Is there a relationship between type D personality and cardiovascular disease? A comprehensive literature review

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    Marzieh Azizi 1, Forouzan Elyasi *2

    1 Ph.D. Student of Reproductive Health, Department of Midwifery and Reproductive health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Email: marziehazizi70@gmail.com

    *2 Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.  E mail: forouzan.elyasi@gmail.com

    Introduction and aim: Psychological distress has been associated with the pathogenesis and progression of cardiovascular diseases (CVDs). Among the several psychological factors, personality traits of an individual have been explored as an important factor influencing the morbidity and mortality of CVDs. Type D personality, known as distressed personality type, comprised of two main characteristics such as negative affectivity and social inhibition.  Studies found that during a period of 6–10 years, the mortality rate among type D patients with cardiovascular diseases was 27%; compared with 7% among healthy subjects. This study aimed to investigate the relation between type D personality and cardiovascular disease according to the literature review.

    Methods: In this review study, researchers conducted their comprehensive computer search in databases such as Google Scholar and more specifically PubMed, PsycINFO, ProQuest, web of science, Cochrane Library, Science Direct and Scopus in the period of 1 August 2020 until 20 August 2020. The keywords which selected by MeSH strategy were [(“Type D personality” OR “Type D personality traits”) AND (“cardiovascular diseases” OR” coronary heart disease” hypertensive disorders”)]. Articles from “1992 to 2020” were selected. Overall 28 articles have been searched. Researchers reviewed the abstract and full text of all searched articles and ultimately they applied 21 articles to write this review.

    Results: The prevalence of type D personality among patients with CHD was reported 18.7 %. Personality  traits such as optimism, conscientiousness, openness to experience, and curiosity have been found to be protective factors against development of CVDs. Studies have found strong association between Type D personality and stress cardiomyopathy after acute emotional stressful triggers leading to acute cardiac events. Individual risk factors such as tendency to unhealthy life style, non-completion of cardiac rehabilitation programs and poor compliance to treatment in individuals with Type D personality has also been found to be associated with the risk of developing serious illness such as CVDs, premature mortality and affect the quality of life in those individuals with chronic medical illness. Psychological issues such as chronic negative affect, low self-esteem, generally dissatisfied with life, suffer from depressive symptoms, chronic tension, anger, pessimism, decreased cognitive functioning, poor social support, and low levels of perceived well-being in individuals with a Type D personality are associated with exacerbating the prognosis of CVDs. Studies have reported that those with type D personality with CVDs experience more cardiac symptoms but are less likely to report cardiac symptoms (such as swollen legs, shortness of breath, etc.) to the medical professionals and tend to seek health care lately which resulting in severe symptoms due to their social inhibition tendency.

    Conclusion: Increasing general public awareness about the role of personality traits and its impact on cardiac illness could be beneficial and various programs for psychological intervention are required to control for the distressed personality of patients with CVDs or hypertensive disorders. 

    Keywords: Type D personality, personality traits, cardiovascular diseases, coronary heart disease,

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    The Cardiac Complications of Methamphetamines

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      Psychocardiology from the viewpoint of Traditional Persian Medicine

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        Background and Objective

        Psychocardiology is a discipline that evaluates the effect of social, behavioral, and psychological factors on the onset, treatment, and progress of the cardiovascular diseases. Nowadays this discipline is noticed significantly and numerous investigations have been started in this field. Psychological factors, such as stress and depression cause poor prognosis in heart diseases.

        More studies are needed to prove the effect of psychological disorder treatment on improvement of heart diseases.

        Traditional Persian Medicine is a holistic system with thousands of years’ history. It considers different parts of the human body as an integrated system in each disease. Persian medicine literature states close and two-way heart and brain relationships with specific physiology.

        In this research, the concept of Psychocardiology from the viewpoint of Traditional Persian Medicine will be discussed.

        Materials and Methods

        In this review study, we investigate Psychocardiology articles and heart disease in Persian Medicine literature.

         

        Results

        According to the articles, the concept of mind–body disease was first proposed by a German psychiatrist in 1818.

        In 1943, a neurologist pointed to the role played by psychological factors in heart disease.

