Patients with cardiovascular disease (CVD) are at an increased risk of developing psychiatric illnesses, particularly depression. Depression is an independent risk factor leading to a cardiac event, which has been shown in patients with or without known coronary artery disease (CAD). Treatment of depression has been shown to improve quality of life and result in a better cardiovascular prognosis in patients with comorbid CVD. However, pharmacological treatment of depression in this particular patient population is not without risk and is not always effective. An emerging approach to improve nonresponse to antidepressants is the use of adjunctive nutraceuticals. This article is to review the pharmacological options for treating depression in patients with CAD. The use of integrative approaches and supplements in patients with CVD is also discussed.

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It has been more than a hundred years since Alzheimer and Binswanger's first description of vascular dementia (VaD). Ever since then, histopathology research and neuroimaging techniques have allowed the development of new pathogenic, etiologic, and treatment hypotheses. The “vascular cognitive impairment (VCI)” concept has also been developed, and it includes all grades of cognitive dysfunction of a vascular origin. Early detection of dementia as well as its primary prevention is the main goals for clinicians. For this reason, new scales, new diagnostic criteria, and preventive treatments have been proposed. The association between stroke and VaD is already known, but a comprehensive review of this relationship reveals a bidirectional causality. Depression has been hypothesized as a risk factor for later dementia development. Late-life depression is the most associated condition; however, studies have found it works as a prodromal state symptom. Deep knowledge in vascular risk factors that are involved in vascular origin cognitive decline is the most important prevention tool. Hypertension, Type II diabetes, cholesterol, and inflammation markers have demonstrated to increase the risk of VaD. Evidence supporting treatments for primary and secondary prevention of VaD and VCI are presented.

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Context: The reported psychopathological symptoms in patients following implantable cardioverter defibrillator (ICD) shocks differ. Reports concern mostly psychosocial distress with trauma-related symptoms: high hyperarousal, re-experiencing, and avoidance behavior. Patients suffering from these impairments require targeted therapy. Until now, only a few publications report psychological treatment for patients with ICD shocks. The aim of the present work was to examine whether the implementation of the specific psychotherapy, including eye movement desensitization and reprocessing (EMDR), during inpatient cardiac rehabilitation is safe and feasible (health-care study) and to explore whether this intervention leads to a reduction of psychopathology in cardiac patients after ICD shocks. As we have no control group design, we can only describe the change but we do not know whether the health status would be the same without our intervention. Methods: Twenty cardiac patients who were distressed after receiving ICD shocks were included in this study. Before and after the 3–5-week psychocardiological inpatient treatment (cardiac rehabilitation including psychotherapy) as well as 6 and 12 months after discharge, the patients were assessed for the following psychological variables: posttraumatic stress, depression, anxiety, and various measures of vital exhaustion and self-efficacy (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-4^th Edition Disorders [SCID], Impact of Events Scale-Revised [IES-R], Beck Depression Inventory [BDI], Hospital Anxiety and Depression Scale [HADS] [Hospital Anxiety and Depression Scale-Anxiety (HADS [A])/Hospital Anxiety and Depression Scale-Depression (D)], Shortened Maastricht Exhaustion Questionnaire [MQ], and General Self-Efficacy Scale [SE]). Results: At baseline, 84.2% (n = 16) of the participants suffered from posttraumatic stress symptoms as assessed by the SCID (68.4% [n = 13] measured by the IES-R). Symptoms of depression were observed in 72.2% (BDI) or in 63.2% (HADS [D]) of patients and anxiety in 78.9% of patients (HADS [A]). The measurements confirm a significant reduction in the symptoms of posttraumatic stress (IES-R: P =0.000), depression (BDI: P = 0.009; HADS [D]: P = 0.000), anxiety (HADS [A]: P = 0.000), and vital exhaustion (MQ: P = 0.006), 1 year after patients underwent treatment. No significant changes were observed in perceived SE (P = 0.194). No significant correlations between medical variables and psychopathology were found (adequate/inadequate shocks; number of shocks; primary/secondary prevention). No appropriate/inappropriate shocks were delivered within the treatment period. Conclusion: Our results suggest that an inpatient cardiac rehabilitation program with intensive targeted psychotherapy including EMDR is a safe intervention for posttraumatic stress in patients who are distressed after receiving ICD shocks. In particular, patients accepted the EMDR treatment, emotional arousal was tolerable, and no cardiac complications occurred during EMDR confrontation. Future strategies could be investigating the impact of intervention on long-term effect, stability, and mortality in this population. In addition, our study showed that some patients had a very long time between ICD shocks and the beginning of the professional therapy. Hence, this leads to the finding that a waiting control group could be acceptable by the ethical commission.

