Psychocardiology: A practical guide for doctors and psychologists PDF
Preview Psychocardiology: A practical guide for doctors and psychologists
Christoph Herrmann-Lingen Christian Albus Georg Titscher Editors Psychocardiology A practical guide for doctors and psychologists Psychocardiology (cid:129) (cid:129) Christoph Herrmann-Lingen Christian Albus Georg Titscher Editors Psychocardiology A practical guide for doctors and psychologists Editors ChristophHerrmann-Lingen ChristianAlbus DepartmentofPsychosomaticMedicine DepartmentofPsychosomatics andPsychotherapy andPsychotherapy UniversityofGöttingenMedicalCentre MedicalFacultyandUniversityHospital, Göttingen,Germany UniversityofCologne Cologne,Germany GeorgTitscher SigmundFreudUniversity Vienna,Austria ISBN978-3-662-65321-0 ISBN978-3-662-65322-7 (eBook) https://doi.org/10.1007/978-3-662-65322-7 #TheEditor(s)(ifapplicable)andTheAuthor(s),underexclusivelicensetoSpringer-VerlagGmbH,DE,partof SpringerNature2022 Thisworkissubjecttocopyright.AllrightsaresolelyandexclusivelylicensedbythePublisher,whetherthe wholeorpartofthematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now knownorhereafterdeveloped. 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Theregisteredcompanyaddressis:HeidelbergerPlatz3,14197Berlin,Germany Preface Psychocardiology: Psychosomatics at the Heart of Medicine CardiovasculardiseasesarethemostcommoncausesofdeathinGermanyandworldwide. Atthesametime,theyarethemostfrequentcausesofillness-relateddisabilityworldwide. Depression and anxiety disorders follow in second place in the industrialized countries when counted together (https://www.who.int/healthinfo/global_burden_disease/estimates/ en/index1.html). In terms of incapacity to work (second place), rehabilitation treatments (secondplace),anddisabilitypensions(firstplace),mentaldisordersareevenfaraheadof cardiovascular diseases in Germany and Austria. The comorbidity of cardiovascular and mentalillnessesthusrepresentsanenormouschallengeformedicine,ifonlybecauseofits quantitativesignificance.However,evenmorethantheircoincidentaloccurrence,thenow extensivelyresearchedinterrelationshipsbetweenheartdisease,psyche,andsocialenvi- ronment are of interest for the everyday care of patients as well as for primary and secondarypreventionapproaches.Thisimprovedunderstandingresultsinadifferentiated, holistic approach to the patient. In addition to biomedical aspects of the disease, the psychological and social dimensions of being ill and their significance for recovery or living with the disease as well as for such important areas as health behavior, treatment adherence,andqualityoflifeareincreasinglycomingintofocus. Sincepre-Christiantimes,peoplehavebeenpreoccupiedwiththeconnectionbetween heartandmind,whichisimmediatelyperceptibleformostpeople.EventheEgyptians,for exampleintheEbersPapyrus(sixteenthcenturyBC),didnotclearlydistinguishbetween heartandpsyche.IntheBabylonianEpicofGilgamesh,aman’sheartfillswithjoyinan erotic encounter.Since then, countlessimages haveaccompanied theheart asa mirror of the psyche through the millennia and cultures and have made it the “joker of German poetry” (Reich-Ranicki 1988). The development and course of heart disease have also alwaysbeenattributedtopsychosocialinfluences,amongothercauses.Inthethirdcentury BC, theSyriancrownprinceAntiochusfellillwith heartdiseasebecauseofhis unhappy loveforhisprospectivestepmotherStratonike.“Butasaruleitisnotthecardiologistswho canhelptheheroesofliterature”(Reich-Ranicki1988).Thecrownprincerecoveredwhen hisfatherlefthimhisteenagebride.ThebiblicalstoryofAnaniasandSapphiraisdifferent. This couple, members of the early Christian community described as “one heart and one v vi Preface soul,” were doomed by embezzlement. When Peter confronts Ananias and notices that SatanhasfilledAnanias’heart,thelatterceasesitsactivityandAnaniassuddenlydies—as doeshiswifeSapphiraafewhourslaterwhenshelearnsofherhusband’sdemise. In a review of psychogenic sudden cardiac death, George Engel (1971) asked to what extent such “folkloristic” descriptions had always been based on folk wisdom. Reliable scientificevidenceonheart-mindinteractionswas,however,onlysparselyavailableupto thattime.Itisonlyresearchoverthelast30–40yearsthathassincefundamentallychanged this picture. And especially in the last 20 years, the former marginal position of psychosomatics in cardiology has changed significantly. Whereas in 1998 only three out of about a thousand presentations at the spring conference of the German Society of Cardiology dealt with psychosomatic topics in a broader sense, psychosocial issues are now an accepted part of the spectrum of cardiological publications, congresses, and training events. And conversely, psychocardiology has also experienced a remarkable upswing in German-speaking psychosomatics since the late 1990s. The founding of the working groups on Psychosomatics in Cardiology in the German College of Psychoso- maticMedicineandCardiologicalPsychosomaticsintheAustrianSocietyofCardiologyin 1997, the Status Conference on Psychocardiology (1998–2002), and the founding of the workinggrouponPsychosocialCardiologyintheGermanSocietyofCardiologyin2002 mark milestones in the