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The High Prevalence of Multiple Psychiatric Disorders in Stable Outpatients With Coronary Heart Disease

From the Behavioral Medicine Division of Preventive Cardiology, Department of Psychiatry (B.B., A.B.L.), Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts; and the Cardiology Division (J.L.J.), Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to Bettina Bankier, MD, Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 401, Boston, MA 02114. E-mail: bbankier{at}partners.org

OBJECETIVE: There is accumulating evidence of high prevalence of comorbid psychiatric disorders in patients with coronary heart disease (CHD). However, most of these studies focused on one psychiatric disorder or one set of psychological symptoms and detected psychiatric disorders in acutely ill CHD patients. To date, no systematic comprehensive psychiatric diagnostic evaluation has been performed in a consecutive sample of stable CHD outpatients.

METHODS: One hundred stable CHD outpatients of the Cardiology Division outpatient clinic at the Massachusetts General Hospital were included in the study. Psychiatric diagnoses were established by using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (axes I-V).

RESULTS: Frequent comorbid psychiatric diagnoses were detected, including single past major depressive episode (29%), current dysthymic disorder (15%), recurrent major depressive disorder with current major depressive episode (31%), current alcohol abuse (19%), posttraumatic stress disorder (29%), current generalized anxiety disorder (24%), current binge-eating disorder (10%), and current primary insomnia (13%). The mean number of comorbid clinical psychiatric disorders per subject was 1.7.

CONCLUSION: The findings suggest high prevalence rates of comorbid psychiatric disorders as well as a broad spectrum of psychiatric disorders in stable CHD outpatients. However, larger epidemiological studies are needed in order to determine the true prevalence of these disorders in CHD patients.

Key Words: coronary heart disease • stable outpatients • multiple psychiatric disorders

Abbreviations: CHD = coronary heart disease;; MGH = Massachusetts General Hospital;; IRB = Institutional Review Board;; MI = myocardial infarction;; PCI = percutaneous coronary intervention;; CABG = coronary artery bypass graft surgery;; CHF = congestive heart failure;; SCID = structured clinical interview for DSM;; DSM = Diagnostic and Statistical Manual of Mental Disorders;; PD = personality disorder;; MDE = major depressive episode;; MDD = major depressive disorder;; PTSD = posttraumatic stress disorder;; GAD = generalized anxiety disorder;; BMI = body mass index;; GAF = Global Assessment of Functioning Scale.

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