干旱区生态环境知识资源中心(Arid): INFLUENCE OF AFFECTIVE DISORDERS WITH DIFFERENT RISK OF SUICIDAL BEHAVIOR ON SURVIVAL OF PATIENTS RECEIVING CONSERVATIVE THERAPY OF CHRONIC CORONARY ARTERY DISEASE

Arid

	INFLUENCE OF AFFECTIVE DISORDERS WITH DIFFERENT RISK OF SUICIDAL BEHAVIOR ON SURVIVAL OF PATIENTS RECEIVING CONSERVATIVE THERAPY OF CHRONIC CORONARY ARTERY DISEASE
	Lebedeva, E. V.; Schastnyy, E. D.; Simutkin, G. G.; Sergienko, T. N.; Nonka, T. G.; Repin, A. N.; Axenov, M. M.; Perchatkina, O. E.; Rakhmazova, L. D.
通讯作者	Lebedeva, EV
来源期刊	SUICIDOLOGY
ISSN	2224-1264
出版年	2017
卷号	8 期号:3 页码:84-94
英文摘要	Objective: to analyze influence of affective disorders (AD) with and without suicidal thoughts on survival rates and to study features of suicidal behavior in patients under conservative therapy of chronic coronary artery disease (CAD) who lived in Tomsk and in the Tomsk Region. Materials and Methods: A prospective cohort study (2008-2014) enrolled patients with chronic CAD (n=333) without invasive interventions; of them 230 male (mean age 59.5 +/- 9.3) and 103 female (mean age 67.9 +/- 8.9) patients. For the purpose of assessment of suicidal risk an anamnesis and clinical data regarding risk factors of suicidal behavior were analyzed as well as the corresponding item of Beck Depression Inventory (BDI). Patients received standard examination and underwent routine screening with use of BDI and ShARS. When obtaining the informed consent, patients were examined by a psychiatrist and, if there were any indications, were treated with antidepressants (n=20). Further patients were divided into 2 groups: with and without comorbid AD. For every sample, we calculated mean and standard deviation during normal sign distribution or the median, 25% and 75% quartiles if those were absent; the statistical significance of differences between groups was determined according to Mann-Whitney (for two independent samples), Wilcoxon (for two dependent samples) criteria. For revealing interrelationship of signs, Spearman correlation analysis was used. For assessment of frequencies Fisher. (2) criterion was used. Kaplan-Meier estimate was used for measuring survival rate. Comparison of survival curves was conducted with use of log-rank test (Mantel-Cox test). Statistical processing of data was carried out with program kit Statistica-8.0. Results: In groups with and without AD, frequency of suicidal behavior (according to BDI) was significantly different statistically (18.75% and 7.9%; p=0.0054). There was disclosed the relationship of the death cases with a high total score of suicidal behavior according to BDI (rs=0.3, p<0.05), anxiety according to ShARS and low level of social adaptation according to SASS in group of patients with AD and chronic CAD. Peculiar suicidal plans and intentions were detected clinically for patients with chronic CAD: patients tended to model situations were non-getting help was guaranteed when provoking angina pectoris: to leave the home without anti-angina agents and to increase physical load ("I leave nitroglycerine home and go/run for a long time in a deserted place until I die from infarction", "I go alone fishing/hunting without medicines"). In this case, the death will be caused by acute cardiovascular accident (socially accepted way of suicide, its main mechanism is non-compliance with medical recommendations and modeling of threatening life state). Among other preferable ways of suicide, patients thought about intake of high doses of prescribed medicines, getting under moving transport or falling from the height. Undiagnosed mental, more frequently, affective disorder forms the basis of these ways. Patients with chronic CAD and AD had a high risk of death in the course of a depressive episode, and for persons without AD it increased over time of observation (p=0.0000). In part, these differences may be explained by peculiar suicidal behavior mentioned above. There were no cases of death in the group of patients with chronic CAD and AD receiving antidepressants during the therapy and a month after discontinuation. Conclusions: Suicidal behavior peculiar for patients with CAD was revealed. It manifested as modeling situation of guaranteed nonreceipt of assistance during provocation of angina pectoris. This likely explained high mortality of patients with chronic CAD without invasive interventions and with comorbid affective disorders during depressive episode (1-2 years of follow-up). Detected relationships between CAD and AD substantiated carrying out of screening of patients suffering from coronary disease. Timely detection and therapy of AD and prevention of suicidal behavior in this group of patients are necessary. Prescription of antidepressants was not associated with increase of risk of death that may evidence their safety. Development of complex approach to rehabilitation of this group of patients (with involvement of psychiatrist/psychotherapist in the multidisciplinary team) and improvement of quality of life of patients are necessary. A special attention should be paid to education of physicians regarding detection of suicidal behavior and therapy of affective disorders.
英文关键词	affective disorders suicidal behavior chronic coronary artery disease antidepressant therapy
类型	Article
语种	Russian
收录类别	ESCI
WOS记录号	WOS:000419698300008
WOS关键词	DEPRESSION ; MORTALITY ; SCALE ; RATES
WOS类目	Psychology, Multidisciplinary
WOS研究方向	Psychology
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/332477
作者单位	[Lebedeva, E. V.; Schastnyy, E. D.; Simutkin, G. G.; Axenov, M. M.; Perchatkina, O. E.; Rakhmazova, L. D.] Russian Acad Sci, Mental Hlth Res Inst, Tomsk Natl Res Med Ctr, Tomsk, Russia; [Sergienko, T. N.; Nonka, T. G.; Repin, A. N.] Russian Acad Sci, Cardiol Res Inst, Tomsk Natl Res Med Ctr, Tomsk, Russia
推荐引用方式 GB/T 7714	Lebedeva, E. V.,Schastnyy, E. D.,Simutkin, G. G.,et al. INFLUENCE OF AFFECTIVE DISORDERS WITH DIFFERENT RISK OF SUICIDAL BEHAVIOR ON SURVIVAL OF PATIENTS RECEIVING CONSERVATIVE THERAPY OF CHRONIC CORONARY ARTERY DISEASE[J],2017,8(3):84-94.
APA	Lebedeva, E. V..,Schastnyy, E. D..,Simutkin, G. G..,Sergienko, T. N..,Nonka, T. G..,...&Rakhmazova, L. D..(2017).INFLUENCE OF AFFECTIVE DISORDERS WITH DIFFERENT RISK OF SUICIDAL BEHAVIOR ON SURVIVAL OF PATIENTS RECEIVING CONSERVATIVE THERAPY OF CHRONIC CORONARY ARTERY DISEASE.SUICIDOLOGY,8(3),84-94.
MLA	Lebedeva, E. V.,et al."INFLUENCE OF AFFECTIVE DISORDERS WITH DIFFERENT RISK OF SUICIDAL BEHAVIOR ON SURVIVAL OF PATIENTS RECEIVING CONSERVATIVE THERAPY OF CHRONIC CORONARY ARTERY DISEASE".SUICIDOLOGY 8.3(2017):84-94.