The mental health of patients is the focus of primary care physicians

Can the heart be separated from the mind? The answer is “no,” according to specialists gathered at the 39th Congress of the Rio de Janeiro State Society of Cardiology (SOCERJ), an event held around May. During a conference on mental health, doctors and psychologists noted that long-term data indicated that people who are under stress are more likely to develop cardiovascular disease. takotsubo heart muscle (Traditional Chinese Medicine) is a prime example of this.

Many different articles in the scientific literature show how negative emotions affect physical health. According to one of the presenters, Gustavo Barberato, MD, cardiologist and member of the Department of Spirituality and Cardiovascular Medicine (DEMCA) of the Brazilian Society of Cardiology (SBC), study Conducted during the 2006 World Cup in Germany, and published in New England Journal of Medicine In early 2008And the Show, for example, that watching a stressful football match more than doubles the risk of acute cardiovascular disease.

In contrast, positive emotions were associated with beneficial effects. Barberato noted that clinical studies have revealed that gratitude, optimism, religiosity, and tolerance therapy, for example, appear to contribute to reducing risk factors related to stress and cardiovascular events. He went on to explain that there are already studies that suggest this approach may help patients change their attitude toward certain diseases (such as Hypertension heart failure) and lowering blood pressure levels. It may also improve compliance with treatment. It is important to remember that while alternative therapies such as meditation, mindfulness, and yoga are helpful, they do not replace medical or mental health care when you need it.

Researchers at Harvard University in Cambridge, Massachusetts have been studying the relationship between happiness and longevity since 1938. According to Claudio Domenico, MD, PhD, clinical cardiologist at Pro‑Cardiac Hospital, Rio de Janeiro, and scientific session director, Harvard study of adult development conducted by Robert Waldinger, MD, and colleagues showed that a person’s level of satisfaction with their relationships and social contacts at age 50 was a better predictor of aging than their cholesterol levels.

Considerations for the elderly

For Dr. Khalil Liz Mahalem, cardiologist and geriatrician at Pro-Cardiac Hospital, every primary care physician must investigate two critical aspects in elderly patients: cognitive deficits and depression.

Regarding cognitive deficits, Mahalam noted that screening has already been shown to be unhelpful for those without complaints. That is, it is only worth investigating the possibility of cognitive deficits in those who have complaints or when relatives report signs that could indicate a problem.

But with regard to depression, it is important to remember that depressed patients do not always appear in a state of sadness or tears, as Mahlem reminds us. He stressed, “Patients often arrive with a physical problem or unclear complaints, as they have gone to many appointments to see many different doctors. It is worth investigating these cases.”

He went on to explain that certain tools, such as the Geriatric Depression Scale (GDS), could be used for this purpose. Doctors can also ask patients if they have felt a loss of interest in the things they used to enjoy, and whether they feel they have less energy or that they cannot carry out daily activities. If the answer to any of these questions is ‘yes’, further investigation may be required.

According to Lilian Shenkman, MD, psychiatrist and professor at the State University of Rio de Janeiro (UERJ), depressed patients with Acute heart failure And coronary artery disease have significantly higher mortality and morbidity rates. Therefore, clinicians need to research this, evaluate patients and refer them to a specialist when needed.

The specialists also highlighted the importance of being physically active, as well as the advantages of a multidisciplinary approach. For them, when health care professionals with specializations in various fields work as a team, patients can receive comprehensive care, and it is easier to monitor the effect of several drugs, which is especially important for elderly patients. “All psychotropic and non-psychotropic substances have their own side effects and drug-drug interactions,” Schenkman said, stressing the need for judicious follow-up and individualized treatment plans.

Mental health and cardiovascular health are closely related, explains Natalia Tillis, MD, a psychiatrist and coordinator in the Department of Psychology at Pro-Cardiac Hospital. “Which patient with a heart problem, such as an arrhythmia or early pain, would not feel anxious, anxious, or afraid of death?” asked Telles, emphasizing that the differential diagnosis of comorbidities is an important issue.

Moreover, one factor can increase the risk of another. “We know that a very anxious patient has a higher chance of developing a cardiovascular problem, and vice versa,” she noted, reinforcing the need for teamwork to treat these patients. Telles also believes hospice care is a good example, as it often requires healthcare professionals to be in contact with one another. “It’s a model for how we treat patients across age groups,” she said.

Pandemic effects

Domenico explained that for French sociologist Edgar Morin, the COVID-19 pandemic poses a challenge to humanity: the need to develop a tolerance for the unknown. This is particularly overwhelming, he said, because we live under the illusion that we are in control.

Even though we don’t really have control over things, this illusion helps us to be better organized and disciplined. “The epidemic came to destroy this delusion,” Schenkman said.

Telles added that the uncertainty imposed by the new Corona virus “stopped life.” By this, she meant that desires and impulses were frozen and people’s lives became increasingly restricted.

In turn, this impact on social life has an impact on mental health, particularly with regard to the increasing number of cases of compulsive eating, alcohol and drug abuse, depression, panic disorders, and Insomnia.

Schenkman also noted a significant daily increase in the search for professional help in the form of psychiatric care. “I think there has been a significant increase in the amount of people suffering,” she said, adding that two groups that have been particularly affected by the pandemic are the elderly and adolescents.

Another problem that has emerged during the pandemic is fatigue. “Work broke into the house, that period between going to work and leaving work at the end of the day just doesn’t exist anymore,” Telles said. She went on to point out that the challenge was even more important for healthcare professionals.

Mahalem stressed the importance of educating primary care physicians about their health. “We have to take care of our mental health,” he said. “I can’t take care of others if I don’t take care of myself.”

This article was translated from Medscape Portuguese Edition.

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