        About one thousand years ago, Persian physicians expressed psychological and spiritual condition as an important factor in cardiac function. Grief, fear and anger induce weakness and inadequacy in cardiac function. Happiness and cheerfulness increase cardiac strength. One of the most important preventive or curative methods in cardiac field is exhilarating instructions or drugs. On the other hand, the Persian physicians pointed to the heart disease as an important etiology of psychological disorders.

         

        Conclusion

        Recent researches emphasizes the effect of psychological factors on heart diseases. This relationship is mentioned in Persian medicine literature and medical and non-medical methods for prevention and treatment are advised. So attention to this approach and setting clinical trials is helpful. 

        Key Words

        Psychocardiology, traditional Persian Medicine, heart, psychology, spirit

        Yasaman vazani

        Department of Traditional Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

        Corresponding author: Yasaman vazani, MD, PhD of Traditional Persian Medicine, Assistant Professor, Shiraz University of Medical Sciences, Shiraz, Iran.

        E mail: yasaman.vazani@gmail.com

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        Obesity and cardiovascular disease

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          Bahareh Tavana, MD

          The development of obesity is multifactorial and it has genetic, environmental and lifestyle causes. People who are overweight or obese have more risk factors for cardiovascular disease (CVD), and are at increased risk of developing hypertension, coronary heart disease, heart failure, and atrial fibrillation .

          This is an overview of the mechanisms of obesity and its relation to cardiovascular risks and  describing the available treatment options to manage this condition.

          Obesity is an independent risk factor for CVD, negatively affecting the heart’s function and structure as well as the blood vessels’ inner lining. Obesity affects the heart through risk factor such as Hypertension, Obstructive Sleep Apnea, Elevated Blood Glucose and  Inflammation. A variety of adaptations/alterations in cardiac structure and function occur as excessive adipose tissue accumulates, even in the absence of comorbidities.

          Adipose tissue is not just a pool for fat, but an endocrine organ that is capable of synthesizing and releasing into the bloodstream a variety of molecules that may impact unfavorably the risk factor profile of a patient.

          Weight loss may prevent the progression of atherosclerosis or the occurrence of acute coronary syndrome events in the obese high-risk population. The available data suggests that even modest weight loss improves diabetes and cardiovascular disease (CVD) risk factors.

          To accomplish satisfactory goals, patients and physicians seek for weight loss, weight maintenance and improvement of the risk factors associated to this condition, especially cardiovascular risk.

          We summarize the treatment options for obesity and the efficacy of these options in  improving cardiovascular risk factors.

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          State and Trait anxiety and their association with physiological indices in patients with acute myocardial infarction

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            Authors: Masoume Rambod 1*, Mahnaz Rakhshan 1, Sara Tohidinik 1, Mohammad Hossein Nikoo2

            1 Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

            2 Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

            Email Masoume Rambod: rambodma@yahoo.com

             

            Introduction: Anxiety is one of the most common and important psychological reactions of patients with myocardial infarction. Anxiety has a negative effect on the trend and physical and mental recovery of the disease. The aim of this study was to determine State and Trait anxiety and their association with physiological indices in patients with acute myocardial infarction.

            Method: This cross-sectional study was conducted on 100 patients with acute myocardial infarction admitted to hospitals affiliated to Shiraz University of Medical Sciences. Spielberger State-Trait Anxiety Inventory was used and physiological indices including heart rate and blood pressure were recorded from patients’ monitors. Data analysis was performed by correlation coefficient test.

             Results: The findings of this study showed that the mean score of State and Trait anxiety in patients with myocardial infarction were 51.67 (SD=3.44) and 49.24 (SD=2.85), respectively, which were in moderate to high level. The mean of heart rate was 78.87 (SD=12.76). Systolic and diastolic blood pressure of patients were 128.08 (SD=19.34) and 75.08 (SD=8.82), respectively. There was no association between State-Trait anxiety with heart rate and systolic and diastolic blood pressure.

            Conclusion: The results of this study showed that the level of State and Trait anxiety in patients with acute myocardial infarction were in moderate to high, which requires special attention in the acute phase of the disease. Interventions to management and reduce anxiety in these patients are recommended.