perception and organization of psychocardiology as a relevant interdisciplinaryfieldofresearchandcare. Sincethen,psychosomaticissueshavebeenincreasinglyrecognizedasanenrichmentof cardiologysocietiesandresearchassociations;andinhealthcare,thereisatleastnolackof verbalacknowledgmentoftheimportanceofpsychosocialfactors.Psychosomaticcontent can now be found in numerous cardiology guidelines and position papers, and the standalone position paper of the German Society of Cardiology on psychosocial factors in cardiology could already be published in its third edition in 2018 (Albus et al. 2019). Even if these commitments have by no means led to comprehensive psychocardiological care,psychosomaticshaslongsincegrowntobecome—despitehistoricalreservations—a fundamentallyrecognisedpartnerofcardiology. The further development of this partnership is also the subject of this book, which is nowalreadyavailableinitsthird,carefullyupdatedandexpandededition.Allthreeeditors, asinternistsorcardiologistsandspecialists inpsychosomatics/psychotherapy,knowboth the daily routine of somatic cardiology and the particularities of psychotherapeutic work with cardiac patients. We would like to invite our cardiological and internal medicine colleaguestobecomemoreintensivelyinvolvedintheencounterwiththeirpatientsandto experiencetheholisticperspectiveandrelationshipasaprofessionalandpersonalenrich- ment. To this end, we provide the essential findings of psychocardiological research and our many years of work at the interface between psychosomatics and cardiology in a mannerthatisaspracticalaspossible.Contributionsbyotherrenownedauthorscomple- menttherangeoftopics. Thisbookisdesignedtohelpinternistsandcardiologists,aswellasfamilyphysicians, gain an informed and sophisticated approach to the psychological and social aspects of Preface vii illnessintheirpatientsandtofamiliarizethemwithkeypsychologicaldiseasepatternsand their treatment options. At the same time, we want to familiarize our psychotherapeutic colleagues with the somatic basis of cardiovascular diseases, the fascinating heart-mind interactions,andtheimpressivetherapeuticpossibilitiesofcardiologyandcardiacsurgery. Beyond individual therapeutic schools, we would like to make the special features of counselling and psychotherapeutic work with people suffering from heart disease understandable. This work very often requires, in addition to a basic understanding of heartdiseaseanditstreatment,anadaptationofpsychotherapeutictechniques,whichhave, asarule,beendevelopedandevaluatedonphysicallyhealthypeople. The earlier cardiological attitude that the psychosomatic approach was nothing but a superfluousluxurycannowconfidentlyberegardedasoutdated.Butthereservationoften expressedinthepastbypsychotherapiststhatitisnotpossibletoworksuccessfullywith heartpatients,whoareoftenolder,comefromlowsocialclasses,showatendencytodeny and low “psychological mindedness,” has proved to be too short-sighted. However, the how of a psychosomatic approach to the heart patient has so far—with few exceptions— hardly been taught in educational curricula for cardiologists and internists and not yet comprehensively in psychotherapeutic training or continuous education. It cannot, of course, be learned from a textbook alone. This book cannot therefore replace psychocardiological training; it is, however, intended to provide a frame of reference against which both those working primarily somatically and those working primarily psychotherapeutically can gather their own experiences, classify them, and reflect on them in in-depth training and continuing education events, supervision, or Balint groups. Thepsychocardiologicalcurricula described inChap. 9enablethose interestedtodeepen whattheyhavereadininterprofessionalgroupsandtotryitoutinpractice.Thesecurricula alsoserveinparticulartopromotediscussionamongtheprofessionsandlearningfromone another. The interdisciplinary and interprofessional dialogue and the integration of psychosomatists/psychotherapists in cardiological treatment teams should—similar to oncology—not only be reserved for rehabilitation facilities (which are also insufficiently equipped with psychologists). In many cases, cooperation between somatic doctors and psychotherapistsisusefulorevennecessary,bothintheacute-carehospitalandinthelong- term outpatient care of patients. Not in all cases can the integration of psychosocial and somaticaspectsofillness beachievedbythegeneral practitioner alone; inmany cases, it requiresteamworkbetweendifferentexperts.Inthelast10years,numerouscardiologists have already acquired additional psychocardiological competencies, and psychocardiologicalorpsychocardiosurgicalconsultationandliaisonservicesareincreas- inglybeingestablishedatheartcenters.Ideally,thiscooperationshouldbebasedonmutual respect,amutualwillingnesstolearn,andaninterestinintegratingtheknowledgegained inthe variously structured partial relationships into a deeper overallunderstanding ofthe patients with their physical and psychological components as well as their social living environment. As a third party in this alliance, the patient can feel competently treated somatically,butatthesametimealsounderstoodandvalued,whichmakesthenecessary