Swipe om te navigeren naar een ander artikel
Posttraumatic stress disorder (PTSD) after acute medical events is associated with medication nonadherence. The mechanisms of PTSD-related nonadherence are poorly understood. We tested whether patients with elevated PTSD symptoms induced by suspected acute coronary syndrome (ACS) were more likely to have aversive cognitions towards cardiovascular medications. We enrolled a consecutive cohort of patients who presented to the emergency department with suspected ACS. One month after discharge, ACS-induced PTSD symptoms were assessed using the PTSD Checklist (PCL-S), and patients were asked “how often did” (1) “you miss your heart medication because you did not want to be reminded about your heart problem”; (2) “thinking about your heart medication make you feel nervous or anxious”; and (3) “thinking about your heart medication make you think about your risk for future heart problems.” Logistic regression was used to determine the association between elevated PTSD symptoms and each aversive cognition, adjusting for age, sex, race, ethnicity, education, depression, and ACS status. Of 424 patients included, 15.8% had elevated PTSD symptoms (PCL-S ≥ 34). In adjusted analyses, higher PCL-S scores were associated with missing medications to avoid reminders of heart disease (OR 1.22 per 5-point PCL-S increase, 95%CI 1.07–1.40), as well as anxiety (OR 1.34, 95%CI 1.19–1.51) and thoughts of future risk (OR 1.19, 95%CI 1.08–1.32) when thinking about cardiovascular medications. We concluded that patients with elevated PTSD symptoms following suspected ACS were more likely to report aversive cognitions about their cardiovascular medications, suggesting that medications can act as traumatic reminders of the cardiac event and ongoing risk in this group.
Log in om toegang te krijgen
Met onderstaand(e) abonnement(en) heeft u direct toegang:
American Psychiatric Association, American Psychiatric Association, & DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association. CrossRef
Bliese, P. D., Wright, K. M., Adler, A. B., Cabrera, O., Castro, C. A., & Hoge, C. W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology,76, 272–281. CrossRefPubMed
Chang, B. P., Sumner, J. A., Haerizadeh, M., Carter, E., & Edmondson, D. (2016). Perceived clinician-patient communication in the emergency department and subsequent post-traumatic stress symptoms in patients evaluated for acute coronary syndrome. Emergency Medicine Journal,33, 626–631. CrossRefPubMedPubMedCentral
Edmondson, D., Rieckmann, N., Shaffer, J. A., Schwartz, J. E., Burg, M. M., Davidson, K. W., et al. (2011). Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality. Journal of Psychiatric Research,45, 1621–1626. CrossRefPubMedPubMedCentral
Girard, T. D., Shintani, A. K., Jackson, J. C., Gordon, S. M., Pun, B. T., Henderson, M. S., et al. (2007). Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: A prospective cohort study. Critical Care,11, R28. CrossRefPubMedPubMedCentral
Meli, L., Alcántara, C., Sumner, J. A., Swan, B., Chang, B. P., & Edmondson, D. (2017). Enduring somatic threat perceptions and post-traumatic stress disorder symptoms in survivors of cardiac events. Journal of Health Psychology. https://doi.org/10.1177/1359105317705982.
National Center for PTSD. (2012). Using the PTSD checklist (PCL).
Patel, M. B., Jackson, J. C., Morandi, A., Girard, T. D., Hughes, C. G., Thompson, J. L., et al. (2016). Incidence and risk factors for intensive care unit-related post-traumatic stress disorder in veterans and civilians. American Journal of Respiratory and Critical Care Medicine,193, 1373–1381. CrossRefPubMedPubMedCentral
Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993, October). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX.
- Posttraumatic stress disorder due to acute cardiac events and aversive cognitions towards cardiovascular medications
S. Ali Husain
Ian M. Kronish
- Springer US