             

            بررسی اضطراب آشکار و پنهان بیماران مبتلا به سکته حاد قلبی و ارتباط آن با شاخص های فیزیولوژیک

             

            نویسندگان: دکتر معصومه رامبد1، دکتر مهناز رخشان1، سارا توحیدی نیک1، دکتر محمدحسین نیکو2

            1. مرکز تحقیقات مراقبت های روان جامعه نگر، دانشگاه علوم پزشکی شیراز، شیراز، ایران
            2. مرکز تحقیقات قلب و عروق، دانشگاه علوم پزشکی شیراز، شیراز، ایران

            ایمیل دکتر معصومه رامبد:rambodma@yahoo.com

             

            مقدمه: اضطراب یکی از شایع ترین و مهمترین واکنش های روانی بیماران مبتلا به سکته قلبی است. این اختلال تاثیر منفی بر سیر بیماری و مرحله بهبودی جسمی و روانی  بیماری دارد. هدف این پژوهش بررسی اضطراب آشکار و پنهان و ارتباط آن با شاخص های فیزیولوژیک در بیماران سکته حاد قلبی بود.

            روش: این مطالعه به صورت مقطعی و بر روی 100 نفر از بیماران مبتلا به سکته حاد قلبی بستری در بیمارستان های مراکز آموزشی درمانی دانشگاه علوم پزشکی شیراز انجام شد. پرسشنامه اشپیلبرگر و شاخص های فیزیولوژیک از جمله ضربان قلب، و فشارخون از مانیتور بیماران ثبت شد. تحلیل داده ها با آزمون ضریب همبستگی انجام شد.

            نتایج: یافته های این مطالعه نشان داد میانگین اضطراب آشکار بیماران مبتلا به سکته قلبی (44/3) 67/51 بود. میانگین اضطراب پنهان در بیماران (85/2)24/49 بود که اضطراب آشکار و پنهان بیماران در سطح متوسط به بالا بود. میانگین ضربان قلب بیماران (76/12) 87/78 بود. فشارخون سیستول و دیاستول بیماران به ترتیب (34/19) 08/128 و (82/8) 08/75 بود. بین اضطراب آشکار و پنهان با ضربان قلب و فشارخون سیستول و دیاستول ارتباط وجود نداشت.

            بحث و نتیجه گیری: نتایج این مطالعه نشان داد سطح اضطراب آشکار و پنهان بیماران دچار سکته حاد قلبی در حد متوسط به بالا است که لازم است توجهات ویژه در مرحله حاد بیماری از آنها به عمل آورد. انجام مداخلاتی جهت کنترل و کاهش اضطراب در این بیماران پیشنهاد می شود.

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            Efficacy of psychological interventions for patients with cardiovascular diseases(A review study)

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              Maliheh Jamehdar1,Bahare Oji2
              1. Resident of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
              2. Psychiatrist, psychosomatic fellowship, Shiraz University of Medical Sciences, Shiraz, Iran

              Cardiovascular diseases (CVDs) are chronic, distressing, and debilitating conditions that affect people’s health with major negative effects on their quality of life. CVDs are among the top causes of death for the past decade. CVDs have impressed our country, Iran, as many countries around the world. unfortunately, the age of onset is much earlier (7-10years) than in other regions. there is a mutual relation between CVDs and psychological problems such as stress, anxiety, and depression. these two problems (anxiety and depression) in addition to the lack of social support increase the use of healthcare services, relapse, or exacerbation of the disease. the important role of psychiatric problems like anxiety and depression in CVDs, induces this question: what should healthcare providers do?

              Focusing on the psychiatric aspect of CVDs should be considered as a part of treatment. the treatment of CVDs is routinely pharmacological and non-pharmacological.

              The alternative therapies include stress management, relaxation therapy, therapeutic massage, guided imagery, and psychological treatment like cognitive behavior therapies and psychoeducational programs (PEPs) that are used to decrease patient’s anxiety and distress.

              The findings support the efficacy of some psychosocial interventions in people with CVDs. Some articles support only the short term effects of some psychosocial interventions for reducing tension, negative emotion, stress, anxiety, and depression in people with CVDs

              It is recommended to perform this approach to reduce psychological problems. Although some articles didn’t report long term effects, more research is required to find the best strategies that could help to maintain long term Positive results of psychosocial interventions in CVDs patients

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              Review of Cigarette Smoking Management in Cardiovascular Patients

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                Nahid Edrisi1, Bahare Oji2 

                1. Resident of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
                2. Psychiatrist, psychosomatic fellowship, Shiraz University of Medical Sciences, Shiraz,Iran

                More than 1.1 million people in North America experienced MI, more than 20% of whom are smokers.

