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Features of formation and clinics depressive disorders in patients after myocardial infarction
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Muxamadiyeva Nigina Bakhodirovna, Assistant of the Department of Psychiatry and Narcology, Bukhara State Medical Institute, Bukhara, Uzbekistan
E-mail: ss-1961@mail.ru
Features of formation and clinics depressive disorders in patients after myocardial infarction
Abstract: Now the problem of depression and somatic diseases, in particular, a cardiovascular profile is extremely actual. In the given research the factors contributing to formation of post infract depression are considered, the characteristic actually post infract is given to depression.
Keywords: acute myocardial infarction, depressive disorders, post infract depression, risk factors.
Depression is very often connected to one another, somatic, to diseases, and in such cases of disease of two different spheres — mental and somatic — aggravate each other, at times leading to serious consequences. In special degree it concerns diseases of cardiovascular system [1]. Among patients with cardiovascular diseases (CVD) frequency of accompanying depression makes 22-33 % [2]. At 17-27 % of patients with the ischemic heart trouble, undergoing procedure coronary angiography depressions [3; 4] come to light, and in patients in post infarct the depression (PID) period are found out in 16-45 % of cases [5; 6]. Presence of depression at patients of CVD not only complicates a current and therapy of these disorders, but also reduces life expectancy of patients. Connected to a heart attack depression predetermines three-quadruple increase in cardiovascular death rate. Though the quantity of the researches devoted to depression at patients of post infract, is rather insignificant, there is a number of proofs of that without treatment it within a year after the transferred myocardial infarction (MI) gets chronic character [7-9].
All of the above, and especially poorly known immediately PMI depression in patients late after suffering a MI, and in the first days after an acute attack has defined the purpose of this study, which is a part of a larger research work.
The aim of the research — studying of the factors promoting occurrence of depressive disorders (DD) at patients with acute myocardial infarction (AMI).
Materials and methods
The given research was spent on the basis of cardiological department of Bukhara branch of the Republican Scientific Center of Emergency Medical Care and a Regional Cardiological Dispensary to the period from 2010 to 2014. 121 patient has been included in research with the established diagnosis of a AMI by criteria MCB-10, given the informed consent and not finding out the expressed changes of the person interfering inspection.
Patients have been divided into 2 groups. In the 1st, the basic, 88 patients with AMI which in the subsequent the DD confirmed clinically and by means of diagnostic scales have developed have entered; the 2nd group have made 33 patients who also have transferred AMI, but not suffering in the subsequent the depression symptoms. Clinic dynamic supervision over patients in the period of PMI has been carried out.
Patients have been included in research as man's (52 persons (59.1 %) in the basic group and 27 persons (81.8 %) in comparison group), and female (36 (40.9 %) and 6 (12.2 %) the person accordingly). At the analysis of distribution ofpatients on age at the moment of the beginning of carrying out of research it has been revealed that the most part of patients both in the basic group, and in comparison group is made by patients at the age from 61 years and is more senior (50 % ofpatients of the basic group and 45.4 % ofpatients ofgroup of comparison). At all investigated patients DD were a consequence of the PMI, that is the fact of a AMI became the psychologic traumatic
Section 5. Medical science
factor promoting occurrence of DD. Patients have not been included in research with endogenous depression, the DD which have developed owing to other psychologic traumatic situation.
In the carried out research methods such mathematical, statistical, clinic psychopathological, clinic catamnesis were used.
Results and discussion
By the time of primary inspection of 74 % surveyed patients (76.1 % of patients of the basic group and 69.7 % of patients of 2 groups) initially arrived in a cardiological hospital with the diagnosis a AMI; at all remained patients the considered case of a AMI happened repeatedly.
At the analysis of a clinical-dynamic currents of the basic disease and its comparison in two groups the following has been revealed. There is no authentic correlation between degree of defeat of a myocardium and probability of occurrence PID though and it is possible to notice that in group of comparison frequency transmural heart attacks was below (80.7 % basically against 54.5 % in comparison group). Clinically doubtfully also to establish interrelation between presence/absence of complications after a PMI, character of the acute phase — on the one hand and frequency of occurrence PMI depressions — with another. However accurate distinctions among compared groups are traced at an estimation of duration of actually ischemic attack. So, in group of patients with developed post infract depression almost at half of patients (47.7 %) duration of painful attack has made more than 20 minutes, and at 38.6 % of representatives of this group it proceeded from 15 till 20 minutes. At the same time in group of comparison at the overwhelming majority surveyed duration of ischemic attack did not exceed 15 minutes (72.7 %); the number of at whom this period has made 15-20 minutes and equals more than 20 minutes 15.2 % and 12.1 % accordingly. Also attracts attention that fact that in the basic group overwhelming number of patients (73 persons that makes 83 %) tried to stop an attack nitroglycerine, but unsuccessfully, at 4.5 % of patients of the basic group these attempts have brought some simplification, the remained patients at all did not use nitroglycerine. In group of comparison the quantity of the patients who were not accepting nitroglycerine for simplification of a painful syndrome, has exceeded half of all patients of the given group (51.2 %), it in 4.12 times above an indicator of the basic group. The inefficient accorded welcome of this preparation in 12.1 % of cases (in the basic group this indicator in 6.9 times above), and only with insignificant effect — in 36.4 %.
From resulted above the data it is possible to draw a conclusion that PID influence occurrence possibility such factors of the basic somatic disease, as duration of ischemic attack and possible attempts independently (and it is inefficient!) to stop an attack a preparation of some nitrates (in our case — nitroglycerine). Last fact, possibly, speaks the generated fear before persistence of a painful syndrome and reduction of belief in rendering assistance.
It is obvious that optimum adapt for a condition after a AMI of the person with hyperthymic personality traits and the balanced persons (21.2 %, 48.5 % accordingly), and at disturbing and psychasthenic people DD (52.3 % and 19.3 % accordingly) is more often were registered. Return correlation between probability of occurrence PID and an educational level of the patient is marked: the above an educational level, the more low probability of formation of DD.
Characterizing actually DD (patients of the basic group), it is possible to allocate following key moments:
1. At 63 patients (71.6 %) PID was estimated by means of diagnostic scales as moderate severity level.
2. At 69 patients (78.4 %) formation of DD has begun already in the first 7 days after the transferred ischemic attack.
3. Prevailing component of a classical depressive triad in a case PMI in our research it has appeared depressions affective (48 patients that has made 54.5 %).
4. Among melancholic, disturbing and dysphoretic affects dominates disturbing (59 cases that makes 67 %).
5. 50 patients marked presence ofproofsuicide thoughts (56.9 %).
Thus, considering the clinical characteristic of a depressive
episode, it is possible to consider expedient appointment of antidepressive therapy already in the first week post infarct the period, and, possibly, it is necessary to give preference to energizers with expressed anxiolytic effect. It will allow to warn formation of the expressed DD and to avoid occurrence of the most dangerous result of depression — suicide thoughts and attempts.
Conclusion:
1. The probability of occurrence PID increases with increase in duration of ischemic attack.
2. PID are more subject to occurrence of the person with the low educational level, the burdened heredity on mental diseases and with disturbing and psychasthenic types of the person.
3. Carrying out of antidepressive therapy is expedient already in the first week after the transferred AMI; preference, possibly, it is necessary to give to preparations with expressed anxiolytic effect.
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