Psychological counseling in heart diseases and cardiovascular surgery

""Each affection of the mind that giving pain or pleasure, hope or fear goes to the heart""

Prof. Dr. Sedat ÖZKAN

People don't want to be sick despite they don't show a certain effort in their life time to avoid ill. What is in fact interesting is to want improving quickly after the illness. They make a high effort to return their normal life as soon. Prolongation of this course negatively affects the improvement.

What our patients should know after the heart surgeries is:

"Time is the best medicine". As a result of our one-year experience, Liaison psychiatry has been proven in a best way to be the handmaid both for the surgeon and the patient to use this medicine.

As the patient's gained confidence and courage before surgery, this contributes to the surgical success; one night perfect sleep or patient's regained personal confidence on returning to home and work have a large contribution to rejoin the patient to community and family.

Prof. Dr. Bingür SÖNMEZ

Our physical and mental health is an indivisible whole. While the physical diseases affect our mental health, our mental state affects our physical functions.

Liaison psychiatry is a specialized psychiatric discipline offering service for searching, diagnosis, treatment, following and preventing of the mental crisis and disorders seen at the patients with a physical disease or those underwent surgical intervention. It integrates medical treatment and care with psychiatric- psychosocial care. All physical diseases and surgical interventions lead to a crisis. They lead to a variety of conflicts from distress to lose reaction, worry about the future, feeling of inadequacy and disability concerns. Besides the body, illness affects emotions, thoughts and relations as well. Different concerns and responses (bereavement, panic, denial, guilt .. etc.) are seen depending on the disease, affected organs, disease characteristics and the conditions of the patient.

Psychological responses developed with the physical diseases and surgeries sometimes may affect our bodily functions such as daily activities, interpersonal relationships, sleep and appetite. These responses may vary from simple compliance difficulties to the psychiatric pictures requiring emergency intervention (such as thoughts of death, mental confusion etc.). Temporary biological changes in the nervous system, personality structure of the patient, mood and environmental factors play a role on the developing of these responses. Behavioral and psychological problems developing with physical diseases and surgeries negatively affect compliance to the treatment, life quality, treatment and care period, course of the illness, improvement and response to the treatment. Psychological and behavioral responses affecting the course of illness, compliance to disease and improvement, can be prevented or improved by appropriate psychological approach, early cooperation and timely treatment. Consultation - Liaison psychiatry is the psychiatry of physical diseases and surgical interventions, and this is a superior area of expertise in advance of general and conventional psychiatry.

Liaison psychiatry is a subdiscipline in the range of the services by psychocardiology that deal with diagnosis and treatment of the psychological conditions revealing during heart diseases and cardiac surgical interventions.

We all know the effects of excitements and mental constraints on the heart. We all experience the reflections of sadness, anger, excitement and distress on the cardiovascular system (palpitations, shortness of breath, increase of blood pressure, fever, etc.) in our daily life. Psychological and behavioral factors directly affect the heart through the sympathoadrenal system. Besides familial predisposition, smoking, hypertension and elevated cholesterol levels and A type behavior that increasingly becomes widespread at today's people is also among the risk factors for the heart disease development. Personality characteristics such as ambition, racing against the time, high achievement motivation, difficulty in coping with anger and rage constitute the basis of this behavior pattern.

Major psychological crisis requiring help and treatment those seen in the wide range from coronary artery disease to cardiac infarction and coronary by-pass surgery are as follows:

• Anxiety and panic states
• Depression
• Difficulty at compliance to disease and treatment (denial, refusing the treatment, sleep and appetite disturbances)
• Neurophysiological disorders ( consciousness and orientation disturbances)
• Personality changes
• Psychosexual problems
• Continuation of risky behaviors (smoking, not stick to diet)

To prepare the patient's psychologically for surgery, to provide psychological care after the surgery and psychological support and follow-up after the discharge are integral parts of the total care and treatment. Preparation of the heart, brain and psychological condition together to the new life complement each other. Medical, surgical and psychological services create a whole.

Signs and symptoms that require psychological counseling and support:

• Distress, depression and mental confusion
• Insomnia, nightmares and frequent night waking
• Hopeless, despair, guilt feelings and thoughts
• Compliance difficulty
• Persistence of the complaints despite appropriate treatment
• Difficulties in coping with the disease and course of treatment
• Social withdrawal and panic states
• Reluctance and unwillingness
• Memory disorder
• Narrowing of the interest
• Personality changes
• Denial, refusing the treatment
• Bereavement reactions
• Destruction of the life ideals and divergence from the vocational functions
• Decrease in the sense of pleasure, desire, interest and activity
• Thought and attention disturbances
• Persistent trait and pessimism
• Continuation of risky behaviors
• Inability to make future plans

Besides medical therapies, often there are medical psychotherapeutic, behavioral (relaxation exercises) and psychosocial treatment and support programs for treatment of the psychological crisis and compliance difficulties and to improve the negative habits (diet, smoking, alcohol) revealed. In this psychological support and treatment programs, besides drugs regulating the nervous system; persons are helped to state their emotions and concerns and to develop strategies in coping with the stress, their family relationships are discussed, and they are helped to develop compliance to changed roles and to new condition. Developing of new interest, work, expectation, emotional investment and creativity are supported. Providing of physical - psychological - environmental compliance with consciousness and emotion from the illness to the health will provide health and happiness. A more experienced, equipped, hopeful and happy (new) life will begin.

Psychological treatment, support and counseling are maintained together with medical treatment and care; with cooperation and coordination of the team during the treatment at the hospital, before surgery, after surgery and following to discharge. 

We all as a team; with the faith and pride of science, trust and love as the highest values, for health and happiness. . .

Prof. Dr. Sedat ÖZKAN
Istanbul University, Medical Faculty
Chairman of Consultation Liaison Psychiatry Department

Office: Yıldız Posta Cad. Ayyıldız Sitesi B Blok Kat: 5 D. 54 Gayrettepe- İstanbul (Pelit Pastanesi Üstü)
Tel: (0212) 275 64 53 Fax: (0212) 274 04 44
Hospital Tel: (0212) 533 63 69 Fax: (0212) 532 59 89
E-mail: msozkan@istanbul.edu.tr