Psychological status during recovery from an acute heart attack

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Abstract

Two hundred and three male patients with ischaemic heart disease who had received initial treatment in the Coronary Care Unit, Royal Infirmary of Edinburgh, were interviewed in a medical ward during their convalescence and an estimate of their medical, psychiatric and social state was made. Psychological testing included a symptom measure of emotional upset (SSI).

Patients presumed to have myocardial ischaemia differed from those with myocardial infarction in that they had poorer work records, were more withdrawn socially and had tolerated psychological symptoms for a shorter time before admission. Though they suffered less severe heart attacks they had at least as much emotional upset during hospitalisation.

The presence of emotional upset (a maximal clinical estimate) was recorded in 131 (65 per cent) patients with symptoms of anxiety and depression predominating, and in 110 (54 per cent) cases this was present before admission. On discharge 79 (42 per cent) of the 191 survivors expected to encounter social problems at work, at home or financially. The reaction of the patient to having a heart attack was closely related to the presence or absence of social problems.

Psychosocial status was not related to the physical severity of the acute attack. Those who were most upset and had severe social problems were not always those who were most ill.

It is suggested that social and psychiatric intervention at an early stage might be appropriate in those patients whose psychosocial problems are at least as debilitating as their physical illness.

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From the Coronary Care Unit, Royal Infirmary of Edinburgh, Department of Psychological Medicine and MRC Unit for Epidemiological Studies in Psychiatry, University of Edinburgh.

This study was supported by a grant from the Scottish Hospital Endowments Research Trust.

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