Psychiatric Consultation in a Coronary Care Unit

Abstract

Of 441 consecutive patients admitted to a coronary care unit, 145 (32.7%) were referred for psychiatric consultation. The three most frequent reasons for referral were anxiety (47), depression (44), and management of behavior (30). The focus of anxiety was impending death or death's heralds: pain, breathlessness, weakness, and new complications. Depression followed injuries to self-esteem caused by the heart attack. Most management problems stemmed from excessive denial of illness, inappropriate euphoric or sexual behavior, and hostile-dependent conflicts with the staff. Consultation requests for each problem followed different time distributions, with an early peak for anxiety on days 1 and 2, a later peak for depression on days 3 and 4, and a bimodal distribution for management referrals. The data suggest a sequence of normal emotional reactions to myocardial infarction. Psychiatric intervention included medication, explanatory clarification, environmental changes, bolstering optimism, anticipation, confrontation, and hypnosis. The mortality of the referral group (4%) was three times less than expected for this coronary care unit.