responsiblecooperationmucheasier,notonlyinovercomingtheacuteillness,butalsoin viii Preface regaininghealthandqualityoflife.Asadecisiveprerequisite,italsoensurestheeffective- ness of somatic treatment and (secondary) prevention. In an interdisciplinary approach, mental comorbidity can also be recognized much better than before and competently treatedwithinanoveralltreatmentplan. Thisbookwaslaunchedin2007asanexperimenttoshowwhetheritispossibletobring tolifeintheformofatextbookwhathasbeenachievedthroughpersonalrelationshipsand interfacework.Withitsclaimofinterdisciplinarityandpracticality,itwasnotintended to replace a textbook on cardiology or psychosomatic medicine. With its intermediate position,itdeliberatelyrefersthereadertofurtherliteratureforsomespecificquestions.At thesametime,itattemptstoclosegapsthatpreviouslyexistedbetweenthespecialties.The great response to the first two editions as well as the extraordinarily positive experiences with the mutual learning process of cardiologists and psychotherapists in more than 15 psychocardiology courses was an incentive for us to take into account the feedback receivedandthefurtherdevelopmentofthefieldinthisnewedition.Morethaninprevious editions, we refer to important current literature findings and guidelines, but without abandoningthefocusonpractical relevance.WewouldliketothankSpringer-Verlagfor theopportunitytocontinuethissuccessfulprojectwithanewfaceafterthewithdrawalof the previous publisher and wish all readers a stimulating read and, above all, many enrichingexperiencesinpsychocardiologicalwork. Göttingen,Germany ChristophHerrmann-Lingen Cologne,Germany ChristianAlbus Vienna,Austria GeorgTitscher April2019 References Reich-RanickiM(1988).DasHerz–derJokerderdeutschenDichtung.In:R.Selbmann (ed)DasInsel-BuchvomHerzen.Insel-Verlag,Frankfurt/M.,pp283-297. Engel GL (1971) Sudden and rapid death during psychological stress. Folklore or folk wisdom?AnnInternMed74:771–782 AlbusC,WallerC,FritzscheK,GunoldH,HaassM,HamannB,KindermannI,KöllnerV, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, SchwaabB,WeberCS,Herrmann-LingenC(2019)Significanceofpsychosocialfactors in cardiology: update 2018: Position paper of the German Cardiac Society. Clin Res Cardiol108:1175–1196. Contents 1 MainFeaturesofCardiacDiseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ChristianAlbusandMarkusHaass 2 BasicConceptsofPsychosomaticMedicine. . . . . . . . . . . . . . . . . . . . . . . . 41 ChristianAlbus 3 EthicalIssuesinPsychocardiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 PeterKampits 4 PsychocardiologyAlongtheLifespan. . . . . .. . . . . . . .. . . . . . . . .. . . . . . 59 ChristophHerrmann-Lingen 5 PsychosomaticProblemAreasandComorbiditiesUsingtheExample ofCoronaryHeartDisease. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 63 ChristianAlbus,ChristophHerrmann-Lingen,VolkerKöllner, RolandvonKänel,andGeorgTitscher 6 OtherImportantClinicalPicturesandInterventionsinCardiology. . . . . . 129 ChristianAlbus,ChristophHerrmann-Lingen,VolkerKöllner,and GeorgTitscher 7 Diagnostics. . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . . .. . . . .. . . . 201 ChristianAlbusandChristophHerrmann-Lingen 8 Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 GeorgTitscher,ChristianAlbus,AnnegretBoll-Klatt,VolkerKöllner, MaryPrincip,RolandvonKänel,andChristophHerrmann-Lingen 9 PsychocardiologicalTrainingandContinuingEducationCurricula. . . . . 335 GeorgTitscherandChristophHerrmann-Lingen AddressList. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 Index. . . . . . . .. . . . . . .. . . . . . . .. . . . . . .. . . . . . .. . . . . . . .. . . . . . .. . . . . 349 ix Editors and Authors About the Editors Christoph Herrmann-Lingen,MD,isaspecialistininternal medicine, psychosomatic medicine and psychotherapy. He is thedirectoroftheDepartmentofPsychosomaticMedicineand PsychotherapyattheUniversityMedicalCentreGöttingen. His research interests focus on psychocardiology and psychodiagnostics in the physically ill. He is a Past President of the German College of Psychosomatic Medicine (DKPM) and of the American Psychosomatic Society, a for- merMemberoftheExecutiveCommitteeoftheAssociationof Scientific Medical Societies in Germany (AWMF) and is a co-authorofnationalandinternationalguidelinesandposition papers. In 2017 he received the Hans Roemer Award for PsychosomaticResearchoftheDKPM. Christian Albus, MD, is a specialist in internal medicine, psychosomatic medicine and psychotherapy. He is the Head of the Department for Psychosomatics and Psychotherapy at theUniversityofCologne. His research focuses on psychosocial aspects and psycho- logical comorbidity in physical diseases, especially coronary heart disease and diabetes mellitus. He is an active member ofnumerousscientificsocietiesandnationalandinternational guidelinecommittees.In2005and2017hereceivedtheHans Roemer Award for Psychosomatic Research of the German College of Psychosomatic Medicine and in 2016 the Interna- tional Collaboration Award of the International Society of BehavioralMedicine.Since2011hehasbeenaFellowofthe EuropeanSocietyofCardiology(FESC). xi
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