Psychological features of patients with Takotsubo syndrome: cross-sectional study

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Abstract

Objective. We aimed to assess the psychological state and personality-adaptive potential in patients with Takotsubo syndrome (TS), and to use the results to construct a prognostic model for the risk of developing the disease.

Materials and methods. A total of 38 patients with TS were examined 10–14 days after the disease onset. The mean age of the men was 63.8±14.73 years, and the women, 33 (86.8%) years. The control group included 40 people; their average age was 66.6±10.4 years, of which 39 (97.5%) were women. Their psychological state and stress resistance were assessed using the following tests and questionnaires: G. Eysenck's personality questionnaire; the hardiness survey; the N.V. Kirsheva and N.V. Ryabchikov personality stress resistance self-test; the scale of perceived stress; the PSM-25 Lemur–Tessier–Fillion psychological stress measure; the Spielberger–Khanin anxiety scale; the Hamilton Anxiety Scale; the Hospital Anxiety and Depression scale; the Beck Depression Scale; and the Montgomery–Asberg depression rating scale.

Results. G. Eysenck's personality questionnaire showed that patients with TS had a higher level of neuroticism (14.6±3.7 and 11.4±4.1, respectively; p <0.01) and tendency to introversion (9.4±3.3 and 12.4±3.5, respectively; p <0.001) than the control group. According to the Spielberger–Khanin psychometric scale, reactive anxiety was higher in the TS group (46.4±9.1 and 37.0±11.4, respectively; p <0.0001), and there was also a tendency toward personal anxiety (45.1±7.3 and 41.8±11.1, respectively; p >0.05). For all three analyzed scales designed to assess internal anxiety, it was found that in patients with TS, this component of the psyche was more pronounced (HARS: 21.8±4.8 and 16.1±5.4, respectively; p <0.0001; HADS: 13.1±3.6 and 7.4±3.0, respectively; p <0.0001). Depression, ranging from mild to severe, was more common in patients with TS, according to all questionnaires (HADS: 100% and 40%, respectively; p <0.05; BDI: 73.7% and 27%, respectively; p <0.05; MADRS: 97.4% and 62.5%, respectively, p <0.05). According to the hardiness test, the TS group had low indicators of overall hardiness (71.4±18.0 and 82.6±19.7, respectively; p <0.05), involvement (32.5±9.1 and 36.8±8.9, respectively; p <0.05), and control (23.3±7.3 and 29.2±7.8, respectively; p <0.01) compared to the control group. Stress resistance was also significantly lower in patients with TS (38.9±6.4 and 34.1±7.3, respectively; p <0.001). Based on the data from the questionnaires and scales, using the classification tree method, an integral model for predicting the development of TS with a high predictive value (96%) was built.

Conclusion. Anxiety and depressive disorders make a significant contribution to the development of TS. Personality traits like introversion, neuroticism, and increased susceptibility to stress with low stress resistance and hardiness also play a role. This suggests the need for timely diagnosis of psychological disorders and their correction in people with this personality type, especially postmenopausal women. Prompt intervention may help prevent or reduce the risk of developing the disease.

About the authors

Dmitrii S. Evdokimov

Mechnikov North-Western State Medical University

Author for correspondence.
Email: kasabian244@gmail.com
ORCID iD: 0000-0002-3107-1691
SPIN-code: 5260-0063

graduate student

Russian Federation, 47 Piskarevsky Ave., 195067, St. Petersburg

Valeriya S. Feoktistova

Mechnikov North-Western State Medical University

Email: lerissima@yandex.ru
ORCID iD: 0000-0003-4161-3535
SPIN-code: 3714-9090

MD, Cand. Sci. (Med.), associate professor

Russian Federation, St. Petersburg

Alena P. Semenova

Mechnikov North-Western State Medical University

Email: semionova.al@mail.ru
ORCID iD: 0000-0002-6386-1612
SPIN-code: 5258-0350

graduate student

Russian Federation, St. Petersburg

Svetlana A. Boldueva

Mechnikov North-Western State Medical University

Email: svetlanaboldueva@mail.ru
ORCID iD: 0000-0002-1898-084X
SPIN-code: 3716-3375

MD, D. Sci. (Med.), Professor, head of the faculty therapy department

Russian Federation, St. Petersburg

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2. Fig. 1. Integral model for forecasting the development of ST. Note. Node of the first order (main) – score on the "reactive anxiety" subscale of he Spielberger–Khanin questionnaire with a diagnostic level of 34 points; nodes of the second order – is a test for self-assessment stress resistance of a person NV Kirsheva and NV Ryabchikov with a threshold level of 38 points and the “control” hardiness component with a threshold level of 18 points.КГ – control group, СТ – takotsubo syndrome.

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Copyright (c) 2023 Evdokimov D.S., Feoktistova V.S., Semenova A.P., Boldueva S.A.

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