Psychiatric aspects of cardiovascular disease.

The co-occurrence of psychiatric and cardiac disease in many patients exemplifies the complexity of psychosomatic medicine, with both psychosomatic and somatopsychic effects. Psychological factors including depression, anxiety, and hostility influence the development, clinical expression, and prognosis of coronary heart disease. Depression and anxiety are especially common problems complicating cardiac disease. The physician must approach the patient with an appreciation of the confounding aspects of diagnosis and a readiness to think flexibly about the nature of the problems encountered. SSRIs play an increasingly prominent role in psychopharmacotherapy of this population. Innovative treatments in cardiology, such as heart transplantation, defibrillators and mechanical ventricular assist devices are associated with characteristic psychiatric problems for which psychiatrists must devise treatment strategies.