Long-term emotional consequences of in-hospital cardiac arrest and myocardial infarction.

OBJECTIVES: Prevalence rates for post-traumatic stress disorder (PTSD) of 10% have been reported following myocardial infarction (MI). However, there has been little research conducted on the long-term emotional sequelae of cardiac arrest (CA). The present study provides new information in that regard. The research aims were: (1). to compare the prevalence and severity of emotional disability in survivors of CA with that of cardiac patients who suffered an MI but no CA, (2). to assess both groups for the symptoms of PTSD, and (3). to assess the validity of a self-report measure for PTSD with a cardiac population. DESIGN: Case-control study. METHOD: Patients who suffered a cardiac arrest in-hospital (N = 27) were compared with patients who had an MI uncomplicated by cardiac arrest (N = 27), 9.6 (5.0) months following their index event. Each patient completed a series of questionnaires and a structured interview to ascertain affective adjustment, and PTSD symptoms and diagnoses. RESULTS: (1). Most MI and CA patients reported high levels of emotional well-being and stability. (2). Five (19%) CA survivors and two (7%) MI survivors (ns) fulfilled DSM-IV criteria for PTSD when assessed by structured clinical interview (SCID). (3). There was relatively poor agreement between the interview and self-report diagnoses when identifying PTSD cases (kappa =.39). CONCLUSION: The significant minority of cardiac patients warranting diagnoses of PTSD has implications for their management and rehabilitation. Identification of these patients is an important step towards improving their overall health outcomes. The structured clinical interview remains the 'gold standard' for the identification of PTSD in cardiac patient populations.

In-hospital cardiac arrest leads to chronic memory impairment.

OBJECTIVE: To assess the prevalence and severity of memory deficits in a group of patients who survived an in-hospital cardiac arrest (IHCA) in comparison with patients resuscitated after cardiac arrest outside hospital (OHCA) and patients with acute myocardial infarction (MI). SUBJECTS: Thirty-five IHCA survivors, 35 OHCA survivors, and 35 patients who had suffered MI uncomplicated by cardiac arrest. PROCEDURE: Participants were assessed 8.2 (4.5) months after the event for current affective state (Hospital anxiety and depression scale (HADS)), pre-morbid intelligence (National adult reading test (NART)), short-term memory (digit span test) and long-term episodic memory (Rivermead behavioural memory test-RBMT). RESULTS: IHCA patients scored lower on the RBMT than MI controls but did not score significantly differently OHCA patients. Moderate or severe memory impairment was found in 26% of the IHCA group and 38% of the OHCA group. None of the MI group was found to have this degree of impairment. This difference in prevalence of memory impairment between the two cardiac arrest groups was not statistically significant. However, both arrest groups had significantly greater memory impairment than the MI control group. CONCLUSIONS: Clinically important memory impairment was found in one in four patients surviving IHCA. The shorter arrest durations that are thought to be associated with IHCA may not be sufficient to protect patients from memory impairment associated with cerebral hypoxia.

Alexithymia and sense of coherence in patients with total spinal cord transection.

OBJECTIVE: The study investigated the possibility that total spinal cord transection leading to tetraplegia would affect the ability to experience and identify emotions. It also examined whether the dispositional orientation of "sense of coherence" contributed to self-rated quality of life after spinal cord transection. METHODS: Twenty patients with total spinal cord transection at the level of the sixth cervical vertebrae and 20 age- and sex-matched healthy control subjects completed measures of alexithymia, sense of coherence, and quality of life. RESULTS: There were no differences between the two groups on alexithymia scores. However, spinal injury patients reported significantly decreased quality of life relative to matched healthy control subjects. A strong sense of coherence was associated with better self-reported quality of life. This relationship remained after controlling for current affective status. CONCLUSIONS: We conclude that 1) loss of afferent feedback to the brain via the spinal cord does not have a significant effect on alexithymia scores, particularly factor 1 (difficulty in identifying feelings), and 2) sense of coherence may be an important factor in determining psychological adjustment after serious injury.