Algengi, greining og meðferð þunglyndis og kvíða sjúklinga í hjartaendurhæfingu
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Issue Date
2007-12-01
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Prevalence, diagnosis and treatment of depression and anxiety in patients in cardiac rehabilitationCitation
Læknablaðið 2007, 93(12):841-5Abstract
OBJECTIVE: The aim of this study was to estimate the prevalence of depression and anxiety among patients in cardiac rehabilitation at Reykjalundur Rehabilitation Center and to study the impact of a 4-5 weeks inpatient cardiac rehabilitation program on these symptoms. Secondly we wished to compare the concordance of our clinical diagnosis with the results of a standardized psychometric scale, Hospital Anxiety and Depression scale, HAD. MATERIALS AND METHODS: Of 224 patients in one year, 200 (89.3%) were included in the study, 151 men and 49 women. The patients were first evaluated by a doctor and a nurse separately at the arrival and a clinical evaluation was made jointly. Shortly after arrival and before departure a HAD questionnaire was to be answered. All new psychiatric treatment was recorded. RESULTS: Prevalence of depression as measured by HAD was reduced from 9.5% to 3.1% and anxiety from 11.6% to 2.5%. The sensitivity of clinical diagnosis of depression as compared to the results of HAD was 73.7% and specificity 87.3%. For anxiety the sensitivity was 86.4% and specificity was 79.2%. The predictive value of a positive clinical diagnosis of depressions was 37.8% and anxiety 33.9%, but predictive value of a negative clinical diagnosis was 96.9% and anxiety 97.9% respectively. CONCLUSION: The prevalence of depression and anxiety is similar or somewhat lower than in other studies on patients with cardiac diseases. The agreement of clinical diagnosis and HAD questionnaire was acceptable and the questionnaire will not be used routinely. A comprehensive cardiac rehabilitation program seems to reduce substancially symptoms of depression and anxiety among patients in cardiac rehabilitation at Reykjalundur.Tilgangur: Markmið rannsóknarinnar var að kanna algengi þunglyndis og kvíða hjá þeim sem komu til hjartaendurhæfingar á Reykjalundi og samsvörun klínískrar greiningar og niðurstöðu viðurkennds þunglyndis- og kvíðakvarða, Hospital Anxiety and Depression Scale (HAD). Einnig að meta áhrif hjartaendurhæfingar á Reykjalundi á einkenni þunglyndis og kvíða. Efniviður og aðferð: Allir sem innrituðust í hjartaendurhæfingu á Reykjalundi frá 1. apríl 2005 til 31. mars 2006 voru beðnir að taka þátt. Læknir og hjúkrunarfræðingur mátu hvort í sínu lagi við innritun sjúklings hvort viðkomandi væri þunglyndur eða kvíðinn og skráðu síðan sameiginlegt klínískt mat. Í fyrstu viku endurhæfingartímans var HAD spurningalistinn lagður fyrir og aftur við brottför. Skráð var öll ný geðmeðferð á dvalartímanum. Niðurstöður: Af 224 sjúklingum sem komu á árinu tóku 200 (89,3%) þátt í rannsókninni, 151 karl og 49 konur. Samkvæmt HAD var algengi þunglyndis 9,5% við komu en 3,1% við brottför og algengi kvíða var 11,6% við komu en aðeins 2,5% við brottför. Næmi klínískrar greiningar þunglyndis borið saman við niðurstöður HAD reyndist 73,7% en sértækni 87,3%. Næmi greiningar kvíða reyndist 86,4% en sértækni 79,2%. Forspárgildi jákvæðar klínískrar greiningar þunglyndis var 37,8% og kvíða 33,9% en forspárgildi neikvæðar klínískrar greiningar þunglyndis 96,9% og kvíða 97,9%. Ályktun: Algengi þunglyndis og kvíða er svipað eða nokkru lægra en í öðrum rannsóknum meðal hjartasjúklinga. Næmi og sértækni klínískra greininga miðað við HAD kvarða er ásættanlegt og ekki virðist því ástæða til að taka upp reglubundna skimun. Hjartaendurhæfing með þjálfun og fjölbreyttum stuðningi ásamt sérhæfðri geðmeðferð, dregur verulega úr einkennum þunglyndis og kvíða.
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