                Smoking causes atherosclerosis and increases the risk of death, myocardial infarction, angina, peripheral vascular disease, and stroke. Smoking cessation is an urgent issue in cardiovascular disease. 

                1) Nicotine replacement therapy (NRT) which includes chewing gum, skin patch, and inhaler.

                2) Non-nicotine replacement therapy (non NRT) which includes bupropion, varenicline, and counseling.

                Previous research has shown that nicotine gum and skin patches do not cause platelet aggregation and thrombotic CVD, do not increase ischemia and are known to be safe. But because research has not been reviewed in the first few weeks after MI, guidelines recommend that NRT should be given with caution, especially in the first two weeks after MI. Another article states that although NRT is safer than cigarettes, there are a number of concerns, including smoking while using a nicotine patch. Additionally nicotine patches preferred due to slower nicotine release and lower concentrations than other NRT methods.

                In the United States, Bupropion (SR) was registered as a smoking cessation treatment in 1997 and was recognized as a first-line treatment in 2001. An important cardiac complication of bupropion is a sympathomimetic activity, including high blood pressure and increased heart rate. Generally, the articles state that it does not increase the risk of cardiovascular complications and mentioned that it can be used safely in the first two weeks after a heart attack.

                Varenicline is a selective, partial nicotinic receptor agonist that is as effective as NRT but more effective than bupropion. Previous articles reported chances of varenicline cardiovascular complications, although recent studies reported the same complications as bupropion. The chance of cardiovascular complications has also been ruled out by the FDA.

                Refrences:

                Sharma A, Thakar S,Lavie CJ,Garg J, Krishnamoorthy P, Sochor O,et al. Cardiovascular Adverse Events Associated with Smoking-Cessation Pharmacotherapie. Curr Cardiol Rep.2015;17:554.

                Ludvig J, Miner B, Eisenberg MJ. Smoking cessation in patients with coronary artery disease. Am Heart J. 2005 Apr;149(4):565-72.

                McRobbie H, Hajek P. Nicotine replacement therapy in patients with cardiovascular disease: guidelines for health professionals. Addiction. 2001 Nov;96(11):1547-51.

                Monárrez-Espino J, Galanti MR, Hansson J, Janszky I, Söderberg-Löfdal K, Möller J. Treatment With Bupropion and Varenicline for Smoking Cessation and the Risk of Acute Cardiovascular Events and Injuries: a Swedish Case-Crossover Study. Nicotine Tob Res. 2018 Apr 2;20(5):606-613.

                Suissa k, Larivière J, Eisenberg MJ, Eberg M, Gore GC, Grad R,et al. Efficacy and Safety of Smoking Cessation Interventions in Patients With Cardiovascular Disease: A Network Meta-Analysis of Randomized Controlled Trials. Circ Cardiovasc Qual Outcomes. 2017 Jan;10(1).

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                Non-pharmacological interventions on the prevention of delirium in patients under open heart surgery: A narrative review

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                  Marzieh Azizi 1, Fatemeh Alizadeh Arimi 2, Forouzan Elyasi *3

                  1 Ph.D. Student of Reproductive Health, Department of Midwifery and Reproductive health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Email: marziehazizi70@gmail.com

                  2 Psychiatric Resident, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Email: fateme.arimi1991@gmail.com

                  *3. Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. E mail: forouzan.elyasi@gmail.com

                   

                  Introduction and aim: Delirium is fluctuating, acute, and multifactorial condition leading to mental confusion, altered level of consciousness and declined cognitive level. It affects 15-70% of the medical and surgical population under open heart surgery admitted to intensive care units. Prevention of delirium is clearly desirable for both patients and healthcare professionals, and can also reduce the health service costs. A range of non-pharmacological interventions for preventing delirium in hospitalized patients have been developed. This study aimed to assess the non-pharmacological interventions on the prevention of delirium in patients under open heart surgery.

                  Methods: The present study is a review in which researchers conducted their computer search in database such as Google Scholar, ScienceDirect,, Web of Science, PubMed and Scopus with using text word and medical Subject Heading (MesH) methods with key words such as [(“non-pharmacological interventions” OR “non-pharmacological strategies” OR “psychological interventions”) AND (“delirium” OR ” acute confusion state) AND (“open heart surgeries” OR “heart surgery”)]. As a result of search process, 40 articles were extracted from 1995-2020. Articles were excluded if they were written in languages other than Persian or English or were irrelevant to the topic. The abstract of all retrieved articles were read and screened and ultimately, we used 31 full text articles to write this review study.

