Psychological trauma of heart attack may undermine treatment

August 30, 2001

Experiencing a heart attack can leave psychological scars that make it harder for some patients to recover, according to a new study.

In the study of 102 heart attack patients, about 10 percent developed significant symptoms of post-traumatic stress disorder. In turn, the patients with these symptoms were less likely to take their heart medication as prescribed.

"Although PTSD was initially thought to be exclusively linked to war and natural disasters, it has recently been recognized that life-threatening diseases may lead to the same constellation of symptoms," says Eyal Shemesh, M.D., of Mount Sinai Medical Center in New York.

"A patient who is suffering from PTSD that is related to medical illness may not take the prescribed medication because taking it serves as a recurrent reminder of the traumatic experience," like a heart attack, Shemesh says.

Following the heart attack patients for six months to one year, Shemesh and colleagues found that 40 percent experienced some symptoms of PTSD, while 10 percent had significant symptoms. These latter patients with significant symptoms returned more pills unused than patients with one or no symptoms of PTSD.

The study is published in the July/August issue of General Hospital Psychiatry.

The researchers found that poor adherence correlated with more serious adverse events, confirming that their measure of adherence, the number of pills patients returned every three months, was a reliable indicator. Serious adverse events were defined as death or as hospitalization due to another heart attack, unstable angina or arrhythmia.

They saw most of the serious adverse events in the patients that suffered more medical symptoms after their heart attack. These patients were more likely to suffer from PTSD symptoms and show a stronger association between these symptoms and nonadherence than post-heart attack patients who asymptomatic after their heart attack, the investigators say.

A questionnaire given to the heart attack patients identifies two of the three constellations of symptoms used to diagnose PTSD. Although, the results of the questionnaire are not sufficient to make a clinical diagnosis of PTSD, the investigators say that in the setting of a busy cardiology clinic, the administration of the short questionnaire is much more practical than conducting a full psychiatric interview with each patient.

Although PTSD is often associated with other psychiatric disorders, such as depression, anxiety and hostility, the presence of any of these problems could not fully explain the level of nonadherence seen in this study. The nonadherence was not associated with "background" psychological disorders, but trauma-specific symptoms related to the patient's heart attack, the investigators say.

Eyal Shemesh received the 2000 American Psychiatric Association/Lilly Resident Research Award for this study.
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Don R. Lipsitt, MD, at (617) 499-5008.

Center for Advancing Health

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