بررسی مشکلات و چالش‌های درمان شناختی رفتاری استاندارد برای اختلال پانیک در جمعیت بیماران قلبی عروقی: یک بررسی روایی

نوع مقاله : مقاله پژوهشی

نویسندگان

1 Department of Clinical and Health Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran.

2 Associate professor, School of Psychology, Deakin University, Burwood, Victoria, Australia.

3 Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Educational Management and Educational Planning, Faculty of Psychology and Educational Sciences, Tehran University, Tehran, Iran.

10.22038/JFMH.2025.85066.3203

چکیده

مقدمه: اختلال پانیک (PD) یک بیماری شایع سلامت روان است که اغلب در کنار بیماری قلبی عروقی (CVD) رخ می‌دهد و چالش‌هایی را برای درمان ایجاد می‌کند. درمان شناختی رفتاری (CBT) یک مداخله تثبیت‌شده برای اختلال پانیک است. با این حال، استفاده از آن در بیماران مبتلا به CVD چالش‌هایی را بر اساس خطرات فیزیولوژیکی و همپوشانی علائم ایجاد می‌کند.
روش‌ کار: این بررسی روایی، خلاصه‌ای از ادبیات فعلی در مورد اختلال پانیک در بیماران قلبی عروقی را با توجه به کاستی‌های CBT استاندارد و سازگاری‌های بالقوه ارائه می‌دهد.
نتایج: چالش‌های استفاده از CBT برای درمان اختلال پانیک در بیماران مبتلا به بیماری قلبی عروقی شامل دشواری در تمایز علائم پانیک و قلبی و اقدامات احتیاطی برای مواجهه درمانی به دلیل خطرات فیزیولوژیکی است. چالش‌های استفاده از CBT برای درمان اختلال پانیک در بیماران مبتلا به بیماری قلبی عروقی شامل دشواری در تمایز بین علائم پانیک و قلبی و همچنین نیاز به احتیاط در طول مواجهه درمانی به دلیل خطرات فیزیولوژیکی بالقوه است. یک پروتکل جدید مبتنی بر درمان شناختی رفتاری، که به عنوان درمان حمله پانیک در بیماری‌های قلبی همراه (PATCHD) شناخته می‌شود، برای رسیدگی به این چالش‌ها از طریق تکنیک‌های مواجهه اصلاح‌شده، ورزش تحت نظارت و آموزش مهارت‌های مقابله‌ای پیشنهاد شده است.

نتیجه‌گیری: اختلالات اضطرابی در بین بیماران مبتلا به بیماری‌های قلبی عروقی شایع است و اثرات نامطلوبی بر پیش‌آگهی بیماری دارد. این جمعیت نیاز به اصلاح دقیق رویکرد استاندارد CBT دارند تا هم ایمن و هم مؤثر باشد. مطالعات آینده باید اثربخشی مداخلات اصلاح‌شده مانند PATCHD را برای بهبود پیامدهای روانی و قلبی عروقی ارزیابی کنند.

