An innovative approach to the assessment of mood disturbances in patients with acute coronary syndrome

Background: The clinical value of the identification of mood disorders in patients with acutecoronary syndrome (ACS) is well established. However, assessment based on DSM criteriapresents some limitations. This study aimed to provide an innovative strategy for evaluating thespectrum of mood disturbances in ACS. Methods: A total of 288 patients with a first episode of ACS underwent interviews based onDSM-IV-TR criteria (major depressive disorder, minor depression, and dysthymia), DiagnosticCriteria for Psychosomatic Research-DCPR (demoralization and type A behavior), and theClinical Interview for Depression-CID. Additional self-report inventories (psychological well-being and distress) were administered. A total of 100 consecutive patients who satisfied criteriafor DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlledtrial on a sequential combination of cognitive-behavioral and well-being therapy (CBT/WBT) vsclinical management (CM) and reassessed up to 30-month post-intervention. Results: A total of 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion ofdemoralization and type A identified psychological distress in 58% of the sample. According toCID, reactivity to social environment, fatigue, depressed mood, and somatic anxiety were themost common symptoms. Somatic symptoms were significantly associated with DSM-IV-TRdepression (fatigue and changes of appetite), whereas environmental reactivity with demoral-ization. Both depression and demoralization were associated with higher distress and lowerwell-being. Unlike CM, CBT/WBT was significantly associated with decrease of guilt, pessi-mism, fatigue, and early insomnia (CID). Conclusions: The findings indicate that standard psychiatric approach identifies only a narrowpart of mood disturbances affecting ACS patients. A more articulated assessment unravelsspecific clinical configurations that may entail prognostic and therapeutic implications.