Mental Disorders Common in Patients With CTEPH

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) commonly have mental health disorders that can affect their quality of life (QOL), according to a new report.

CTEPH is a debilitating form of pulmonary hypertension marked by clots that do not resolve after pulmonary embolism. As a result, patients experience elevated pulmonary arterial pressure and pulmonary vascular resistance, which can lead to heart failure or death, explained the authors of the new study.

For patients, the symptoms of exertional dyspnea and impaired exercise tolerance, in addition to the looming potential need for invasive procedures, can raise the risk of disorders like anxiety and depression, they wrote. Yet, most existing studies on mental disorders in people with CTEPH have focused exclusively on anxiety and depression (rather than other disorders) and were based on user questionnaires.

In their new study in Frontiers in Psychiatry, the investigators report data from structured clinical interviews with patients with CTEPH, pulmonary arterial hypertension (PAH), and healthy controls. They also applied their findings to probe the potential impact of these disorders on patient QOL.

A total of 107 patients with CTEPH and 217 patients with PAH were included in the study. For the general population control group, the investigators used the results of a national German survey of adults that included more than 5000 people.

The investigators found that 1 in 3 patients with CTEPH (31.8%) had a current psychological disorder, with panic disorders and specific phobias (both present in 8.4% of the group) being the most prevalent. Another 6.5% suffered from major depressive disorder.

The survey found panic disorder was higher in the CTEPH group than in the general population, but rates of major depressive disorder were higher in the PAH group. There was no significant difference in major depressive disorder rates between the CTEPH and control groups. Rates of mental disorders did not appear to be linked with the type of therapy a patient with CTEPH was receiving, the investigators said.

“One reason for the significantly increased prevalence of panic disorders in patients with CTEPH compared to the general population might be that symptoms of dyspnea can be perceived as threatening, cause anxiety, and potentially leading to avoidance of potentially dyspnea-evoking activities,” they suggested.

In their QOL analysis, the investigators found that patients with a mental disorder had a significantly lower QOL than those without a mental disorder, in terms of psychological and physical quality. This finding suggests clinicians need to be better equipped to understand the possibility of mental disorders in their patients.

“Since the presence of any mental disorder had a substantial impact on overall and psychological QOL, there is a need for screening tools, as most PH physicians are not trained in detecting mental disorders,” they wrote. In the interim, the Hospital Anxiety and Depression Score may be a useful tool to identify patients at risk of panic disorders or depression, the authors said.

They concluded that future studies should look at the presence or absence of mental disorders prior to a patient’s diagnosis with CTEPH or PAH, saying that social support and physical comorbidities are also important factors to consider when assessing the impact of CTEPH.

Reference

Dering M-R, Lepsy N, Fuge J, et al. Prevalence of mental disorders in patients with chronic thromboembolic pulmonary hypertension. Front Psychiatry. Published online March 2, 2022. doi:10.3389/fpsyt.2022.821466