Metacognitions in Patients With Frequent Mental Disorders After Diagnosis of Pulmonary Arterial Hypertension

Abstract

BackgroundThe prevalence of mental disorders, particularly adjustment disorder (AD), major depressive disorder (MDD) and panic disorder (PD) is increased in patients with pulmonary arterial hypertension (PAH). However, it is unclear which pathogenic mechanisms determine their development and could therefore be targeted in prevention or therapeutic interventions. Here, we assessed metacognitions in a sample of PAH patients with and without MDD and PD. Moreover, we reconstructed the course of mental illnesses following the PAH diagnosis.MethodsTwo hundred seventeen PAH patients were included in this cross-sectional study. The prevalence of AD was assessed retrospectively using DSM-V criteria. Current mental disorders were assessed using the structured clinical interview for DSM-V. Additionally, metacognitive beliefs and processes were assessed using established questionnaires (MCQ-30, AnTI).ResultsPatients with an AD consecutive to the PAH diagnosis more frequently developed MDD (37.5 vs. 13.9%, p < 0.001) and PD (26.3 vs. 8.8%, p = 0.001) later on compared to PAH patients without a former AD. Moreover, patients with current MDD/PD displayed more dysfunctional metacognitions than those without current MDD/PD (p < 0.001). Patients with current MDD/PD in the context of former AD had more dysfunctional metacognitive worries and beliefs compared to patients with current MDD/PD without former AD (p = 0.009).ConclusionOur results suggest that in the context of PAH, dysfunctional metacognitions are associated with MDD and PD. Therefore, a metacognitive approach to treat and prevent those mental illnesses seems promising and should be investigated in future studies.

Prevalence of post-traumatic stress and tests of metacognition as a PTSD risk marker in patients with coronary heart disease and elevated HADS scores: analysis of data from the PATHWAY RCT's in UK cardiac rehabilitation

“…Consistent with this prediction, maladaptive metacognitions have been found to be elevated across psychological disorders ( 16 ) and among individuals with PTSD ( 17 , 18 ). A small number of studies suggest that such metacognitions are positively associated with greater anxiety and depression ( 19 ) and greater negative affectivity ( 20 ) in CHD, and poorer mental health in Pulmonary Arterial Hypertension ( 21 ). However, there is a gap in the literature concerning the contribution of metacognitive beliefs to PTSD in CHD patients.…”

End-of-Life and Palliative Care Issues for Patients Living with Pulmonary Arterial Hypertension: Barriers and Opportunities

“…Needless to say, PAH patients experience high degree of existential distress and emotional burden from their disease itself. 4,8,9 In addition to the mental health effects, HRQoL has been linked to progression of PAH. 3 End-of-life care is an integral part of the multidisciplinary team to address such complex needs of PAH patients.…”

“…Needless to say, PAH patients experience high degree of existential distress and emotional burden from their disease itself. 4 8 9 In addition to the mental health effects, HRQoL has been linked to progression of PAH. 3…”