Are Heart Attacks Preceded By Psychological Warning Symptoms?

Main Category: Psychology / Psychiatry
Article Date: 06 Sep 2005 - 0:00 PDT

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A group of investigators of the University of Modena and Reggio Emilia (Italy) has published a report on the psychological symptoms which may precede a heart attack. Little is known about the psychosocial characteristics of patients who had an heart attack in the period that preceded the myocardial infarction (MI).

The aim of this study was to explore this phase (prodromal phase of MI)with methodologies which have been standardized in affective disorders.

The psychological evaluation of patients with MI diagnosis is currently based on DSM-IV criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. In this study, we are going to compare these new criteria, i.e. the Diagnostic Criteria for Psychosomatic Research (DCPR), with DSM-IV in a population where a high prevalence of psychological problems is expected. A semistructured research interview based on Paykel's Clinical Interview for Depression for eliciting prodromal symptoms was administered to a consecutive series of 92 patients with a first episode MI diagnosis. Two interviews for the evaluation of psychological problems were administered according to DSM-IV and DCPR criteria.

Most of the patients reported prodromal symptoms. Irritability, depressed mood and somatic anxiety were the most common ones. The results also show that the number of DCPR diagnoses was higher than the number of DSM-IV diagnoses. At least one DCPR diagnosis was found in all patients, whereas at least one DSM-IV diagnosis was present in 42 (46%) patients.

The prodromal phase of MI was found to be characterized by prodromal symptoms of affective type. The joint use of DSM-IV and DCPR criteria was found to improve the identification of psychological factors which could affect this phase. The results should alert the physician to the fact that patients presenting with irritability, depressed mood (including demoralization), anxiety and insomnia may be at risk of developing coronary artery disease.

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