Relevance. The Republic of Kazakhstan ranks ninth in the ranking of mortality from coronary heart disease in the Commonwealth of Independent States. Almost every tenth citizen of Kazakhstan today suffers from coronary heart disease, and among those who died from it-a large proportion of the economically active population aged 18 to 64 years . In patients who have suffered a myocardial infarction, psychogenic neurotic reactions are observed, as well as neurotic disorders in the form of mainly asthenic, anxiety and depressive states . In turn, it was found that the depressive state of the patient negatively affects the clinical course of the disease, the overall quality of life of patients, the tendency to treatment and the implementation of medical recommendations . All this dictates the need for timely detection and timely treatment of psychoemotional disorders in patients . The reasons that lead to the development of cardiological events include psychophysiological (for example, increased stress reactivity, high levels of signs of subclinical inflammation and changes in metabolism) and behavioral factors (low physical activity, unhealthy lifestyle , untimely implementation of the doctor's recommendations). In addition, the prognosis of these factors varies depending on the views of patients on their own health, the Health Organization of that state, and the level of socio-economic development due to different stereotypes in each state. Patients who have suffered a myocardial infarction have several different psychological reactions to the disease . This means not only the initial reaction in the form of fear, uncertainty about the positive outcome of the disease, etc., but also further changes in the psyche directly related to the development of the disease and the person's understanding of his condition. There are 2 types of attitudes to the disease: normal (adequate) psychological reactions and pathological (neurotic) psychological reactions .
Objective: Determination of the level of psychoemotional disorders in patients with myocardial infarction using the HADS scale.
Materials and methods. At the Shymkent heart center of JSC, 64 patients with a myocardial infarction ( age 54.6±10.5 years) aged 46-65 years who were affected by a myocardial infarction for 3 weeks (age 54.6 ± 10.5 years) were selected, methods of interview and general clinical research were conducted and patients were selected according to the specified criteria. Before the start of the study,the course of the study was explained in a language accessible to all patients, the nature of the procedures carried out, and after familiarizing the patients with the course of the study, they signed an informed agreement. Physical rehabilitation of patients was carried out according to the methodology of individual physical exercises, which form a complex of basic exercises with a mode of movement of the VII stage, special for the stages of each disease degree for patients who have experienced a myocardial infarction (Aronov D.M., Bubnova M.H.,Pogosova G.V). Patients completed a questionnaire for depression and anxiety HADS to determine their mental status 2-4 days after hospitalization.
When interpreting the data of the HADS survey, taking into account the indicators of all scales, the results of the study are divided into 3 indicators: 0-7 points - the norm; 8-10 points - subclinically expressed anxiety/depression; 11 points or higher - clinically pronounced anxiety / depression. The hospital Anxiety and Depression scale HADS (The hospital Anxiety and Depression Scale Zigmond A. S., Snaith R. P.) is designed for the primary detection of depression and anxiety in general medical practice. Four possible answers correspond to each statement of the HADS scale. The HADS scale for determining the level of anxiety and depression does not cause difficulties for the patient and does not require a long time to fill in and interpret the results. Also, patients with pronounced anxiety and depressive disorders that require the supervision of a psychiatrist were not included in the study.
Results. Results of the HADS survey of depression and anxiety, which determines the mental status of patients (M±S) "depression scale" (absolute number of patients by %): normal indicator (0-7 points) was found in 27 (42.18%) patients; clinically pronounced depression (HADS > 8) was found in 26 (40.62%) patients, high degree depression (HADS > 11) was found in 11 (17.18%) patients.
The"anxiety" scale was based (on the absolute number of patients by%) : normal (0-7 points) was found in 26 (40.62%) patients, clinically pronounced anxiety (HADS > 8) was found in 28 (43.75%) patients, and high degree anxiety (HADS >11) was found in 12 (18.75%) patients.
In the course of the interview, it was found that the most disturbing feelings of anxiety in patients with psychoemotional disorders are: angina attacks, decreased physical activity,the result of the disease , concern for the well-being of the family, work, self - health, general weakness, a feeling of constant fatigue, irritability, sleep disorders, the development of repeated myocardial infarction and fear of sudden death.
Conclusions. As a result of psychological testing on the HADS scale, symptoms of clinically pronounced depression were detected in 40.62% of all patients due to the disease, and high - grade depression was detected in 17.18%. And on the anxiety scale, normal indicator symptoms were found in 26 (40.62%) patients. The level of stress and anxiety that determines the pathological response of patients to the disease can provide sufficient data on the state of health of patients during rehabilitation. In turn, it was found that the depressive state of the patient negatively affects the clinical course of the disease, the overall quality of life of patients, their predisposition to treatment and compliance with medical recommendations. All this creates the need for timely detection and timely treatment of psychoemotional disorders in patients.
- Myocardial infarction as the main cause of death of the population of South Kazakhstan region and scientific bases for improving its prevention. // Dissertation work for the academic degree of Master of Health in the specialty 6m110200" Public Health". Shymkent, 2016 P. 66.
- AHA/ACCF Secondary Prevention and Risk Reduction Therapy for patients with coronary and other atherosclerotic vascular disease: 2019 update a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 2011;58(23):2432–46.
- Naughton J. Exercise training for patients with coronary artery disease. Cardiac rehabilitation revisited. Sports Med 2018 ;14(5):304–19.
- Романова В.П. Факторы, обуславливаю- щие выбор эффективных программ реабилитации больных, перенесших острый инфаркт миокарда. Вестник новых медицинских технологий 2010;17(4):87–91. [Romanоva V.P. Factors, causing the choice of efficient rehabilitation programs for the patients, who undergo the acute myocardial infarction. Vestnik novykh meditsinskikh tekhnologiy = New medical technologies herald 2010;17(4):87–91. (In Russ.)].
- Boden W.E., O'Rourke R.A., Teo K.K. et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356(15):1503–16.