                  Results: Among studies showed that there are different non-pharmacological strategies to prevent the delirium in patients under heart surgeries. Results were classified in three main categories. Physical interventions (such as counteraction of immobilization, range of motion exercises, multicomponent physical therapy, multicomponent intensive occupational therapy including positioning, physical rehabilitation, paired awakening and breathing, avoidance of sensory deprivation (glasses, denture and hearing aids)), environmental interventions (such as bright light therapy, environmental manipulation, inserted familiar objects in the room such as clock and calendar), psychosocial intervention (such as systematic cognitive screening, multicomponent orientation and cognitive stimulation and training, cognitive-behavioral methods, relative involvement such as reorientation using family voice and family supportive reorientation, daily proactive geriatrics consultation, progressive muscle relaxation, relaxing breathing techniques, (self) hypnosis, guided imagery or autogenic training, psychoeducational interventions, music therapy and singing).

                  Conclusion: Given the possibility of delirium incidence in patients under the heart surgery is relatively high, so considering multicomponent interventions such as multicomponent non-pharmacological in the therapeutic planning may be useful in preventing of the delirium in these patients.

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                  Biopsychosocial factors related of sexual dysfunction in women with cardiovascular diseases

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                    Marzieh Azizi 1, Forouzan Elyasi *2

                    1 Ph.D. Student of Reproductive Health, Department of Midwifery and Reproductive health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Email: marziehazizi70@gmail.com

                    *2 Sexual and Reproductive Health Research Center, Addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.  E mail: forouzan.elyasi@gmail.com

                    Introduction and purpose: Patients with cardiovascular disease (CVD) often experience changes in their ability to engage in and enjoy of sexual activities, which can lead to less frequent and less satisfying sexual relationship. The problem of sexual dysfunction in women with CVD has less attention to the healthcare professional and also researchers all over the world and most of studies were conducted on men with cardiovascular diseases and erectile dysfunction. Based on the literature approximately 60-90% of patients with congestive heart failure reported the sexual dysfunction in their disease period. The aim of this study is to investigate the biopsychosocial factors related of sexual dysfunction in women with cardiovascular diseases.

                    Methods: The present study is a review in which researchers conducted their computer search in public database like Google Scholar and more specific databases such as ScienceDirect, SID, Web of Science, PubMed and Scopus with using text word and medical Subject Heading (MesH) methods with key words such as [(“sexual dysfunction” OR “sexual disorders” OR “sexual activity”) AND (“cardiovascular diseases” OR “coronary artery disease” OR ” congestive heart failure “) AND (“psychiatric disorders” OR “psychological problems”)]. As a result of searching process, 33 articles were extracted from 2002-2020. Articles were excluded if they were written in languages other than English or Persian, were duplicates or were irrelevant to the topic. Researchers reviewed the abstract of all retrieved articles and ultimately, they used 25 full text articles to write this review study.

                     Results: Studies showed that different factors lead to sexual dysfunction in these patients. Biological causes such as changes in blood circulation and reduced amount of blood supplied to distant area of body in these patients such as the genital region can lead to erectile dysfunction in men and sexual arousal difficulties in women. Also symptoms of cardiovascular disease such as chest pain, shortness of breath, and fatigue may also interfere with sexual performance and enjoyment of sexual activities. Having multiple chronic comorbidities such as diabetes, chronic pulmonary disease, cancer and side effects of medications such as diuretics and beta-blockers may also disrupt sexual activity. Social issues such as unhealthy behaviors included of smoking, inadequate sleep, alcohol abuse, physical inactivity and higher age have also negative effect on these patient’s desire for sexual relationships. Psychological issues such as emotional distress, depression and anxiety due to suffering from CVD in the first stages of disease, fear of not safe to be sexually active, adjustment and relational challenges among couples also increased the prevalence of sexual dysfunction and disturbed quality of life among these patients.

                    Conclusion: Due to the sexual activity directly effect on the quality of life such as mental and physical health among patients with CVD, so healthcare professionals should seriously notice to these patient’s sexual relationships and for cases with sexual dysfunction, the appropriate counseling in this regard should be considered and provided.

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