ABSTRACT
Objetivo: brindar orientación sobre las conductas terapéuticas farmacológicas, psicoterapéuticas y otras que se deben instaurar en pacientes con enfermedad cardiaca y trastornos psicoemocionales que le preceden o son consecuencia de ella. Método: se exponen las consideraciones básicas del tratamiento, los fundamentos generales de las psicoterapias que deben emplearse y una breve descripción de cada una de ellas y de las técnicas que se deben instaurar en este tipo de pacientes. Se termina con las recomendaciones farmacológicas, donde se incluyen guías de formulación, riesgos de eventos adversos de psicofármacos, dosis y seguridad de los antidepresivos, ansiolíticos y moduladores del afecto. Resultados: se introduce a consideraciones terapéuticas generales que se deben tener presentes en el paciente con cardiopatía deprimido, ansioso o estresado. Se determinan las actividades que deben ser promovidas para un estilo de vida saludable que disminuya los riesgos de cardiopatías, depresión, ansiedad y estrés. Conclusiones: la consideración de tratamientos psicoterapéuticos, de diferentes modalidades, es prioritaria para disminuir los riesgos y el agravamiento de los padecimientos.
Objective: To provide an orientation on pharmacological therapeutic conducts, psychotherapy and others which should be implemented in patients with cardiovascular disease and psychological and emotional disorders that precede or appear as a consequence of them. Method: This review exposes basic treatment considerations, general basis on psychotherapy with a brief description of each of them and the techniques that should be implemented in these types of patients. Pharmacological recommendations including guides for prescription, psychiatric pharmacological agents risk of adverse effects, dosage and security profile of antidepressants, anxiolytics and mood stabilizers are addressed. Results: This paper reviews the general therapeutical considerations that should be considered in a cardiac disease patient with depression, anxiety or stress. Lifestyle modifications and healthy habits currently recommended to decrease the risk of cardiopathy, depression, anxiety and stress are determined. Conclusions: in order to reduce risks and worsening of illness a priority should be made in regards to psychotherapeutic treatments in their different modalities.
ABSTRACT
El artículo permite concebir la relación entre la enfermedad cardiaca y los estados psicoemocionales que le preceden o son consecuencia de ella. La introducción nos brinda datos estadísticos de diversos estudios clínicos y epidemiológicos que relacionan las enfermedades cardiacas con trastornos depresivos o ansiosos, estrés y el tipo de personalidad. La segunda parte se refiere, primero, a los aspectos clínicos psicoemocionales básicos, cuyos impactos biológicos se constituyen en factores de riesgo de enfermedad cardiaca, y, segundo, a los procesos inherentes a las cardiopatías, que a su vez determinan la aparición de depresión y ansiedad. Se analizan los aspectos básicos de la personalidad Tipo A y su relación con las cardiopatías; así mismo, la cascada biológica desencadenada por el estrés que predispone a alteraciones cardiacas. Finalmente, se exponen unas breves conclusiones y recomendaciones, así como de la bibliografía consultada.
Recent studies provide clear evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary disease. This evidence is composed largely of data relating cardiac disease risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation and (5) chronic and acute life stress. Pathophysiological mechanisms underlying the relationship between these entities can be due to a excessive sympathetic nervous system activation, endothelial dysfunction, immunological and hematological abnormalities. In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and cardiac disease, identify pathologic mechanisms that may be responsible, and describe a paradigm for studying positive psychologic factors that may act as a buffer; also we review new approaches to improve the delivery of behavioral services and patient compliance. These are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for cardiac disease, are not only highly interrelated, but also require team work between the cardiologist and the psychiatrist.
ABSTRACT
Tha case of a 55 year old man who presented with severe global headache 8 hours after having been drinking heavily, and who over a two hour period developed deep coma and flaccid paralysis of all four extremities is reported. A CT scan of the brain was normal; however, on Magnetic Resonance Imaging (MRI) extensive hyperintense areas in the brain stem, mainly in the pons, were easily identified. Based upon the clinical and MRI findings a diagnosis of Central Pontine Myelinolysis was made. Following several months of supportive therapy the patient partially recovered and was able to leave the hospital.