Attention those interested in internal medicine, family medicine, cardiology and cardiac surgery! Did you know that there's a link between mental illness and cardiovascular disease?

While not entirely well understood, the link between mental illness and CVD goes both ways. Specifically those with mental illness are at higher risk of heart disease, likely secondary to substance use, unhealthy lifestyle behaviours, and side effects of certain psychotropic medications, as wellas higher rates of mortality and morbidity related to heart disease, perhaps due to noncompliance with medications, and physiologic effects of stress and low mood on the body.

However, those with heart disease are also at higher risk for depression and anxiety. In fact, growing evidence indicates that rates of depression are higher among those with CAD, as well as those who have had a history of MI and/or cardiac revascularization procedures compared to that of the general population. 

While new studies are being conducted to examine the use of certain medications, such as SSRIs in treating heart disease and statins for management of depression, our current focus should be on optimizing our patients' well-being and reminding ourselves of the connection between physical and mental health. As such, consider the emotional impact of a new diagnosis of CVD or recommendation of surgery, and consider screening for mental health conditions in patients with known heart disease as addressing both issues is important to a patient's overall function, longevity, and quality of life. 

"I’ve chatted with patients about the crippling demands that heart transplants or bypass surgeries place on them. I’ve listened as patients struggle to speak, breathing heavily, lungs filled with fluid from congestive heart failure. Some patients fall into despair after years of endless medications, hospitalizations and poor health. Others are petrified by the operating room and the long road to recovery that lies ahead...

...Depressed patients with cardiac disease have mortality rates twice as high as their non-depressed counterparts. Heart disease patients with depression are at higher risk of cardiac arrest, complications from surgery and hospital readmission after undergoing procedures than those without depression."​

To read more, visit:

• https://www.washingtonpost.com/national/health-science/mental-illness-and-heart-disease-are-often-found-in-the-same-patients/2017/02/17/665e5dd0-ee1d-11e6-9973-c5efb7ccfb0d_story.html?utm_term=.e2bf61573b2e
• https://well.blogs.nytimes.com/2015/11/05/ask-well-what-is-the-link-between-depression-and-heart-disease/?smid=pl-share&_r=1
  

Put your knowledge and skills to the test with the case of Mr. C, a 61 year old man, who presents to clinic for follow-up on his antipsychotic medications that are used to manage psychosis and depression. He currently uses chlorpromazine 100mg/day and has had no psychotic symptoms in the last 3 years.

In terms of his psychiatric history, Mr. C first began to experience auditory and visual hallucinations at age 48, as well as a decline in cognition that led to his retirement from employment shortly thereafter. He has had 3 inpatient psychiatric admissions, and has continued to be treated with antipsychotics as discontinuation often leads to relapse of his psychosis.

While Mr. C has a history of aortic regurgitation, CHF, HTN, and sensorineural hearing loss, he also describes a history of cocaine abuse from 21-45. More interestingly, he also reveals a diagnosis of syphilis at 48yo, which went untreated for many months until he was diagnosed with neurosyphilis (tertiary syphilis) after developing abnormal gait, blurred vision, and general weakness.

Do you think Mr. C's psychiatric symptoms are related to his diagnosis of neurosyphilis? What tests would you order? What would you advise him on further management/treatment?

​"Psychosis in Treated Neurosyphilis: Is Now The Time To Stop His Antipsychotic?" by Kamalika Roy, Richard Balon, and Varma Penumetcha.

Check out all the news related to mental health and psychiatry from last week!