کلیدواژه‌ها


  1. Hanna MR, Caspi A, Houts RM, Moffitt TE, Torvik FA. Co-occurrence between mental disorders and physical diseases: A study of nationwide primary-care medical records. Psychol Med 2024; 54(15): 4274-86.
  2. Sohier L, Dallaire-Habel S, Turcotte S, Foldes-Busque G. Prevalence of mood and anxiety disorders in Canadians with cardiovascular disease: A cross-sectional study. Heart and mind 2024; 8(1): 40-46.
  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington. D.C.: American Psychiatric Association; 2022.
  4. Mensah GA, Roth GA, Fuster V. The global burden of cardiovascular diseases and risk factors: 2020 and beyond. J Am Coll Cardiol 2019; 74(20): 2529-32.
  5. Roth GA, Mensah GA, Fuster V. The global burden of cardiovascular diseases and risks: A compass for global action. J Am Coll Cardiol 2020; 76(25): 2980-1.
  6. Nakada S, Ho FK, Celis-Morales C, Jackson CA, Pell JP. Individual and joint associations of anxiety disorder and depression with cardiovascular disease: a UK biobank prospective cohort study. Eur Psychiatry 2023; 66(1): e54.
  7. Depression WH. Other common mental disorders: Global health estimates. Geneva: World Health Organization; 2017.
  8. Jiang W. Anxiety in individuals with cardiovascular diseases: A narrative review and expert opinion. Heart and mind 2022; 6(2): 52-7.
  9. Sharma Dhital P, Sharma K, Poudel P, Dhital PR. Anxiety and depression among patients with coronary artery disease attending at a cardiac center, Kathmandu, Nepal. Nurs Res Pract 2018; 2018: 4181952. 
  10. Abdisa L, Letta S, Nigussie K. Depression and anxiety among people with hypertension on follow-up in Eastern Ethiopia: A multi-center cross-sectional study. Front Psychiatry 2022; 13: 853551.
  11. Sisay T, Mulate M, Hailu T, Belete TM. The prevalence of depression and anxiety among cardiovascular patients at University of Gondar specialized hospital using beck's depression inventory II and beck anxiety inventory: A cross-sectional study. Heliyon 2024; 10(2): e24079. 
  12. Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R. Prevalence of anxiety disorders in men and women with established coronary heart disease. J Cardiopulm Rehabil Prev 2007; 27(2): 86-91. 
  13. Tully PJ, Cosh S, Pedersen S. Cardiovascular manifestations of panic and anxiety. Brain and heart dynamics. Cham: Springer; 2020: 261-79.
  14. Burg MM. Psychological treatment of cardiac patients. Washington. D.C.:American Psychological Association; 2018.
  15. Goodwin RD, Davidson KW, Keyes K. Mental disorders and cardiovascular disease among adults in the United States. J Psychiatr Res 2009; 43(3): 239-46.
  16. Sundbom LT, Bingefors K. The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden. Patient Prefer Adherence 2013; 7: 805-11.
  17. Sullivan MD, LaCroix AZ, Spertus JA, Hecht J. Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease. Am J Cardiol 2000; 86(10): 1135-8.
  18. Ono M, Serruys PW, Hara H, Kawashima H, Gao C, Wang R, et al. 10-year follow-up after revascularization in elderly patients with complex coronary artery disease. J Am Colle Cardiol 2021; 77(22): 2761-73.
  19. Zhen J, Wang J, Wang YL, Jiao J, Li J, Du XJ, et al. Fear of recurrence in elderly patients with coronary heart disease: the current situation and influencing factors according to a questionnaire analysis. BMC Cardiovasc Disord 2022; 22(1): 419.
  20. Jia Z, Du X, Du J, Xia S, Guo L, Su X, et al. Prevalence and factors associated with depressive and anxiety symptoms in a Chinese population with and without cardiovascular diseases. J Affect Disord 2021; 286: 241-7.
  21. Peng B, Meng H, Guo L, Zhu J, Kong B, Qu Z, et al. Anxiety disorder and cardiovascular disease: A two-sample Mendelian randomization study. ESC Heart Failure 2024; 11(2): 1174-81.
  22. Walli-Attaei M, Rosengren A, Rangarajan S, Breet Y, Abdul-Razak S, Al Sharief W, et al. Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study. Lancet 2022; 400(10355): 811-21.
  23. Garfield LD, Scherrer JF, Hauptman PJ, Freedland KE, Chrusciel T, Balasubramanian S, et al. Association of anxiety disorders and depression with incident heart failure. Psychosom Med 2014; 76(2): 128-36.
  24. Tully PJ, Cosh SM, Baumeister H. The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. J Psychosom Res 2014; 77(6): 439-48.
  25. Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: A meta-analysis. J Am Coll Cardiol 2010; 56(1): 38-46.
  26. Emdin CA, Odutayo A, Wong CX, Tran J, Hsiao AJ, Hunn BH. Meta-analysis of anxiety as a risk factor for cardiovascular disease. Am J Cardiol 2016; 118(4): 511-9.
  27. Rezaee M, Darroudi H, Etemad L, Shad AN, Zardast Z, Kohansal H, et al. Anxiety, a significant risk factor for coronary artery disease: What is the best index. BMC Psychiatry 2024; 24(1): 443.
  28. Liebowitz MR, Gorman JM, Fyer AJ, Levitt M, Dillon D, Levy G, et al. Lactate provocation of panic attacks: II. Biochemical and physiological findings. Arch Gen Psychiatry 1985; 42(7): 709-19.
  29. Kotianova A, Kotian M, Slepecky M, Chupacova M, Prasko J, Tonhajzerova I. The differences between patients with panic disorder and healthy controls in psychophysiological stress profile. Neuropsychiatr Dis Treat. 2018; 14: 435-41.
  30. Abrignani MG, Renda N, Abrignani V, Raffa A, Novo S, Lo Baido R. Panic disorder, anxiety, and cardiovascular diseases. Clinical neuropsychiatry 2014; 11(5): 130-44.
  31. Caldirola D, Schruers KR, Nardi AE, De Berardis D, Fornaro M, Perna G. Is there cardiac risk in panic disorder? An updated systematic review. J Affect Disord 2016; 194: 38-49.
  32. Wu M, Zhu Y, Lv J, Guo Y, Yang L, Chen Y, et al. Association of anxiety with cardiovascular disease in a Chinese cohort of 0.5 million adults. J Affect Disord 2022; 315: 291-6.
  33. Um YH, Han KD, Kim TW, Jeong JH, Hong SC, Seo HJ. Does panic disorder increase the risk of cardiovascular diseases in diabetics?: A nationwide population-based study. J Affect Disord 2023; 325: 604-10.
  34. Chang HM, Pan CH, Chen PH, Chen YL, Su SS, Tsai SY, et al. Premature death and causes of death among patients with panic disorder and comorbid psychiatric disorders: A nationwide cohort study. J Psychiatr Res 2022; 148: 340-7.
  35. Pogosova N, Saner H, Pedersen SS, Cupples ME, McGee H, Höfer S, et al. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur J Prev Cardiol 2015; 22(10): 1290-306.
  36. Blumenthal JA, Smith PJ, Jiang W, Hinderliter A, Watkins LL, Hoffman BM, et al. Longer term benefits of exercise and escitalopram in the treatment of anxiety in patients with coronary heart disease: Six month follow-up of the UNWIND randomized clinical trial. Am Heart J 2022; 251: 91-100.
  37. Levy HC, Worden BL, Davies CD, Stevens K, Katz BW, Mammo L, et al. The dose-response curve in cognitive-behavioral therapy for anxiety disorders. Cogn Behav Ther 2020; 49(6): 439-54.
  38. Dubovsky SL, Marshall D. Benzodiazepines remain important therapeutic options in psychiatric practice. Psychother Psychosom 2022; 91(5): 307-34.
  39. Kaplan H. Kaplan and Sadock's synopsis of psychiatry. 11th ed. Philadelphia: Wolter Kluwer; 2014.
  40. Tully PJ, Sardinha A, Nardi AE. A new CBT model of Panic Attack Treatment in Comorbid Heart Disease (PATCHD): How to calm an anxious heart and mind. Cognitive and behavioral practice 2017; 24(3): 329-41.
  41. Tully PJ. Cognitive behavioural therapy for anxiety in cardiovascular diseases and implantable devices: A cautionary note. Eur J Prev Cardiol 2020; 27(19): 2049.