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The Connection Between Mental & Cardiac Health

2/27/2017

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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

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Think Like A Psychiatrist - Psychotic Symptoms and A Previous Diagnosis of Neurosyphilis

8/24/2016

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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.

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Psych In The News - Week 67

6/21/2015

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

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Think Like A Psychiatrist - A Physician With Depression & Pain 

6/4/2015

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Put your knowledge and skills to the test with this case of Dr. D, a 33 year old physician who presents with depression, suicidal ideation, and somatic complaints.  He tells you about the many pressures of running his practice, including financial stresses, of conflicts with his wife, of feeling lonely and having a lack of close friends, and of feeling generally unhappy, unsatisfied and exhausted.  On top of his emotional complaints, he also describes increased tension and pain from his shoulders, neck and face.  He has also noticed that he has not been as attentive, which has begun to impact his work performance and patient care.  With regards to family history, both Dr. D's mother and grandfather had depression.

How would you manage this patient? What treatment would you offer or suggest?

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A physician who feels hopeless and worthless and complains of pain" by Daniel J. Rapport, Angele McGrady, Vipul Mahajan, and Ernest Brookfield (Current Psychiatry).

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People with mental health disorders twice as likely to have heart disease or stroke

10/31/2014

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A study by Dr. Katie Goldie at the Centre for Addiction and Mental Health in Toronto explored the associations between cardiovascular risk and disease, mental health disorders and the use of psychiatric medication. The study found that people who used psychiatric medications were twice as likely to have heart disease and three times as likely to have had a stroke compared to those not taking these medications. Among the psychiatric drugs examined were antipsychotic, antidepressant, benzodiazepine and mood-stabilizing medications.

Dr. Goldie mentions three main factors that accounts for the elevated risk. First, people with mental health disorders often exhibit behavioural risk factors, including tobacco and alcohol use, poor diet and physical inactivity. Second, psychiatric medications can induce weight gain and impair the breakdown of fats and sugars by the body. This can lead to obesity, high cholesterol and diabetes. A third issue is access to health care. Patients with mental health disorders may have difficulty communicating their health needs.

Read more here: http://esciencenews.com/articles/2014/10/31/people.with.mental.health.disorders.twice.likely.have.heart.disease.or.stroke


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