzodiazepines, antidepressants and neuroleptic agents) for psychiatric conditions in the MI patient will be provided. Postdischarge issues that occur in both the patient and his or her family are outlined, and the enrollment in cardiac rehabilitation programs is encouraged.