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Objectives: We aimed to explore the potential mediating effects of neuroticism, depressive and anxiety symptoms, and somatic symptoms in the relationship between insomnia and health-related quality of life (HRQoL). Methods: This was a cross-sectional family study, which recruited a total of 297 adolescents (eighty insomniacs as determined by clinical interview) and 318 parents (93 insomniacs). HRQoL was measured by short form-36 (SF-36) health survey. A series of questionnaires were employed to measure insomnia severity, neuroticism personality, and depressive, anxiety and somatic symptoms. Results: Participants with insomnia had lower HRQoL than those without insomnia (71.9 vs. 77.1, P < 0.001). Insomnia severity (as measured byInsomnia Severity Index) was significantly associated with HRQoL (correlation coefficient = −0.451, P < 0.001). A total of 53% of the variance of SF-36 could be explained by the mediation model, which showed that a large proportion of the variances in the association between insomnia severity and HRQoL was mediated by depressive symptoms, somatic symptoms, and neuroticism personality trait. Conclusions: The close associations between insomnia severity and impaired HRQoL are largely mediated by psychological symptomatology and personality dimension. Further prospective study is warranted to investigate the long-term impact of insomnia symptoms on HRQoL and the roles of mood and somatic symptoms.

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Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Cardiac preconditioning, an endogenous phenomenon, has been shown to protect the heart from acute myocardial infarction by subjecting it to brief cycles of ischemia and reperfusion. The concept of ischemic preconditioning has led to a group of cardiac conditioning strategies that include preconditioning, postconditioning, and remote conditioning. Other than complete reperfusion, cardiac conditioning is considered the most powerful intervention available for reducing infarct size in animal models and in clinical trials. A comprehensive investigation into the mechanisms underlying cardiac conditioning has led to the identification of several therapeutic targets for pharmacological intervention, including the ATP-dependent potassium channel. Remote cardiac conditioning has garnered a great deal of attention as a noninvasive method to deliver conditioning. Several signaling mechanisms have been investigated, including humoral communication and neuronal stimulation. Although the cardioprotective pathways of remote conditioning are widely studied, the translation to clinical practice has been controversial. Two recent, large, and well-designed clinical trials highlight the challenges of implementing remote conditioning. However, a number of cardioprotective therapies involving conditioning have shown promising results. Future research should continue to explore the potential of remote conditioning.

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Although it has been proposed in scholarly works for centuries that psychological factors play a role in the pathophysiology of somatic disease, this belief has not been validated mechanistically until relatively recently. This article discusses one specific instance of this general phenomenon: psycho-cardiology. Combining insights from epidemiological research, which has been prolific in showing associations between cardiovascular and psychological diseases, and the basic science research that has recently begun elucidating the biological mechanisms that may underlie those associations, the aim of this article is to provide a broad overview of the field of psycho-cardiology as it is presently understood. Beginning with a history of the development of psycho-cardiology, the article proceeds through separate sections that discuss contemporary research in the field under the following categories: epidemiology, clinical manifestations, structural and functional derangements, induction mechanisms, the impact of technological and diagnostic changes, and the practical implications for treatment. Taken together, the body of work that this article surveys points clearly to the need to integrate the evaluation for and treatment of psychological disease into the scope of clinical cardiology.

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Objectives: The objective of this study was designed to assess the attitudes of Chinese nonpsychiatric health-care providers in Guangdong to mental health services (MHSs) integrated into the system of health care. Methods: A cross-sectional study was conducted to evaluate the attitudes of nonpsychiartric health-care providers to integrated MHS in 16 tertiary general hospitals from December 2012 to March 2013. A multiple regression model was used to analyze the impact factors of the subjects' attitudes to integrated MHS. Results: Of all the 2574 subjects, 1842 (71.6%) subjects strongly supported integrated MHS in general hospitals while only 4.3% (111) of subjects disagreed/strongly disagreed with integrated MHS. The rest of subjects (621/24.1%) remained neutral. The multiple regression model analyses presented that those male subjects with postgraduate diplomas who agreed with integrated MHS were interested in training on MHS. Approximately, more than 30% of subjects who were diagnosed with mental disorders and worked for 8–10 h/day were prone to obtain MHS and own a positive attitude to MHS in clinical practice. Conclusions: Most subjects owned positive attitudes to MHS in clinical practice. Lack of MHS knowledge is the major obstacle to those subjects who disagreed with integrated MHS.

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