Clinical Practice Review For Assessment And Treatment Of Anxiety And Depression

Submitted By vacuoso
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An Article Critique of "Clinical Psychology and Cardiovascular Disease: An Up-to-Date Clinical Practice Review for Assessment and Treatment of Anxiety and Depression”

CLINICAL PSYCHOLOGY AND CARDIOVASCULAR DISEASE 2 Dying from a broken heart—is it just an overused melodramatic aphorism, or could there be some medical truth in the old adage? Most, if not all, doctors and nurses will tell you that such a thing is “an old-wives’ tale”; however, there is much more truth in that statement than most medical professionals will admit. It is an easy thing, to equate a “broken heart” with the diagnosis of depression. What, if any, is the link between depression (and its associated condition of anxiety) and cardiovascular disease? The article, "Clinical Psychology and Cardiovascular Disease: An Up-to-Date Clinical Practice Review for Assessment and Treatment of Anxiety and Depression”, found in a 2011 issue of Clinical Practice & Epidemiology in Mental Health, discusses the existence of a definite causative connection between the broken hearts of the psychological variety (depression & related anxiety) and broken hearts of the physiological variety (Cardiovascular Disease (CVD), especially Coronary Heart Disease (CHD) and Myocardial Infarction (MI)). This critique of that article will summarize its key points, explore the main articles it draws its information from, offer my own reaction as an RN student, and explain how I plan to incorporate the knowledge it contains into my practice. First of all, what is the connection between depression and cardiovascular disease? A 2008 American Heart Association (AHA) Science Advisory mentions that, over the past forty years, there have been more than sixty studies examining the link between depression and, specifically, CHD. It states, “Depression is ≈3 times more common in patients after an acute myocardial infarction (AMI) than in the general community” (Lichtman, et al., 2008). An American Medical Association study from 2001 expounds on what the higher incidence of depression that accompanies CVD means to the patient: “Patients with cardiovascular diseases, such as ischemic heart disease, acute myocardial infarction, and stroke, have a high prevalence
CLINICAL PSYCHOLOGY AND CARDIOVASCULAR DISEASE 3 of depressive disorder, and greater morbidity compared to patients without depression” (Jiang, et al., 2001) [Italics mine]. What this means is that not only are patients with CVD more likely to be depressed, but that if they do exhibit depression, they are more likely to die due to complications of their cardiovascular problems. The article this paper is reviewing includes the diagnosis of anxiety and expounds, “In fact, patients who have anxiety or depression during hospital admission are at increased risk for higher rates of in-hospital complications such as recurrent ischemia, re-infarction and malignant arrhythmias” (Compare, et al. 2011). When one considers this in conjunction with the epidemic quality of CVD, as illustrated by the statistics provided by the AHA report “Heart Disease and Stroke Statistics—2013 Update”, namely, that “in 2009, CVD accounted for 32.3% (787,931) of all 2,437,163 deaths, or 1 of every 3 deaths in the United States. On the basis of 2009 death rate data, >2150 Americans die of CVD each day, an average of 1 death every 40 seconds” (Go, et al. 2013). It becomes apparent that controlling the depression and anxiety that accompanies CVD needs to be a priority for all health care professionals who interact with people with, or who are at increased risk for, Cardiovascular Disease. The important question then becomes, “How do health care professionals, especially someone beginning his nursing career (as I am), create and introduce effective interventions that will make a real difference in the prognosis of these individuals?” This question can be answered