Psychosomatic Disorders in Patients with Pulmonary Hypertension: Impact on Treatment Adherence

The aim of work: to study psychosomatic disorders manifesting in connection with the circumstances of pulmonary hypertension (PH), to evaluate the impact of psychosomatic pathology on the features of the internal picture of the disease formation, the level of compliance, to determine the need for psychocorrectional measures.

Material and methods: there were 40 patients with PH of the 1st and 4th groups admitted consistently from September 2017 to September 2018 in the City Clinical Hospital №51 of the Moscow City Health Department. The following parameters were evaluated: frequency, spectrum and severity of diagnosed psychiatric disorders, their duration, personality disorders and types of response to the disease using experimental psychological methods. These parameters were compared with indicators of the severity of PH at the time of the psychiatric examination.

Results: from 40 patients in 30 (75%) were diagnosed with mental disorders in the framework of psychosomatic pathology. All patients were divided into 4 groups depending on the type of registered psychosomatic diso refers. Diagnosed psychosomatic pathology differs in the mechanisms of development duration, severity of mental disorders, depends on the severity of symptoms of PH. In each group, features of the internal picture of the disease and differences in the level of compliance depending on the type of psych о somatic pat ho logy we re revealed. In addition, in the considered groups,the need for psychopharmacotherapy and psychotherapy.

Conclusion: the presence of comorbid psychosomatic pathology in patients with PH significantly influences the formation of theinternal picture of the disease and the level of compliance, which emphasizes the importance of formation the multidisciplinary team of specialists, including psychiatrists and psychotherapists in the management of this patients group.

1. Galie N. Humbert М, Vachiery J. et al. 2015 ESC/ ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). European Heart Journal. 2016;37(1):67-119. DOI: 10.1093/eurheartj/ehv317.

2. Yorke J. Deaton C, Campbell M, et al. Symptom severity and its effect on health-related quality of life over time in patients with pulmonary hypertension: a multisite longitudinal cohort study. BMJ Open Respiratory Research. 2018;5(l):e000263. DOI: 10.1136/bmjresp2017-000263.

3. Pfeuffer E, Krannich H, Halank M, et al. Anxiety, Depression, and Health-Related QOL in Patients Diagnosed with PAH or СТЕРН. Lung. 2017;195(6):759-68. DOI: 10.1007/s00408-017-0052-z.

4. Tartavoulle TM. A predictive model of the effects of depression, anxiety, stress, 6-minute-walk distance, and social support on health-related quality of life in an adult pulmonary hypertension population. Clinical nurse specialist. 2015;29(l):22-28. DOI: 10.1097/nur.0000000000000099

5. Smulevich АВ. Mental disorders in clinical practice. M.: MEDpress-inform; 2011. (In Russ.).

6. Hare DL, Toukhsati SR, Johansson P. Jaarsma T. Depression and cardiovascular disease: a clinical review. European Heart Journal. 2014;35(21):1365-1372. DOI: 10.1093/eurheartj/eht462.

7. Petrova NN, Pilevina YuV. Mental disorders and compliance of patients with chronic heart failure. Psikhicheskie rasstroistva vobschei medicine. 2012;3:26-31. (In Russ.)

8. Zrazhevskaya IA. Actual problems of psychiatry, narcology and psychology — verge of contact — interdisciplinary integration for searching the solutions. Materials of the Second Annual scientific-practical conference with international participation «Drozdovski Readings»; December 8-9, 2015; Moscow. Available at: https://psychiatr.ru/download/2579?view=l&name=C6opник+II+Дроздовские+чтения.pdf. Accessed Mayl3, 2019. (In Russ.).

9. Alekhin AN. Trifonova EA, Chernoray AV. Attitude to disease in patients following cardiac emergencies. Arteriainaya gipertenziya. 2012;18(4):317-24. (In Russ.).

10. Урываев BA, Тарасова AA. Личностные детерминанты реакции на стресс. Ученые записки университета им. П.Ф. Лесгафта. 2011;б(76):168-173. [Uruvaev VA, Tarasova AA. Determinants of personality stress reaction. Uchenye zapiski universiteto imeni P.F. Lesgajta. 2011;6(76):168-173. (In Russ.)].

11. Dempe C, Jiinger J, Hoppe S, et al. Association of anxious and depressive symptoms with medication nonadherence in patients with stable coronary artery disease. Journal of Psychosomatic Research, 2013:74(2): 122-127. D0I: 10.1016/j.jpsychores.2012.12.003.

12. Smulevich AB, Ivanov SV, Myasnikova LK i dr. Stress-induced dissociation in the trajectory of schizotypal personality disorder (on the model of nosogenias in oncologic patients). Zhurnol nevrologii i psikhiatrii imeni S.S. Korsakova. 2014;114(12):12-22. D0I: 10.17116/jnevro201411412112-22. (In Russ.)].

13. Smulevich AB, Ivanov SV. Myasnikova LK i dr. Dissociative disorders in oncology: psychopathology, comorbidity with personality disorders Psikhicheskie rasstroistva v obscheimedicine. 2014;3-4:4-14. (In Russ.).

14. Saran RK, Puri A. Agarwal M. Depression and the heart. Indian Heart Journal. 2012;64(4):397-401. D0I: 10.1016/j.ihj.2012.06.004.

15. Teply RM, Packard KA, White ND, et at. Treatment of Depression in Patients with Concomitant Cardiac Disease. Progress in Cardiovascular Diseases. 2016;58(5):514-528. D0I: 10.1016/j.pcad.2015.11.003.