Psycho-emotional state of patients with chronic non-communicable diseases: important aspects of therapy

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Acute and chronic stress, as well as emotional disturbances as a consequence of stressful situations, are significant risk factors for the development and progression of some of acute and chronic non-communicable diseases, including cardiovascular diseases (CVD), among which the most common are arterial hypertension, chronic heart failure and atherosclerotic CVD. Specific emotional disturbances that arise after exposure to significant traumatic or stressful situations include acute and post-traumatic stress disorder. When a stress factor does not reach high intensity or significance, adjustment disorder may develop. Stress-related emotional disturbances significantly affect other CVD risk factors, reduce patients’ adherence to healthy lifestyle changes and drug therapy, deteriorate quality of life and increase the risk of disability. The urgency of identifying and managing post-stress emotional disturbances in the practice of internists is caused by high frequency of these disturbances in outpatient patients. It is especially important to manage and prevent these disturbances in patients with CVD due to increased number of adverse outcomes resulting from this combination. Treatment of emotional disturbances resulting from stressful situations includes both drug and non-drug methods. Antidepressants and benzo-diazepine anxiolytics are the main classes among the drugs used to treat post-stress emotional disorders. However, the prescription of these drugs requires taking into account a wide range of possible side effects, especially in patients with CVD. The choice of drugs with a favourable safety profile and a rapid onset of sedative and anti-anxiety effects is a key element in the modern effective patient management strategy. Tofisopam and buspirone are the most advanced of this group of drugs in therapeutic and cardiological practice.

Stress-related emotional disturbances in patients with cardiovascular diseases

Shishkova

2023

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Marker associations of chronic heart failure severity and cognitive dysfunction in elderly patients

Shishkova,

Shishkov,

Ustarbekova

2024

Introduction. Next to neurodegenerative disorders, cardiovascular diseases are now the most common cause of cognitive impairment. The combination of factors such as older age and chronic heart failure is a corner-stone of a greater risk for developing vascular cognitive impairment.Aim. To study the relationship between the parameters of the left ventricular ejection fraction and the concentration of NT-proBNP with the results of neuropsychological testing in patients with chronic heart failure in old age.Materials and methods. The study included 200 elderly patients with CHF II–III FC. The neuropsychological examination included tests: tracking, Schulte tables, verbal associations, the Montreal Cognitive Function Assessment Scale (МоСА test). Laboratory tests included determination of the concentration of NT-proBNP in serum.Results. During neuropsychological testing, reduced indicators were obtained: during the MOS test in patients with left ventricular ejection fraction (LVEF) values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 7230 [3325; 8830] pg/ml; in the Schulte test, an increase in execution time was noted in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 2900 [700; 7500] pg/ml; in the tracking test – an increase in time in part A in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 5385 [2125; 8675] pg/ml and part B in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 6947 [3325; 9310] pg/ml, in the verbal association test – in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 2090 [608; 7126] pg/ml. Correlation analysis showed the presence of a significant relationship between LVEF indicators, the concentration of NT-proBNP and the results of neuropsychological testing (p < 0.001), while, according to the Rea&Parker classification, the connection was assessed as relatively strong and medium strength.Conclusion. The cognitive impairments identified in this study in elderly patients with chronic heart failure were characterized by a decrease in concentration, memory, executive functions and the overall integrative index of cognitive functions. These disorders were significantly associated with a decrease in the left ventricular ejection fraction and a high concentration of NT-proBNP.

New insight into the management of psychoemotional risk factors in patients with cardiovascular diseases in middle and young age

Shishkova

2023

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Affective spectrum disorders, such as depression and anxiety disorders, are important psychoemotional risk factors for the development and complicated course of many common chronic non-communicable diseases, including cardiovascular ones: arterial hypertension, coronary heart disease, chronic heart failure, atrial fibrillation, acute coronary syndrome, etc. A feature of this comorbidity is the significant impact of psychoemotional factors on the motivation and adherence of patients to a healthy lifestyle, as well as various drug treatment options, which involves an increased risk of complications and, as a consequence, increased healthcare costs. The topicality of the issues of screening and management of psychoemotional disorders in the internist practice arises from a variety of reasons. On the one hand, it is a high incidence of these disorders in patients with cardiovascular diseases, including young and middle-aged ones, which is associated with a deterioration in the quality of life and an increased risk of complications and adverse outcomes in the future. On the other hand, it is caused by insufficient level of awareness among doctors about new possibilities for the management of the psychoemotional state of such patients. This review presents data on the effectiveness and safety of therapy of psychoemotional disorders in patients with various CVDs with a drug containing D,L-hopanthenic acid (rat-hopanthenic acid) as an active substance of the nootranquilizer class, which has a wide range of clinical effects, including a beneficial effect not only on psychoemotional sphere, but also on cognitive functions. The prospects for prescribing a D,L-hopantenic acid drug to young and middle-aged patients with CVD, which reduces the drug burden on the patient and provides high quality of life for patients both in hospital and at subsequent stages of treatment, are discussed. The key point is availability of an option for prolonged use of D,L-hopanthenic acid drug without any risk of addiction, withdrawal syndrome or hyperstimulation, which is an important clinical aspect of drug therapy for patients with CVD, especially in young and middle age.